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Mirghani H, Fnjan AM, Almalki AF, Almadan AF, Alammar OAM, Alhwiati AS, Laradhi AA, Bakour AM, Aljahed MA, Alzahrani AM. Thyroidectomy Effects on the Body Mass Index and Thyroid-Stimulating Hormone: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54585. [PMID: 38524065 PMCID: PMC10959464 DOI: 10.7759/cureus.54585] [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: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Thyroidectomy is common and is performed for malignancy, goiters with pressure symptoms, and certain types of Grave's disease. Weight and body mass index (BMI) following thyroidectomy were discussed controversially. This meta-analysis aimed to assess weight and BMI following thyroidectomy. A systematic literature search was conducted in PubMed, Medline, and Google Scholar with interest in articles that assessed body weight and BMI following total or subtotal thyroidectomy. The search engine was limited to the period from inception up to January 2024. Keywords "total thyroidectomy", "subtotal thyroidectomy", "Graves' disease", "multinodular goiter", "differentiated thyroid carcinoma", and "toxic nodules" were used. Out of the 634 articles retrieved, 89 full texts were screened, and only six studies (five retrospective and one prospective cohort) fulfilled the inclusion and exclusion criteria. No differences were evident regarding weight and BMI before and after thyroidectomy (odds ratio: -0.63, 95%CI: -1.50 to -0.24, P-value for the overall effect: 0.15; and odds ratio: -0.12, 95% CI: -0.41 to -0.16, P-value for the overall effect: 0.40 respectively). No heterogeneity was observed (I2 for heterogeneity: 0.0%). No association between thyroidectomy (when performed for differentiated thyroid carcinoma and hyperthyroidism), weight, and BMI was found. Further studies assessing thyroid-stimulating hormone (TSH) levels, radioactive iodine therapy, and thyroxine dose are needed.
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Affiliation(s)
- Hyder Mirghani
- Department of Internal Medicine, University of Tabuk, Tabuk, SAU
| | - Ahmad M Fnjan
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | | | - Ali F Almadan
- Department of Internal Medicine, University of Tabuk, Tabuk, SAU
| | | | | | - Amer A Laradhi
- Department of Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Ahmed M Bakour
- Department of Internal Medicine, University of Tabuk, Tabuk, SAU
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Biondi B, Celi FS, McAninch EA. Critical Approach to Hypothyroid Patients With Persistent Symptoms. J Clin Endocrinol Metab 2023; 108:2708-2716. [PMID: 37071856 PMCID: PMC10686697 DOI: 10.1210/clinem/dgad224] [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: 03/02/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/20/2023]
Abstract
Hypothyroidism is a common condition, and numerous studies have been published over the last decade to assess the potential risks associated with this disorder when inappropriately treated. The standard of care for treatment of hypothyroidism remains levothyroxine (LT4) at doses to achieve biochemical and clinical euthyroidism. However, about 15% of hypothyroid patients experience residual hypothyroid symptoms. Some population-based studies and international population-based surveys have confirmed dissatisfaction with LT4 treatment in some hypothyroid patients. It is well established that hypothyroid patients treated with LT4 exhibit higher serum thyroxine:triiodothyronine ratios and can have a persistent increase in cardiovascular risk factors. Moreover, variants in deiodinases and thyroid hormone transporter genes have been associated with subnormal T3 concentrations, persistent symptoms in LT4-treated patients, and improvement in response to the addition of liothyronine to LT4 therapy. The American (ATA) and European Thyroid Association (ETA) guidelines have recently evolved in their recognition of the potential limitations of LT4. This shift is reflected in prescribing patterns: Physicians' use of combination therapy is prevalent and possibly increasing. Randomized clinical trials have recently been published and, while they have found no improvement in treating hypothyroid patients, a number of important limitations did not allow generalizability. Meta-analyses have reported a preference rate for combination therapy in 46.2% hypothyroid patients treated with LT4. To promote discussions about an optimal study design, the ATA, ETA, and British Thyroid Association have recently published a consensus document. Our study provides a useful counterpoint on the controversial benefits of treating hypothyroid patients with combination therapy.
