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Machado CR, Braun AM, Ceolin J, Richter SA, Ribeiro MC, Santos LD, Rigo MM, de Souza APD, Padoin AV, Alves LB, Mottin CC, Drumond Costa CA, Mundstock E, Cañon-Montañez W, Ayala CO, Mattiello R. Variation of modulation and expression of biomarkers associated with inflammation in bariatric surgery patients: A systematic review and meta-analysis. Surgery 2023; 174:1114-1144. [PMID: 37633813 DOI: 10.1016/j.surg.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/02/2023] [Accepted: 07/08/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Bariatric surgery is an effective intervention that causes a series of metabolic changes related to inflammatory processes; however, the variation of biomarkers related to these processes is not entirely understood. Our objective was to investigate the variation of modulation and expression of biomarkers associated with inflammation in patients who underwent bariatric surgery. METHODS We searched the MEDLINE (via PubMed), EMBASE (via Elsevier), Cochrane Central Register of Controlled Trials, Latin American and Caribbean Literature on Health Sciences (via virtual health library), Cumulative Index to Nursing and Allied Health Literature (via EBSCO), Web of Science core collection, and Scopus (via Elsevier) databases, and the gray literature was examined from inception to January 2022. Three pairs of reviewers performed data screening, extraction, and quality assessment independently. Meta-analysis with random effects models was used for general, subgroup, and sensitivity analyses. The I2 statistic was used to assess heterogeneity between studies. RESULTS In total, 96 articles were included in this systematic review; of these, 87 studies met the criteria for the meta-analysis, involving 3,533 participants. Five biomarkers were included in the meta-analysis (tumor necrosis factor alpha; interleukin 6; leptin; interleukin 1 beta, and lipopolysaccharides). Only leptin showed a significant decrease in the first month after surgery (mean difference -20.71; [95% confidence interval: -28.10 to -13.32, P < .0001; I2 = 66.7%), with moderate heterogeneity. The 12 months after surgery showed a significant decrease in tumor necrosis factor alpha (mean difference -0.89; [95% confidence interval: -1.37 to -0.42], P = .0002; I2 = 94.7%), interleukin 6 (mean difference -1.62; [95% confidence interval: -1.95 to -1.29], P < .0001; I2 = 94.9%), leptin (mean difference -28.63; [95% confidence interval: -34.02 to -23.25], P < .0001; I2 = 92.7%), and interleukin 1 beta (mean difference -2.46; [95% confidence interval: -4.23 to -0.68], P = .006; I2 = 98.3%), all with high heterogeneity. The type of surgery did not show significant differences for the biomarkers at the first month and 12 months, and the results have not changed with high-quality studies. In the 12-month measurement, variations in tumor necrosis factor alpha and leptin were associated with body mass index. CONCLUSION The findings of this meta-analysis suggest that Roux-en-Y gastric bypass and sleeve gastrectomy bariatric surgeries are associated with a significant reduction in leptin at 1 month after bariatric surgical intervention and tumor necrosis factor alpha, leptin, and interleukin 1 beta after 12 months.
