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Demirpolat MT, Sisik A. Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Function Tests and Levothyroxine Doses in People With Obesity. Cureus 2024; 16:e56219. [PMID: 38618433 PMCID: PMC11016230 DOI: 10.7759/cureus.56219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION We investigated how laparoscopic sleeve gastrectomy (LSG) affected serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in obese patients with hypothyroidism. We additionally examined whether the dose of levothyroxine decreases as a result of weight loss in this study. MATERIALS AND METHODS Fifty-one people with obesity who received levothyroxine treatment for hypothyroidism and underwent LSG between January 2017 and January 2023 were retrospectively examined. Weight, body mass index (BMI), TSH, FT4, FT3, weekly levothyroxine dose changes, and weight-adjusted levothyroxine doses before surgery and the sixth month after surgery were compared. RESULTS Among the 51 patients included in this study, 50.98% ceased the use of levothyroxine, and nearly half (41.18%) required an adjustment of their levothyroxine dose during the follow-up period (sixth month). Notably, the total weekly dose of levothyroxine (mcg) decreased in the sixth month following surgery (p<0.001). The weekly weight-adjusted dose (mcg/kg) decreased during the same time frame (p<0.001). The preoperative total weekly dose of levothyroxine, EWL% and absence of hyperlipidemia were found to be the independent predictors of the weight-adjusted weekly levothyroxine dose change (p<0.001, p=0.038, and p=0.044, respectively). CONCLUSIONS Thyroid function tests in people with obesity can show improvement after LSG. LSG may reduce the weight-adjusted dose of levothyroxine at six months postoperatively and therefore patients should be monitored for possible levothyroxine dose readjustments based on weight loss.
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Affiliation(s)
- Muhammed Taha Demirpolat
- General Surgery, University of Health Science, Umraniye Training and Research Hospital, Istanbul, TUR
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Tian Z, Nie Y, Li Z, Wang P, Zhang N, Hei X, Ping A, Liu B, Meng H. Total weight loss induces the alteration in thyroid function after bariatric surgery. Front Endocrinol (Lausanne) 2024; 15:1333033. [PMID: 38352711 PMCID: PMC10861714 DOI: 10.3389/fendo.2024.1333033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
Background Bariatric surgery is an effective approach to weight loss, which may also affect thyroid function. However, alteration in thyroid-stimulating hormone (ΔTSH) and thyroid hormones after bariatric surgery and the relationship between thyroid function and postoperative weight loss still remains controversial. Methods Data were collected from euthyroid patients with obesity who underwent sleeve gastrectomy and Roux-en-Y gastric bypass from 2017 to 2022. The alterations of free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), total triiodothyronine (TT3), and TSH were calculated 1 year after surgery. Pearson correlation analysis was used to assess the correlation between the percentage of total weight loss (%TWL) and ΔTSH. Multivariable linear regression was utilized to determine the association between %TWL and ΔTSH. Results A total of 256 patients were included in our study. The mean %TWL was 28.29% after 1 year. TSH decreased from 2.33 (1.67, 3.04) uIU/mL to 1.82 (1.21, 2.50) uIU/mL (P < 0.001), FT3 decreased from 3.23 ± 0.42 pg/mL to 2.89 ± 0.41 pg/mL (P < 0.001), FT4 decreased from 1.11 ± 0.25 ng/dL to 1.02 ± 0.25 ng/dL (P < 0.001), TT3 decreased from 1.13 (1.00, 1.25) ng/mL to 0.89 (0.78, 1.00) ng/mL (P < 0.001), and TT4 decreased from 8.28 ± 1.69 ug/mL to 7.82 ± 1.68 ug/mL 1 year postoperatively (P < 0.001). %TWL was found to be significantly correlated to ΔTSH by Pearson correlation analysis (Pearson correlation coefficient = 0.184, P = 0.003), indicating that the more weight loss, the more TSH declined. After adjusting for covariates in multivariable linear regression, %TWL was found to be independently associated with ΔTSH (β = 0.180 [95% confidence interval (CI), 0.048 - 0.312], P = 0.008). Moreover, %TWL was divided into 3 categorical groups (%TWL ≤ 25%, 25% < %TWL ≤ 35%, and %TWL > 35%) for further exploration, and was also found to be an independent predictor for ΔTSH after adjusting for covariates in multivariable linear regression (β = 0.153 [95% CI, 0.019 - 0.287], P = 0.025). Conclusion TSH, FT4, FT3, TT4, and TT3 decrease significantly 1 year after bariatric surgery. The decline in TSH is independently mediated by postoperative weight loss; the more the weight loss, the more the TSH decrease.