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Affiliation(s)
- Bernadette Biondi
- Division of Internal Medicine and Cardiovascular Endocrinology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy
| | - Francesco S Celi
- Division of Endocrinology and Metabolism, Department of Medicine UConn Health, Farmington, CT 06030-8075, USA
| | - Elizabeth A McAninch
- Division of Endocrinology, Metabolism and Gerontology, Stanford University Medical Center, Stanford, CA 94305, USA
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Croce L, Pallavicini C, Busca N, Calì B, Bellastella G, Coperchini F, Magri F, Chiovato L, Cena H, Rotondi M. Pre-surgery dietician counseling can prevent post-thyroidectomy body weight gain: results of an intervention trial. Endocrine 2023:10.1007/s12020-023-03365-z. [PMID: 37074559 PMCID: PMC10293335 DOI: 10.1007/s12020-023-03365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE It is widely accepted that patients experience weight gain after total thyroidectomy, and preventive measures should be recommended. METHODS A prospective study was designed to assess the efficacy of a dietetic intervention to prevent post-thyroidectomy weight gain in patients undergoing surgery for both benign and malignant thyroid conditions. Patients undergoing total thyroidectomy were prospectively and randomly assigned to receive a personalized pre-surgery diet counseling (GROUP A) or no intervention (GROUP B), according to a 1:2 ratio. All patients underwent follow-up with body-weight measurement, thyroid function evaluation and lifestyle and eating habits assessment at baseline (T0), 45 days (T1) and 12 months (T2) post-surgery. RESULTS The final study group encompassed 30 patients in Group A and 58 patients in Group B. The two groups were similar in terms of age, sex, pre-surgery BMI, thyroid function and underlying thyroid condition. The evaluation of body weight variations showed that patients in Group A did not experience significant body weight changes at either T1 (p = 0.127) nor T2 (p = 0.890). At difference, patients in Group B underwent a significant body weight increase from T0 to both T1 (p = 0.009) and T2 (p = 0.009). TSH levels were similar in the two groups, both at T1 and T2. Lifestyle and eating habits questionnaires failed to register any significant difference between the two groups, apart from an increase in sweetened beverages consumption in Group B. CONCLUSIONS A dietician counseling is effective in preventing the post-thyroidectomy weight gain. Further studies in larger series of patients with a longer follow-up appear worthwhile.
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Affiliation(s)
- Laura Croce
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
- NBFC, National Biodiversity Future Center, Palermo, 90133, Italy
| | - Cristina Pallavicini
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Noemi Busca
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Benedetto Calì
- Istituti Clinici Scientifici Maugeri IRCCS, Department of General and Minimally Invasive Surgery, Pavia, 27100, Italy
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesca Coperchini
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Luca Chiovato
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy
| | - Hellas Cena
- NBFC, National Biodiversity Future Center, Palermo, 90133, Italy
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Clinical Nutrition and Dietetics Service, Unit of Endocrinology, 27100, Pavia, Italy
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Italy.
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Pavia, 27100, Italy.
- NBFC, National Biodiversity Future Center, Palermo, 90133, Italy.
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Celik SU, Konca C. Body composition changes following total thyroidectomy: A one-year follow-up study. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:14-20. [PMID: 36764744 DOI: 10.1016/j.endien.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/24/2022] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Thyroid hormones play an important role in body weight regulation. In this study, we investigated which body composition parameters cause a change in body weight after total thyroidectomy. MATERIALS AND METHOD We performed a retrospective cohort study of a prospectively maintained database of patients who underwent total thyroidectomy. Demographics, thyroid function tests, indications for surgery, final pathology, and postoperative thyroid status were collected. Body composition analyses measured by the bioelectrical impedance analysis method were recorded at two-time points, 12 months apart. RESULTS Forty-four patients were included in the study with a mean age of 51.6 years. There were statistically significant increases in weight (p=0.049), body mass index (p=0.021), and fat mass (p=0.001) over time. While 12 patients (27.3%) lost or maintained weight, 32 patients (72.7%) gained weight. There was no significant difference in age, sex, preoperative thyroid function tests, postoperative thyroid status, or pathology between those who gained weight and those who did not. Although changes in all body composition parameters were higher in males than in females, these differences were not significant overall. Multivariable regression analysis revealed a significant positive relationship between increase in fat mass and baseline free-T3 (p=0.041) and found that lower baseline percent body fat was a significant factor for greater fat mass gain (p=0.016). However, no predictors of change in weight were identified. CONCLUSION We conclude that total thyroidectomy results in a significant change in body weight and fat mass. Higher free-T3 and lower percent body fat at baseline were significant factors of fat mass gain.