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Affiliation(s)
- Cátia R Machado
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Amanda M Braun
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jamile Ceolin
- Federal University of Santa Maria, Rio Grande do Sul, Brazil
| | - Samanta A Richter
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Leonardo D Santos
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratory of Clinical and Experimental Immunology, Health and Life Science School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maurício M Rigo
- Kavraki Lab, Department of Computer Science, Rice University, Houston, TX
| | - Ana P D de Souza
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Laboratory of Clinical and Experimental Immunology, Health and Life Science School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alexandre V Padoin
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Center for Obesity and Metabolic Syndrome, Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Letícia B Alves
- Center for Obesity and Metabolic Syndrome, Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Claudio C Mottin
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Center for Obesity and Metabolic Syndrome, Hospital São Lucas, Porto Alegre, RS, Brazil
| | - Caroline A Drumond Costa
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Health and Life Science School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo Mundstock
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Education, Sport, and Leisure of Canela, RS, Brazil
| | | | - Camila Ospina Ayala
- Medicine School, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil. http://twitter.com/CamilaOAyala2
| | - Rita Mattiello
- Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Tee SA, Tsatlidis V, Razvi S. The GLP-1 receptor agonist exenatide reduces serum TSH by its effect on body weight in people with type 2 diabetes. Clin Endocrinol (Oxf) 2023; 99:401-408. [PMID: 36843143 DOI: 10.1111/cen.14901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVE Glucagon-like peptide-1 receptor agonist (GLP-1 RA) therapy in patients with type 2 diabetes and obesity leads to a significant reduction in serum thyrotropin (TSH) levels but it is unclear whether this is related to weight loss and improvement in sensitivity to thyroid hormones (TH). DESIGN, PATIENTS AND MEASUREMENTS We prospectively analysed clinical and biochemical data in patients with type 2 diabetes and obesity who were commenced on the GLP-1 RA exenatide and followed them for 12 months. We assessed the relationship between changes in body weight and serum TSH and resistance to TH indices. RESULTS In 112 patients (mean age: 53.5 years, 43.8% female, mean body mass index: 39.8 kg/m2 ), 12 months of exenatide treatment was associated with a mean (95% CI) percent body weight loss of 6.5% (5.0%-8.1%) and change in serum TSH of -0.25 mU/L (-0.43 to -0.06). There was a significant negative and nonlinear relationship between change in serum TSH and percent body weight loss: -0.25 mU/L with 5%, -0.4 mU/L with 10% and -0.5 mU/L with 15%, respectively, whereas a rise in serum TSH of 0.5 mU/L was associated with 5% weight gain. There were no changes observed in serum FT4 levels with weight loss but a significant reduction in resistance to TH indices was noted. CONCLUSIONS Exenatide therapy reduces serum TSH levels and improves central sensitivity to TH action over 12 months via its effect on weight loss. The effectiveness of weight loss strategies, rather than TH replacement, should be investigated in individuals with obesity and mildly raised serum TSH levels.
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Affiliation(s)
- Su Ann Tee
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Vasileios Tsatlidis
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Alamro N, Azhri AS, Almuqati A, Azzeh F, Azhar W, Qadhi A, Almohmadi NH, Abusudah WF, Ghafouri K. Effect of Bariatric Surgery on Metabolic Syndrome, Framingham Risk Scores and Thyroid Function during One-Year Follow-Up: A Saudi Retrospective Study. Healthcare (Basel) 2022; 10:healthcare10122530. [PMID: 36554054 PMCID: PMC9778226 DOI: 10.3390/healthcare10122530] [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] [Received: 11/01/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022] Open
Abstract
Bariatric surgery (BS) has been demonstrated to achieve sustained weight loss with significant metabolic improvement, including a reduction in cardiovascular disease and diabetes. The aim of this retrospective study is to measure the effect of BS on the Framingham risk score (FRS) and metabolic syndrome (MetS) among patients who underwent bariatric surgery. Additionally, we determine the effect of BS on thyroid-stimulating hormone (TSH) among euthyroid obese patients. A retrospective follow-up study was conducted at King Abdullah Medical City, Makkah, Saudi Arabia. A total of 160 patients underwent BS and completed one-year follow-up visits. Medical history, anthropometric, biochemical, and hormonal parameters were evaluated at baseline and 3−12 months after BS. The International Diabetes Federation (IDF) criteria were used to diagnose MetS. There was a significant decrease in systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (Hba1c), TSH, low-density lipoprotein (LDL), triglycerides, and total cholesterol (p < 0.001). A significant decrease was seen in MetS, BMI, FRS, SBP, DBP, Hba1c, LDL, triglycerides, cholesterol, and liver enzymes, with a significant increase in high-density lipoprotein levels 12 months postoperatively (p < 0.001). At 12 months, the prevalence of MetS, DM, and HTN and the FRS significantly decreased from 72.5%, 43.1%, 78.1%, and 11.4 to 16.3%, 9.4%, 22.5%, and 5.4, respectively. In addition to achieving substantial weight loss, BS improves MetS prevalence and cardiovascular risk profiles.