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Affiliation(s)
- Ziru Tian
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Yuntao Nie
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Zhengqi Li
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Pengpeng Wang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Nianrong Zhang
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Xiaofan Hei
- Department of Emergency, China-Japan Friendship Hospital, Beijing, China
| | - An Ping
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Baoyin Liu
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Hua Meng
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
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Almukainzi M, AlQahtani R, Alanazi R, Alamri R, Alayed H. Insight of the Biopharmaceutical Implication of Sleeve Gastrectomy on Levothyroxine Absorption in Hypothyroidism Patients. Obes Surg 2024; 34:192-197. [PMID: 38091193 DOI: 10.1007/s11695-023-06970-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/15/2023] [Accepted: 11/26/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE The growing rate of obesity led to an increased number of bariatric surgeries (BS) as a treatment option for obesity. The gastrointestinal tract (GIT) changes following BS can impact many drugs' absorption. Levothyroxine (LT4) is a synthetic thyroxine (T4) replacement used commonly as tablets to manage hypothyroidism disorder, which is more prevalent among patients with obesity. This study aims to examine the LT4 oral tablet form therapy after sleeve gastrectomy. MATERIALS AND METHODS A retrospective cohort study was conducted in multi-center. The LT4 doses and TSH and T4 levels were compared before and after BS. The post-surgery readings were categorized into three periods: (one to three months), (four to six months), and (> six ) months after surgery. ANOVA test was used for analysis. RESULTS A total of 14374 patients who underwent BS from (1/2019 to 3/2022) were screened for eligibility, and n = 101 participants matched the inclusion criteria. The TSH and T4 were not statistically significant differences before and after surgery (P-values of 0.4864 and 0.5970, respectively). However, the doses significantly differed before and after surgery in all the follow-up time point periods (P < 0.002). CONCLUSION The LT4 required doses significantly reduced after sleeve gastrectomy, which can be related to the improved endogenous thyroid production in patients with obesity. However, the abnormality of the GIT induced by the sleeve gastrectomy may affect the exogenous LT4 absorption. Using liquid forms of LT4 while monitoring the thyroid function parameters can optimize the treatment after the procedure.
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Affiliation(s)
- May Almukainzi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia.
| | - Reem AlQahtani
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Rimah Alanazi
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Rawan Alamri
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, 11671, Riyadh, Saudi Arabia
| | - Hajar Alayed
- Pharmaceutical Care, Dr. Suliman AlHabib Medical Group, Riyadh, Saudi Arabia
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Kamal MEEDM, Aisha HAA, Fahmy MH, Abosayed AK. The Impact of Laparoscopic Sleeve Gastrectomy on Thyroid Functions in Egyptian Patients with Obesity. J Gastrointest Surg 2023; 27:1345-1352. [PMID: 37020159 PMCID: PMC10366286 DOI: 10.1007/s11605-023-05662-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/03/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) continues to be one of the most popular bariatric procedures all over the world. Thyroid-stimulating hormone (TSH) frequently shows a slight elevation in patients with obesity. The effect of SG on thyroid hormones has been rarely investigated. AIM OF THE STUDY This study aimed to assess the short-term effect of SG on thyroid functions in Egyptian patients with morbid obesity and the potential predictors of the postoperative thyroid functions. PATIENTS AND METHODS This study included patients undergoing SG at kasr al ainy hospitals. The patients underwent preoperative 3-, 6-, and 12-month postoperative analyses of the thyroid functions and other biochemical markers. RESULTS The study included 106 patients who showed significant improvement in thyroid functions at the follow-up assessment. Twelve-month TSH positively correlated with the 12-month measures of LDL and HbA1c. TSH change at 12-month follow-up (TSH) was inversely correlated to 12-month BMI and positively correlated to preoperative TSH and 12-month percentage of total weight loss (TWL%). Univariable linear regression analysis demonstrated that preoperative TSH (p < 0.001), 12-month TWL% (p = 0.042), 12-month HbA1c (p = 0.001), and 12-month LDL (p = 0.049) were significant predictors for the 12-month TSH levels. Multivariable analysis showed that only preoperative TSH levels (p < 0.001) and 12-month HbA1c levels (p = 0.021) could affect the 12-month TSH levels. CONCLUSION The current study supports the evidence of thyroid function improvement after sleeve gastrectomy. This improvement was affected by the amount of weight loss after surgery.