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Affiliation(s)
- Suleyman Utku Celik
- Department of General Surgery, Gulhane Training and Research Hospital, Ankara, Turkey; Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey.
| | - Can Konca
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
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Edwards ER, Hazkani I, Stein E, Josefson JL, Samis JH, Miller JL, Rastatter J. Total Thyroidectomy and Subsequent Weight Gain in Pediatric Populations. Laryngoscope 2022; 133:1518-1523. [PMID: 36537365 DOI: 10.1002/lary.30532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/02/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate weight gain in children post-thyroidectomy and identify predictors. METHODS Charts from patients at a tertiary health care facility who underwent total thyroidectomy from 2014 to 2020 were reviewed for Body Mass Index z-scores (BMIz) at the time of thyroidectomy and at 1 and 2-year post-operation intervals. Patient demographic information, comorbidities, pre- and postoperative thyroid stimulating hormone, and postoperative free T4 levels were also extracted. Patients with other known endocrine abnormalities, chronic kidney disease, or without sufficient follow-up were excluded. RESULTS A total of 56 patients (ages 3-17 years old) met the inclusion criteria (n = 17 Graves' disease; n = 39 presumed cancer). Over the first year, average BMIz significantly increased in patients with Graves' disease (∆BMIz = 0.45 ± 0.77, p = 0.03), Hispanic ethnicity (∆BMIz = 0.43 ± 0.68, p = 0.004), Medicaid/no insurance coverage (∆BMIz = 0.33 ± 0.74, p = 0.038), age <13 years at thyroidectomy (∆BMIz = 0.35 ± 0.68, p = 0.016), and persistent postoperative hypothyroidism (∆BMIz = 0.41 ± 0.41, p = 0.012). These changes remained significant after the second year. Age at thyroidectomy correlated negatively with ∆BMIz only after the first year (r = -0.40, p = 0.002). Regression analysis, controlling for Graves' status, persistent postoperative hypothyroidism, and insurance coverage, identified age at thyroidectomy as a significant predictor of ∆BMIz after the first year (b = -0.06, p = 0.004) and Hispanic ethnicity as a significant predictor after the second year (b = 0.60, p = 0.003). CONCLUSION A small increase in BMIz post-thyroidectomy was observed across several patient subgroups. Younger age at thyroidectomy and Hispanic ethnicity were associated with increased BMIz in the first 2 years post-thyroidectomy. LEVEL OF EVIDENCE Level 4 - Historically controlled cohort Laryngoscope, 133:1518-1523, 2023.
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Affiliation(s)
- Evan R. Edwards
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
| | - Inbal Hazkani
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Eli Stein
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
| | - Jami L. Josefson
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Endocrinology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jill H. Samis
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Endocrinology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jennifer L. Miller
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Endocrinology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jeffrey Rastatter
- Feinberg School of Medicine Northwestern University Chicago Illinois USA
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
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Scerrino G, Salamone G, Corigliano A, Richiusa P, Proclamà MP, Radellini S, Cocorullo G, Orlando G, Melfa G, Paladino NC. Weight Gain and Asthenia Following Thyroidectomy: Current Knowledge from Literature Review. J Clin Med 2022; 11:jcm11185486. [PMID: 36143133 PMCID: PMC9500853 DOI: 10.3390/jcm11185486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Thyroidectomy is a common procedure all over the world. Its complication rate is low, but some patients complain of weight gain and/or asthenia. The aim of this review is to investigate the correlation between thyroidectomy and weight change and asthenia. MATERIALS AND METHODS Seven papers concerning weight gain and four concerning asthenia were found. RESULTS Weight gain would seem to be more related to the change in habits after surgery. Asthenia seems to be more linked to endocrine mechanisms not yet clarified although a deficiency of triiodothyronine and its metabolites could explain some of its aspects. CONCLUSION Patients who are candidates for thyroidectomy should be adequately informed of the onset of both possible implications of the surgical act in terms of weight gain and chronic asthenia.
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Affiliation(s)
- Gregorio Scerrino
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Giuseppe Salamone
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Alessandro Corigliano
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, Aix-Marseille University, 147 Boulevard Baille, 13005 Marseille, France
- Correspondence: ; Tel.: +33-04-9143-5511
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Jin YJ, Hah JH, Kwon MJ, Kim JH, Kim JH, Kim SK, Park B, Choi HG. Association between Thyroid Cancer and Weight Change: A Longitudinal Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6753. [PMID: 35682332 PMCID: PMC9180614 DOI: 10.3390/ijerph19116753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate body mass index (BMI) and systolic blood pressure (SBP)/diastolic blood pressure (DBP) between Korean adults who underwent thyroidectomy and comparison groups. METHODS Data were included from the Korean National Health Insurance Service-Health Screening Cohort (2002-2015). BMI and SBP/DBP were measured before thyroidectomy, 1 and 2 years after thyroidectomy (n = 1995 in study I, n = 2162 in study II), comparing 1:4 matched participants (n = 7980 in study I, n = 8648 in study II). The paired t-test and linear mixed model were used to identify the differences between groups. RESULTS DBP in both thyroid cancer II and comparison II group were significantly lower after thyroidectomy than before thyroidectomy. However, the interaction effect of thyroidectomy in study I and study II did not reach statistical significance. CONCLUSION BMI, SBP and DBP were not significantly different between the thyroidectomy group and the matched comparison group.