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Affiliation(s)
- Nuha Alamro
- Clinical Nutrition Administration, King Abdullah Medical City, P.O.Box 24246, Makkah 21955, Saudi Arabia
| | - Afnan S. Azhri
- Clinical Nutrition Administration, King Abdullah Medical City, P.O.Box 24246, Makkah 21955, Saudi Arabia
| | - Asma Almuqati
- Clinical Nutrition Administration, King Abdullah Medical City, P.O.Box 24246, Makkah 21955, Saudi Arabia
| | - Firas Azzeh
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O Box 715, Makkah 21955, Saudi Arabia
| | - Wedad Azhar
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O Box 715, Makkah 21955, Saudi Arabia
| | - Alaa Qadhi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O Box 715, Makkah 21955, Saudi Arabia
| | - Najlaa H. Almohmadi
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O Box 715, Makkah 21955, Saudi Arabia
| | - Wafaa F. Abusudah
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O Box 715, Makkah 21955, Saudi Arabia
| | - Khloud Ghafouri
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O Box 715, Makkah 21955, Saudi Arabia
- Correspondence: ; Tel.: +966-125-270-000
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Mele C, Mai S, Cena T, Pagano L, Scacchi M, Biondi B, Aimaretti G, Marzullo P. The pattern of TSH and fT4 levels across different BMI ranges in a large cohort of euthyroid patients with obesity. Front Endocrinol (Lausanne) 2022; 13:1029376. [PMID: 36313780 PMCID: PMC9606412 DOI: 10.3389/fendo.2022.1029376] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE A multifold association relates the hypothalamo-pituitary-thyroid axis to body weight. The potential underlying mechanisms are incompletely understood. Further, the mild severity of obesity and the small proportion of individuals with obesity in so far published cohort studies provide little insights on metabolic correlates of thyroid function in obesity. METHODS We retrospectively enrolled 5009 adults with obesity (F/M, 3448/1561; age range, 18-87 years; BMI range, 30.0-82.7 kg/m2), without known thyroid disease in a study on TSH and fT4 levels, lipid profile, glucose homeostasis and insulin resistance, anthropometric parameters including BIA-derived fat mass (%FM) and fat-free mass (FFM). RESULTS The overall reference interval for TSH in our obese cohort was 0.58-5.07 mIU/L. As subgroups, females and non-smokers showed higher TSH levels as compared to their counterparts (p<0.0001 for both), while fT4 values were comparable between groups. There was a significant upward trend for TSH levels across incremental BMI classes in females, while the opposite trend was seen for fT4 levels in males (p<0.0001 for both). Expectedly, TSH was associated with %FM and FFM (p<0,0001 for both). TSH and fT4 showed correlations with several metabolic variables, and both declined with aging (TSH, p<0.0001; fT4, p<0.01). In a subgroup undergoing leptin measurement, leptin levels were positively associated with TSH levels (p<0.01). At the multivariable regression analysis, in the group as a whole, smoking habit emerged as the main independent predictor of TSH (β=-0.24, p<0.0001) and fT4 (β=-0.25, p<0.0001) levels. In non-smokers, %FM (β=0.08, p<0.0001) and age (β=-0.05, p<0.001) were the main significant predictors of TSH levels. In the subset of nonsmokers having leptin measured, leptin emerged as the strongest predictor of TSH levels (β=0.17, p<0.01). CONCLUSIONS Our study provides evidence of a gender- and smoking-dependent regulation of TSH levels in obesity.