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Affiliation(s)
| | | | - Mohamed H Fahmy
- General Surgery Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amir K Abosayed
- General Surgery Department, Faculty of Medicine, Cairo University, Giza, Egypt.
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Alfaifi HH, Altowairgi MA, Algethami RG, Altowairqi AH, Althomali HD, Almalki OM. Effectiveness of Bariatric Surgery for Improving Thyroid Function and Reducing Levothyroxine Dose in Patients With Obesity and Overt Hypothyroidism. Cureus 2023; 15:e38780. [PMID: 37303346 PMCID: PMC10249914 DOI: 10.7759/cureus.38780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Hypothyroidism is a major hormonal condition that affects more women than men in Saudi Arabia. Studies indicate a bidirectional link between hypothyroidism and obesity, which may improve following bariatric surgery (BS). The focus of this research is to assess how hypothyroidism patients' thyroid function and levothyroxine dosage are impacted by bariatric surgery. METHODOLOGY This was an observational retrospective study conducted in two centres at Taif, Saudi Arabia. All morbidly obese patients who were diagnosed with overt hypothyroidism and underwent laparoscopic sleeve gastrectomy from January 2016 to December 2021 were included. The changes in the thyroid profile and the changes in the doses or cessation of levothyroxine were evaluated after the laparoscopic sleeve gastrectomy. RESULTS Our results demonstrate that a total of 70 patients dominated by women out of 1202 from both centers who meet our inclusion criteria showed a statistically significant decrease on comparison of clinical parameters (thyroid-stimulating hormone [TSH], free T4 [FT4], free T3 [FT3], levothyroxine [L-T4]) before and after BS. The average TSH levels were determined to be 4.45 ± 4.41 mIU/L prior to BS, and they significantly decreased (3.17 ± 2.77 mIU/L) following BS (p=0.009). When compared to before BS (13.17 ± 2.73 pmol/L), the mean FT4 levels after BS (11.63 ± 5.88 pmol/L) exhibited a significant decline (p=0.046). The mean FT3 levels before and after BS also were statistically significantly lower (1.94 ± 2.12 pg/mL) than before (2.75 ± 1.96 pg/mL), p=0.009. The mean L-T4 levels after BS considerably decreased from before BS (98.68 ± 56.18 mcg) to after BS (79.39 ± 41.49 mcg), p=0.046. CONCLUSION Better thyroid profiles and lower levothyroxine dosage show that bariatric surgery improves hypothyroidism.
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Affiliation(s)
- Hanan H Alfaifi
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | | | - Rawan G Algethami
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | | | - Hajar D Althomali
- Medicine and Surgery, College of Medicine, Taif University, Taif, SAU
| | - Owaid M Almalki
- Department of Surgery, College of Medicine, Taif University, Taif, SAU
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Thyroid Function Before and After Laparoscopic Sleeve Gastrectomy in Patients with Obesity. Obes Surg 2022; 32:1954-1961. [PMID: 35364797 DOI: 10.1007/s11695-022-06035-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Effect of laparoscopic sleeve gastrectomy (LSG) on thyroid function of patients with obesity remains unclear. The aim of this study was to evaluate the changes in thyroid function before and after LSG in patients with obesity. METHODS Data was retrieved from a retrospectively collected database of patients with morbid obesity and normal thyroid function who received LSG. At 12 months after surgery, changes of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and intact parathyroid hormone (iPTH) were evaluated. In addition, the correlation between thyroid hormone levels and body mass index (BMI) and other metabolic indicators and anthropometric parameters were analyzed. RESULTS Eighty-five patients were included in the study. The concentrations of FT3 (5.7 ± 0.7 vs 5.1 ± 0.6, p < 0.001) and TSH (2.2 ± 1.0 vs 1.9 ± 0.9, p = 0.002) significantly decreased 12 months postsurgery, while mean FT4 levels increased from12.0 ± 1.9 vs 12.4 ± 2.0 pmol/L (p = 0.013). Furthermore, mean iPTH decreased from 53.3 ± 48.3 to 38.7 ± 13.2 pg/mL (p = 0.011). Multiple stepwise regression analysis showed that changes in LDL levels were an independent factor contributing to changes in TSH levels (β = 0.362, p = 0.001). Moreover, TSH did not correlate with BMI. CONCLUSIONS In this study, FT3, TSH, and iPTH were decreased in euthyroid patients with obesity after LSG, while FT4 was significantly increased. Changes in TSH were positively correlated with LDL, but no statistically significant correlation was found with BMI. Additionally, FT3, FT4, and iPTH were correlated with VB12, age, and BMI, respectively.