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Affiliation(s)
- Young Ju Jin
- Department of Otorhinolaryngology—Head & Neck Surgery, Wonkwang University Hospital, Wonkwang University College of Medicine, Iksan 54538, Korea;
| | - Jeong Hun Hah
- ThanQ Seoul Thyroid—Head and Neck Surgery Center, Seoul 06150, Korea;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Sung-Kyun Kim
- Department of Otorhinolaryngology—Head & Neck Surgery, Hallym University College of Medicine, Dongtan 18450, Korea;
| | - Bumjung Park
- Department of Otorhinolaryngology—Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
| | - Hyo Geun Choi
- Department of Otorhinolaryngology—Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Korea;
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea
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Yotsapon T, Waralee C, Hussamon P, Panita S, Siriwan B, Soontaree N, Ekgaluck W, Rajata R, Thep H. Duration of antithyroid drug treatment may predict weight gain after radioactive iodine therapy in patients with Graves' disease. Heliyon 2022; 8:e09471. [PMID: 35615430 PMCID: PMC9124706 DOI: 10.1016/j.heliyon.2022.e09471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/18/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Weight gain post-radioiodine (RAI) treatment is observed in patients with hyperthyroid Graves’ disease. Previous studies, mostly in Caucasian patients, demonstrated excessive weight gain averaging 5–7 kg from initial presentation. Aim The aim of this study was to determine the extent and risk factors of weight gain in Thai patients with RAI-treated Graves’ disease. Methods This was a 5-year retrospective study of patients with hyperthyroid Graves’ disease who received RAI treatment during 2016–2020. The proportion and associated risk factors of weight gain ≥5% in patients who was followed for at least 3 months when compared with weight at RAI administration were analyzed. Results There were 347 patients with Graves’ disease (females 81.0%, mean age 38.8 ± 12.1 years, BMI 23.3 ± 4.0 kg/m2) who were treated with RAI. Almost all RAI-treated patients (91.9%) eventually developed hypothyroidism. During the median follow-up period of 25 months, 73.1% of them had weight gain. The mean weight change was +2.5 ± 4.9 kgs when compared with weight at the time RAI administration and +3.4 ± 6.5 kgs when compared with recalled body weight before the onset of hyperthyroidism. The proportion of patient in the obesity class I (BMI 25.0–29.9 kg/m2) increased from 23.6% to 28.0% and obesity class II (BMI ≥30.0 kg/m2) increased from 5.2% to 8.9%. Duration of antithyroid drug treatment less than 6 months after the diagnosis of hyperthyroidism was the only factor associated with weight gain ≥5%. Conclusions Weight gain post-RAI treatment was common, and a significant proportion of patients went on to develop obesity. Early intervention with weight management support should be employed in patients with less than 6 months of antithyroid drug treatment before RAI.
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Affiliation(s)
| | | | | | | | - Butadej Siriwan
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
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Le Moli R, Vella V, Tumino D, Piticchio T, Naselli A, Belfiore A, Frasca F. Inflammasome activation as a link between obesity and thyroid disorders: Implications for an integrated clinical management. Front Endocrinol (Lausanne) 2022; 13:959276. [PMID: 36060941 PMCID: PMC9437482 DOI: 10.3389/fendo.2022.959276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Obesity is strongly associated with chronic low-grade inflammation. Obese patients have an increased risk to develop thyroid autoimmunity and to became hypothyroid, suggesting a pathogenetic link between obesity, inflammation and autoimmunity. Moreover, type 2 diabetes and dyslipidemia, also characterized by low-grade inflammation, were recently associated with more aggressive forms of Graves' ophthalmopathy. The association between obesity and autoimmune thyroid disorders may also go in the opposite direction, as treating autoimmune hyper and hypothyroidism can lead to weight gain. In addition, restoration of euthyroidism by L-T4 replacement therapy is more challenging in obese athyreotic patients, as it is difficult to maintain thyrotropin stimulation hormone (TSH) values within the normal range. Intriguingly, pro-inflammatory cytokines decrease in obese patients after bariatric surgery along with TSH levels. Moreover, the risk of thyroid cancer is increased in patients with thyroid autoimmune disorders, and is also related to the degree of obesity and inflammation. Molecular studies have shown a relationship between the low-grade inflammation of obesity and the activity of intracellular multiprotein complexes typical of immune cells (inflammasomes). We will now highlight some clinical implications of inflammasome activation in the relationship between obesity and thyroid disease.
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