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Affiliation(s)
- Chiara Mele
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- *Correspondence: Chiara Mele,
| | - Stefania Mai
- Istituto Auxologico Italiano, IRCCS, Laboratory of Metabolic Research, S. Giuseppe Hospital, Piancavallo, Italy
| | - Tiziana Cena
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Massimo Scacchi
- Istituto Auxologico Italiano, IRCCS, Division of General Medicine, S. Giuseppe Hospital, Piancavallo, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gianluca Aimaretti
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Istituto Auxologico Italiano, IRCCS, Laboratory of Metabolic Research, S. Giuseppe Hospital, Piancavallo, Italy
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Or Koca A, Öztürk D, Koca HS, Dağdeviren M, Keskin M, Buluş H. The Effect of Sleeve Gastrectomy on the Function and Volume of the Thyroid Gland. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2019.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arzu Or Koca
- Department of Endocrinology and Metabolism, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Doğan Öztürk
- Department of General Surgery, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Hüseyin Samet Koca
- Department of Otorhinolaryngology, Yüksek İhtisas University, Ankara, Turkey
| | - Murat Dağdeviren
- Department of Endocrinology and Metabolism, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Müge Keskin
- Department of Endocrinology and Metabolism, Ankara City Hospital, Ankara, Turkey
| | - Hakan Buluş
- Department of General Surgery, Keçiören Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Leptin Receptors Are Not Required for Roux-en-Y Gastric Bypass Surgery to Normalize Energy and Glucose Homeostasis in Rats. Nutrients 2021; 13:nu13051544. [PMID: 34064308 PMCID: PMC8147759 DOI: 10.3390/nu13051544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/29/2022] Open
Abstract
Sensitization to the adipokine leptin is a promising therapeutic strategy against obesity and its comorbidities and has been proposed to contribute to the lasting metabolic benefits of Roux-en-Y gastric bypass (RYGB) surgery. We formally tested this idea using Zucker fatty fa/fa rats as an established genetic model of obesity, glucose intolerance, and fatty liver due to leptin receptor deficiency. We show that the changes in body weight in these rats following RYGB largely overlaps with that of diet-induced obese Wistar rats with intact leptin receptors. Further, food intake and oral glucose tolerance were normalized in RYGB-treated Zucker fatty fa/fa rats to the levels of lean Zucker fatty fa/+ controls, in association with increased glucagon-like peptide 1 (GLP-1) and insulin release. In contrast, while fatty liver was also normalized in RYGB-treated Zucker fatty fa/fa rats, their circulating levels of the liver enzyme alanine aminotransferase (ALT) remained elevated at the level of obese Zucker fatty fa/fa controls. These findings suggest that the leptin system is not required for the normalization of energy and glucose homeostasis associated with RYGB, but that its potential contribution to the improvements in liver health postoperatively merits further investigation.
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Mahdavi M, Amouzegar A, Mehran L, Madreseh E, Tohidi M, Azizi F. Investigating the prevalence of primary thyroid dysfunction in obese and overweight individuals: Tehran thyroid study. BMC Endocr Disord 2021; 21:89. [PMID: 33931052 PMCID: PMC8086289 DOI: 10.1186/s12902-021-00743-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Due to the increasing worldwide prevalence of obesity, it is essential to determine the prevalence of obesity-related thyroid dysfunctions. The purpose of this study was to investigate the prevalence of thyroid dysfunctions, namely hypothyroidism and hyperthyroidism, and their association with BMI among adult Iranian overweight and obese individuals. METHOD This cross-sectional study was carried out within the framework of the Tehran Thyroid Study (TTS); 5353 participants (57.5% female) entered our study. Anthropometric measurements were performed. Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibody (TPOAb) were assayed. We categorized individuals into 3 BMI groups (normal-weight, overweight and obese), then calculated prevalence rate, odds ratio (OR), and 95% confidence interval (CI) for outcomes in overweight and obese groups. The normal-weight group was used as the control group. RESULTS We found a higher prevalence of hypothyroidism (11.6% vs 8.2% Total, 4.0% vs 1.1% overt and 7.6% vs 7.1% subclinical, P < 0.001) and TPOAb positivity (17.3% vs 11.6%, P < 0.001) in obese participants compared with normal-weight participants. Hyperthyroidism's overall prevalence was 4.2, 5.7, and 4.9% in obese, overweight, and normal-weight groups, respectively. Obesity was associated with higher odds of overt hypothyroidism (OR: 2.0, 95% CI: 1.15-3.49, P < 0.05) and TPOAb positivity (OR: 1.29, 95% CI: 1.04-1.60, P < 0.05) after adjusting for confounding variables. In contrast, no association was observed between the overweight group and the odds of hypothyroidism and TPOAb positivity in the adjusted results. CONCLUSIONS Obesity was associated with an increased risk of overt hypothyroidism and TPOAb positivity.
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Affiliation(s)
- Mahdi Mahdavi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran
- Institute of Medical Science and Technology (IMSAT), Shahid Beheshti University, Tehran, Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran
| | - Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran
| | - Elham Madreseh
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, Iran.