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Cordido M, Juiz-Valiña P, Urones P, Sangiao-Alvarellos S, Cordido F. Thyroid Function Alteration in Obesity and the Effect of Bariatric Surgery. J Clin Med 2022; 11:jcm11051340. [PMID: 35268429 PMCID: PMC8911439 DOI: 10.3390/jcm11051340] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/26/2022] Open
Abstract
The most common endocrine disease in obesity is hypothyroidism and secondary endocrine alterations, including abnormal thyroid function, are frequent in obesity. It is unclear whether impaired thyroid function is the cause or the consequence of increased adiposity; furthermore, there are no clear data regarding the best way to dose levothyroxine for patients with both hypothyroidism and obesity, and the effect of bariatric surgery (BS). The aim of the present article is to review some controversial aspects of the relation between obesity and the thyroid: (1) Thyroid function in obesity and the effect of BS (2) Thyroid hormone treatment (THT) in obese patients with hypothyroidism and the effect of BS. In summary: In morbidly obese patients, TSH is moderately increased. Morbid obesity has a mild central resistance to the thyroid hormone, reversible with weight loss. In morbidly obese hypothyroid patients, following weight loss, the levothyroxine dose/kg of ideal weight did not change, albeit there was an increment in the levothyroxine dose/kg of actual weight. From a clinical practice perspective, in morbid obesity, diagnosing mild hypothyroidism is difficult, BS improves the altered thyroid function and THT can be adapted better if it is based on ideal weight.
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Affiliation(s)
- María Cordido
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Servicio Urgencias, Hospital Universitario A Coruña, 15006 A Coruña, Spain
| | - Paula Juiz-Valiña
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - Paula Urones
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
| | - Susana Sangiao-Alvarellos
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Correspondence: (S.S.-A.); (F.C.); Tel.: +34-981178127 (S.S.-A. & F.C.); Fax: +34-981178204 (S.S.-A. & F.C.)
| | - Fernando Cordido
- Grupo Fisiopatoloxía Endócrina, Nutricional e Médica (FENM), Facultad de Ciencias de la Salud, Universidade da Coruña, 15006 A Coruña, Spain; (M.C.); (P.J.-V.); (P.U.)
- Instituto de Investigación Biomedica (INIBIC), Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña, 15006 A Coruña, Spain
- Servicio Endocrinología y Nutrición, Hospital Universitario A Coruña, 15006 A Coruña, Spain
- Correspondence: (S.S.-A.); (F.C.); Tel.: +34-981178127 (S.S.-A. & F.C.); Fax: +34-981178204 (S.S.-A. & F.C.)
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Tu Y, Bao Y, Zhang P. Metabolic surgery in China: present and future. J Mol Cell Biol 2021; 13:mjab039. [PMID: 34240190 PMCID: PMC8697345 DOI: 10.1093/jmcb/mjab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Obesity and its related complications comprise a serious public health problem worldwide, and obesity is increasing in China. Metabolic surgery is a new type of treatment with unique advantages in weight loss and obesity-related metabolic complications. The pathogenesis of obesity is complex and not yet fully understood. Here, we review the current efficacy and safety of metabolic surgery, as well as recent progress in mechanistic studies and surgical procedures in China. The exciting and rapid advances in this field provide new opportunities for patients with obesity and strike a balance between long-term effectiveness and safety.