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Almunif DS, Bamehriz F, Althuwaini S, Almigbal TH, Batais MA. The Effect of Laparoscopic Sleeve Gastrectomy on Serum Thyroid-Stimulating Hormone Levels in Obese Patients with Overt and Subclinical Hypothyroidism: a 7-Year Retrospective Study. Obes Surg 2021; 30:1491-1497. [PMID: 31848987 DOI: 10.1007/s11695-019-04337-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inconsistent results were reported by several studies that evaluated the effect of weight loss induced by bariatric surgery on thyroid function panel. This study is aimed at evaluating this effect on thyroid-stimulating hormone (TSH) and thyroid hormone replacement dosages in obese population with overt and subclinical hypothyroidism (SH). METHODS A retrospective study was performed on all morbidly obese patients with previous diagnosis of overt and subclinical hypothyroidism who underwent laparoscopic sleeve gastrectomy from October 2009 to January 2017. The correlation between TSH and body mass index (BMI) and the effect of weight loss induced by bariatric surgery on TSH were investigated. RESULTS The prevalence of overt and SH in morbidly obese patients was 10.8% and 7.2%, respectively. Thirty-six hypothyroid patients and 67 subclinically hypothyroid patients were included in the study. Hypothyroidism improved in 44.5% of patients and completely resolved in 22.2%, and 33.3% experienced no change. Ninety-one percent of SH patients completely resolved, 6% improved, but 3% worsened, with one patient developed hypothyroidism. Both groups achieved a significant decrease in postoperative BMI. A positively statistically significant association was found between BMI and TSH (p < 0.005). CONCLUSIONS Our results favor the effect of laparoscopic sleeve gastrectomy in the obese population with overt and SH as shown by the majority of SH resolution and overt hypothyroidism improvement.
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Affiliation(s)
- Dina S Almunif
- Family and Community Medicine Department, King Saud University, Riyadh, Saudi Arabia.
| | - Fahad Bamehriz
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Saad Althuwaini
- Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Turky H Almigbal
- Family and Community Medicine Department, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed A Batais
- Family and Community Medicine Department, King Saud University, Riyadh, Saudi Arabia
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Fu J, Zhang L, An Y, Duan Y, Liu J, Wang G. Association Between Body Mass Index and Thyroid Function in Euthyroid Chinese Adults. Med Sci Monit 2021; 27:e930865. [PMID: 33739959 PMCID: PMC7986724 DOI: 10.12659/msm.930865] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity can influence thyroid function through multiple routes, even in people who are euthyroid. The correlation between weight and thyroid function is a matter of debate. The present study investigated the relationship between body weight and thyroid function in euthyroid Chinese adults. MATERIAL AND METHODS A total of 1564 participants with serum thyrotropin (TSH) and thyroid hormone levels within the reference range were included. All of them were tested for thyroid function parameters and categorized, based on body mass index (BMI), into 3 groups: normal weight, overweight, and obese. The effects of BMI on thyroid function were examined using linear (continuous values) and logistic (dichotomous levels according to medians or means) regression and controlling for age and sex. RESULTS There were significant differences in free triiodothyronine (FT3) levels and FT3/free thyroxine (FT4) ratios among participants who were normal weight, overweight, and obese (both P<0.001). Multivariable regression analysis (P<0.001) showed that BMI was positively associated with FT3 levels and FT3/FT4 ratios. Compared with the normal weight group, the patients who were overweight or obese had significantly higher FT3 levels and FT3/FT4 ratios that were higher than average, according to logistic regression analyses. CONCLUSIONS We found that Chinese adults who are obese may have higher FT3 levels and FT3/FT4 ratios than those who are of normal weight, even if their thyroid function values are within the normal range.
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Affiliation(s)
- Jing Fu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Lin Zhang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yu An
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yan Duan
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jia Liu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Guang Wang
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland).,Department of Endocrinology, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, China (mainland)
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Nijsten K, Koot MH, van der Post JAM, Bais JMJ, Ris-Stalpers C, Naaktgeboren C, Bremer HA, van der Ham DP, Heidema WM, Huisjes A, Kleiverda G, Kuppens SM, van Laar JOEH, Langenveld J, van der Made F, Papatsonis D, Pelinck MJ, Pernet PJ, van Rheenen-Flach L, Rijnders RJ, Scheepers HCJ, Siegelaar SE, Vogelvang T, Mol BW, Roseboom TJ, Grooten IJ, Painter RC. Thyroid-stimulating hormone and free thyroxine fail to predict the severity and clinical course of hyperemesis gravidarum: A prospective cohort study. Acta Obstet Gynecol Scand 2021; 100:1419-1429. [PMID: 33606270 PMCID: PMC8360038 DOI: 10.1111/aogs.14131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Introduction Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be causally involved. In this study, we aimed to assess the utility of thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) as a marker and predictor for the severity and clinical course of HG. Material and methods We conducted a prospective cohort study including women admitted for HG between 5 and 20 weeks of gestation in 19 hospitals in the Netherlands. Women with a medical history of thyroid disease were excluded. TSH and FT4 were measured at study entry. To adjust for gestational age, we calculated TSH multiples of the median (MoM). We assessed HG severity at study entry as severity of nausea and vomiting (by the Pregnancy Unique Quantification of Emesis and nausea score), weight change compared with prepregnancy weight, and quality of life. We assessed the clinical course of HG as severity of nausea and vomiting and quality of life 1 week after inclusion, duration of hospital admissions, and readmissions. We performed multivariable regression analysis with absolute TSH, TSH MoMs, and FT4. Results Between 2013 and 2016, 215 women participated in the cohort. TSH, TSH MoM, and FT4 were available for, respectively, 150, 126, and 106 of these women. Multivariable linear regression analysis showed that lower TSH MoM was significantly associated with increased weight loss or lower weight gain at study entry (ΔKg; β = 2.00, 95% CI 0.47‐3.53), whereas absolute TSH and FT4 were not. Lower TSH, not lower TSH MoM or FT4, was significantly associated with lower nausea and vomiting scores 1 week after inclusion (β = 1.74, 95% CI 0.36‐3.11). TSH and FT4 showed no association with any of the other markers of the severity or clinical course of HG. Twenty‐one out of 215 (9.8%) women had gestational transient thyrotoxicosis. Women with gestational transient thyrotoxicosis had a lower quality of life 1 week after inclusion than women with no gestational transient thyrotoxicosis (p = 0.03). Conclusions Our findings show an inconsistent role for TSH, TSH MoM, or FT4 at time of admission and provide little guidance on the severity and clinical course of HG.
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Affiliation(s)
- Kelly Nijsten
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjette H Koot
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris A M van der Post
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joke M J Bais
- Department of Obstetrics and Gynecology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Carrie Ris-Stalpers
- Laboratory of Reproductive Biology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Christiana Naaktgeboren
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk A Bremer
- Department of Obstetrics and Gynecology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - David P van der Ham
- Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | - Wieteke M Heidema
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anjoke Huisjes
- Department of Obstetrics and Gynecology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Gunilla Kleiverda
- Department of Obstetrics and Gynecology, Flevo Hospital, Almere, The Netherlands
| | - Simone M Kuppens
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Judith O E H van Laar
- Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Zuyderland Hospital, Heerlen, The Netherlands
| | - Flip van der Made
- Department of Obstetrics and Gynecology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Dimitri Papatsonis
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, The Netherlands
| | - Marie-José Pelinck
- Department of Obstetrics and Gynecology, Scheper Hospital, Emmen, The Netherlands
| | - Paula J Pernet
- Department of Obstetrics and Gynecology, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Robbert J Rijnders
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sarah E Siegelaar
- Department of Internal Medicine, Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tatjana Vogelvang