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Affiliation(s)
- Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
- Department of Endocrinology and Metabolism, Jinshan
District Central Hospital of Shanghai Sixth People's
Hospital, Shanghai 201599, China
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s
Hospital, Shanghai 200233, China
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Laparoscopic Sleeve Gastrectomy has A Positive Impact on Subclinical Hypothyroidism Among Obese Patients: A Prospective Study. World J Surg 2021; 45:3130-3137. [PMID: 34175966 DOI: 10.1007/s00268-021-06201-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The effect of bariatric surgery on postoperative thyroid function remains incompletely understood. In this study, we aimed to evaluate the changes in thyroid functions after gastric sleeve operation for morbidly obese Egyptian patients. METHODS This was a prospective study that recruited 128 patients who underwent sleeve gastrectomy through the period from December 2016 to April 2020. We measured thyroid-stimulating hormone (TSH), free thyroxin (FT4), and free triiodothyronine. Subclinical hypothyroidism was defined by a TSH level > 4.5 mIU/L but a normal FT4 level. All patients were followed for 12 months after the procedure. RESULTS Preoperatively, 30 (23.4%) patients had subclinical hypothyroidism. The prevalence of subclinical hypothyroidism decreased significantly to reach 7.8% at the end of follow-up (p < 0.001). None of the patients developed de novo hypothyroidism at the end of follow-up. Patients with subclinical hypothyroidism were more likely to be females (p = 0.037) and had significantly higher waist circumference (p < 0.001), DBP (p = 0.02), serum cholesterol (p < 0.001), and serum triglyceride (p < 0.001). However, patients with subclinical hypothyroidism at the end of follow-up had significantly higher BMI at the end of the sixth month (p = 0.048). Similarly, patients with subclinical hypothyroidism at the end of follow-up had significantly higher serum cholesterol (p = 0.002), LDL, (p = 0.038), and serum triglyceride (p < 0.001) at the end of the sixth months of follow-up. A similar trend was noted at the end of the 12th month. The preoperative value of serum TSH correlated significantly with serum cholesterol and triglyceride levels. CONCLUSION The positive effect of the LSG procedure on the hypothyroid bariatric population, including enhanced thyroid function, was demonstrated.
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Thyroid Hormone Changes After Sleeve Gastrectomy With and Without Antral Preservation. Obes Surg 2020; 31:224-231. [PMID: 32748200 DOI: 10.1007/s11695-020-04896-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effect of bariatric surgery on thyroid hormone changes yielded inconsistent results. The aim of the present study was to assess the change of thyroid hormone levels following laparoscopic sleeve gastrectomy (LSG), with or without antral preservation (AP). METHODS Thyroid hormones (TSH, FT3, FT4) were examined preoperatively, at the end of the first postoperative month, and first postoperative year. Secondly, antral resection (AR) and AP were compared at inducing weight loss and thereby affecting thyroid hormone levels. RESULTS Euthyroid obese patients (86 female/20 male) underwent LSG. Of these, 58 patients underwent AR and 48 patients AP. The mean FT3 levels significantly decreased both in the first postoperative month and the first year (P < 0.001), whereas mean TSH levels decreased significantly in the first postoperative year (P < 0.001). FT4 levels remained nearly unchanged (P = 0.517). Postoperative first year body mass index (BMI) loss, excess BMI loss percentile (%EBMIL), and total body weight loss percentile (%TWL) were significantly higher in AR group than the AP group (P ≤ 0.01). When the change in thyroid hormone levels was analyzed by pyloric distance according to time periods, no significant difference was found in TSH and FT4 levels (P > 0.05); however, reduction in FT3 levels was significantly greater in patients with AR than in AP patients (P = 0.028). CONCLUSION LSG promotes significant reduction in TSH and FT3 levels, whereas FT4 levels remain unchanged. LSG with AR provides more weight loss in short term and appears to be more effective at lowering FT3 levels.
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Abstract
BACKGROUND The aim of this study was to determine changes in thyroid hormones and morphology with weight loss after bariatric surgery in obese patients. METHODS This prospective study was performed in our endocrinology and surgery clinic. Pre- and post-bariatric surgery thyroid function tests and thyroid ultrasonography parameters were compared. RESULTS Four hundred seventy-two patients were included in the study. Mean weight loss after surgery was 30.7 ± 5.1 kg. TSH levels decreased statistically significantly parallel with weight loss and decreased BMI (p = 0.025) after bariatric surgery. However, no statistically significant change was observed in fT4 or fT3 levels (p > 0.05). A significant increase in thyroid parenchyma echogenicity, correlated with weight loss and time elapsed since surgery, was detected at ultrasonography (US) grayscale histogram analysis compared with muscle echogenicity (p = 0.032). An increase in echogenicity was even detected in patients with isoechoic thyroid parenchyma before surgery. Fasting insulin and HOMA-IR levels decreased after surgery (p = 0.010 and p = 0.001, respectively). Patients were divided into three groups based on weight loss. In group 3, preoperative TSH of 4.1 ± 0.7 decreased to 1.6 ± 0.7 postoperatively (p = 0.001), while preoperative HOMA-IR of 4.9 ± 1.9 decreased to 2.4 ± 0.8 postoperatively (p = 0.001). CONCLUSIONS Obesity causes thyroid hormone resistance through a mechanism similar to insulin resistance and leads to an increase in TSH similar to hyperinsulinemia. Our findings show that echogenicity at thyroid US increases in line with weight loss following bariatric surgery.