- Department of Obstetrics and Gynecology, Diakonessenhuis, Utrecht, The Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Tessa J Roseboom
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Iris J Grooten
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynecology, Amsterdam Reproduction & Development research institute, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Azran C, Hanhan-Shamshoum N, Irshied T, Ben-Shushan T, Dicker D, Dahan A, Matok I. Hypothyroidism and levothyroxine therapy following bariatric surgery: a systematic review, meta-analysis, network meta-analysis, and meta-regression. Surg Obes Relat Dis 2021; 17:1206-1217. [PMID: 33839048 DOI: 10.1016/j.soard.2021.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/01/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many health benefits of bariatric surgery are known and well-studied, but there is scarce data on the benefits of bariatric surgery on the thyroid function. OBJECTIVE We aimed to make a meta-analysis regarding the impact of bariatric surgery on thyroid-stimulating hormone (TSH) levels, levothyroxine dose, and the status of subclinical hypothyroidism. SETTING Systematic review and meta-analysis. METHODS PubMed, EMBASE, and Cochrane Library were searched up to December 2020 for relevant clinical studies. Random-effects model was used to pool results. Network meta-analysis was performed, incorporating direct and indirect comparisons among different types of bariatric surgery. Meta-regression analysis was performed to evaluate the impact of moderator variables on TSH levels and required levothyroxine dose after surgery. We followed the PRISMA guidelines for data selection and extraction. PROSPERO registry number: CRD42018105739. RESULTS A total of 28 studies involving 1284 patients were included. There was a statistically significant decrease in TSH levels after bariatric surgery (mean difference = -1.66 mU/L, 95%CI [-2.29, -1.03], P < .0001). In meta-regression analysis, we found that the following moderator variables: length of follow-up, mean age, baseline TSH, and preoperative thyroid function, could explain 1%, 43%, 68%, and 88% of the between-study variance, respectively. Furthermore, subclinical hypothyroidism was completely resolved in 87% of patients following bariatric surgery. In addition, there was a statistically significant decrease of levothyroxine dose in frank hypothyroid patients following bariatric surgery (mean difference = -13.20 mcg/d, 95%CI [-19.69, -6.71]). In network meta-analysis, we found that discontinuing or decreasing levothyroxine dose was significant following Roux-en-Y gastric bypass, 1 anastomosis gastric bypass, and sleeve gastrectomy, (OR = 31.02, 95%CI [10.34, 93.08]), (OR = 41.73, 95%CI [2.04, 854.69]), (OR = 104.03, 95%CI [35.79, 302.38]), respectively. CONCLUSIONS Based on our meta-analysis, bariatric surgery is associated with the resolution of subclinical hypothyroidism, a decrease in TSH levels, and a decrease in levothyroxine dose.
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Affiliation(s)
| | - Nirvana Hanhan-Shamshoum
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tujan Irshied
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tomer Ben-Shushan
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dror Dicker
- Rabin Medical Center, Hasharon Hospital, Petah Tikva, Israel
| | - Arik Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Matok
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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12
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Leng O, Razvi S. Treatment of subclinical hypothyroidism: assessing when treatment is likely to be beneficial. Expert Rev Endocrinol Metab 2021; 16:73-86. [PMID: 32216473 DOI: 10.1080/17446651.2020.1738924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
Introduction: Subclinical hypothyroidism (SCH) is a common condition diagnosed in up to 16% of the population. SCH is diagnosed when serum TSH is high and circulating thyroid hormones are within the reference range. SCH is considered to be a mild form of thyroid failure by some due to the log-linear relationship between TSH and thyroid hormones. Nevertheless, it is unclear whether the treatment of SCH with thyroid hormones is beneficial, and hence, it is not surprising that expert opinions and recommendations from societies differ in their opinions on how best to manage SCH.Areas covered: This article reviews the currently available evidence pertaining to SCH and provides recommendations as to when treatment of SCH should be considered. An electronic search of PubMed from 1970 to 2019 was performed and systematically reviewed studies assessing the effects of treatment in SCH. The main areas that are considered are the effects of treatment on symptoms and quality of life, and important clinical consequences including psychocognitive outcomes and cardiovascular events.Expert opinion: Treatment of SCH with thyroid hormones is debated and the current literature in this area lacks clarity. We provide an evidence-based recommendation for when treatment of SCH with thyroid hormones should be considered.