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Duran İD, Gülçelik NE, Bulut B, Balcı Z, Berker D, Güler S. Differences in Calcium Metabolism and Thyroid Physiology After Sleeve Gastrectomy and Roux-En-Y Gastric Bypass. Obes Surg 2019; 29:705-712. [PMID: 30460439 DOI: 10.1007/s11695-018-3595-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Bariatric surgery may modulate the hormones and elements which maintain thyroid and calcium homeostasis. These adaptations in hormonal and elemental aspects have previously been determined via some studies with variations in their findings. Thyroid volume and 24-h urinary calcium are two parameters which have not been investigated regarding whether they change during the bariatric postsurgical period. This study planned to examine the changes in calcium metabolism and thyroid gland functioning after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS Seventy-three morbidly obese patients with planned bariatric surgery were enrolled in the study. Before and 12 months after the operation, parathormone (PTH), 25-OH-vitamin D3(25vitD3), TSH, free triiodothyronine (fT3), free thyroxine (fT4), calcium (Ca), 24-h urinary Ca and ultrasonography-guided thyroid volume were measured. RESULTS In the beginning, 73 patients were examined and 12 months after surgery out of 25 patients continuing follow-up, 20 (80%) had undergone sleeve gastrectomy (SG) while five (20%) had undergone Roux-en-Y gastric bypass (RYGB). Accompanied by significant BMI decrease, 24-h urinary Ca and thyroid volume did not significantly increase in RYGB, SG, and the whole group after 12 months. The SG group showed a significant drop in TSH (p 0.03) level, while the RYGB group showed significant decreases in fT4 (p 0.00) and fT3 (p 0.00); and significant fT3 decrease (p 0.01) was recorded for the whole group. CONCLUSION Bariatric surgery may modify Ca homeostasis and thyroid gland functional status. We documented that these were not statistically significant increases in 24-h urinary Ca level and thyroid volume after 1 year. Further studies are needed to understand the issue, enrolling more patients who underwent the same bariatric procedure and after accounting for the inhibition of supplementary vitamin and mineral effects.
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Affiliation(s)
- İffet Dağdelen Duran
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey.
| | - Neşe Ersöz Gülçelik
- Ankara Gülhane Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Bekir Bulut
- Ankara Numune Education and Research Hospital, Department of General Surgery, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Zeynep Balcı
- Ankara Numune Education and Research Hospital, Department of General Surgery, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Dilek Berker
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
| | - Serdar Güler
- Ankara Numune Education and Research Hospital, Department of Endocrinology and Metabolic Diseases, TC. Sağlık Bakanlığı, Ankara, Turkey
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13
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Zhu C, Gao J, Mei F, Lu L, Zhou D, Qu S. Reduction in Thyroid-Stimulating Hormone Correlated with Improved Inflammation Markers in Chinese Patients with Morbid Obesity Undergoing Laparoscopic Sleeve Gastrectomy. Obes Surg 2019; 29:3954-3965. [DOI: 10.1007/s11695-019-04063-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Euthyroid Patients with Morbid Obesity. Nutrients 2019; 11:nu11051121. [PMID: 31137484 PMCID: PMC6566754 DOI: 10.3390/nu11051121] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 12/14/2022] Open
Abstract
Obesity is associated with several endocrine abnormalities, including thyroid dysfunction. The objective of this study was to investigate the effect of weight loss after bariatric surgery on thyroid-stimulating hormone (TSH) levels in euthyroid patients with morbid obesity. We performed an observational study, evaluating patients with morbid obesity submitted to bariatric surgery. We included 129 patients (92 women) and 31 controls (21 women). Clinical, anthropometric, biochemical, and hormonal parameters were evaluated. The primary endpoint was circulating TSH (µU/mL). Fasting TSH levels were higher in the obese group (3.3 ± 0.2) than in the control group (2.1 ± 0.2). The mean excessive body mass index (BMI) loss (EBMIL) 12 months after bariatric surgery was 72.7 ± 2.1%. TSH levels significantly decreased in the obese patients after surgery; 3.3 ± 0.2 vs. 2.1 ± 0.2 before and 12 months after surgery, respectively. Free thyroxine (T4) (ng/dL) levels significantly decreased in the obese patients after surgery; 1.47 ± 0.02 vs. 1.12 ± 0.02 before and 12 months after surgery, respectively. TSH decreased significantly over time, and the decrement was associated with the EBMIL. In euthyroid patients with morbid obesity, weight loss induced by bariatric surgery promotes a significant decline of the increased TSH levels. This decrement of TSH is progressive over time after surgery and significantly associated with excess BMI loss.
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