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Affiliation(s)
- Owain Leng
- Department of Endocrinology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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13
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Al Mohareb O, Al Saqaaby M, Ekhzaimy A, Hamza M, AlMalki MH, Bamehriz F, Abukhater M, Brema I. The Relationship Between Thyroid Function and Body Composition, Leptin, Adiponectin, and Insulin Sensitivity in Morbidly Obese Euthyroid Subjects Compared to Non-obese Subjects. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2021; 14:1179551420988523. [PMID: 33613038 PMCID: PMC7868467 DOI: 10.1177/1179551420988523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022]
Abstract
Background/Objectives Thyroid function tests (TFTs) changes in obese people have been studied with increasing interest, however, studies have been inconsistent hence it remains poorly understood. We compared the TFTs of morbidly obese euthyroid Saudi subjects with non-obese controls and then we examined the influence of leptin, adiponectin, and insulin resistance on TFTs. Subjects/Methods Fifty-five euthyroid obese subjects attending bariatric surgery clinic and 52 non-obese age-and gender-matched controls were recruited. We measured body weight, BMI, body composition, thyroid-stimulating hormone (TSH), Free T4 (FT4), Free T3(FT3), thyroid antibodies, fasting leptin, adiponectin, and lipid profile. Insulin resistance was quantified by HOMA-IR. Data are presented as mean ± SEM. Results Mean BMI was 45.6 ± 1.5 and 23.2 ± 0.5 kg/m2, for the obese and non-obese controls, respectively, P value < 0.001. Mean TSH was 2.7 ± 0.18 mIU/L in obese subjects and 1.7 ± 0.13 mIU/L (0.27-4.2) in the non-obese controls, respectively, P value .014. Mean FT3 was 3.9 ± 0.1 pmol/L (3.1-6.8) in obese subjects compared to 5.0 ± 0.1 pmol/L in non-obese controls, respectively, P value 0.001, however, FT4 was similar in the 2 groups. In the whole group (N = 107), BMI correlated positively with TSH and negatively with FT3. Leptin correlated negatively with both FT4 and FT3 in the non-obese group only while none of the TFTs correlated with HOMA-IR or adiponectin in either group. Binary logistic regression showed that each 1 unit increase in TSH increased the odds of becoming obese by 12.7, P value 0.009, 95 C.I. (1.9-85.0). Conversely, each - unit increase in FT3 decreased the odds of becoming obese by 0.2, P value 0.023, 95% C.I. (0.05-0.80). Conclusions We report a small increase in TSH and a small decrease in FT3 within the normal range in obese subjects compared to non-obese controls. We also report a positive correlation between TSH and BMI with increased odds ratio of becoming obese with the increase in TSH and decrease in FT3. These changes may be either causally related or adaptive to the obesity state. FT4 and FT3 seem to correlate with leptin (but not with adiponectin or HOMA-IR) in the non-obese controls only. Larger mechanistic studies are needed to further elucidate the interesting association between obesity and TFTs.
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Affiliation(s)
- Ohoud Al Mohareb
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Moath Al Saqaaby
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Aishah Ekhzaimy
- Department of Endocrinology, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Muaawia Hamza
- Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mussa H AlMalki
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia.,Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad Bamehriz
- Department of General Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | | | - Imad Brema
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
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14
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Richou M, Gilly O, Taillard V, Paul De Brauwere D, Donici I, Guedj AM. Levothyroxine dose adjustment in hypothyroid patients following gastric sleeve surgery. ANNALES D'ENDOCRINOLOGIE 2020; 81:500-506. [PMID: 32445637 DOI: 10.1016/j.ando.2020.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 02/04/2023]
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15
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Dai H, Zhang L, Han X, Zhao H, Guo J, Li Z, Yang A. Body mass index (BMI) is associated with serum thyroid-stimulating hormone (TSH) level in infertile women: a cross-sectional study. Endocr J 2020; 67:923-928. [PMID: 32418923 DOI: 10.1507/endocrj.ej19-0441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Studies suggest that there is a relationship between body mass index (BMI) and thyroid-stimulating hormone (TSH) levels. But conflicting evidence exists regarding the relationship between the two variables. Moreover, thyroid function is closely related to female fertility and has certain effects on infertility. Therefore, the present study will explore the relationship between BMI and TSH levels in patients with infertility in our center. We retrospectively analyzed relevant indicators of 2,789 in Tubal Factor Infertility patients undergoing assisted reproduction technology from January 2016 to December 2018 in our center in order to analyze the relationship between BMI and serum TSH level. The medical histories of patients were reviewed. The relationship between BMI and TSH was assessed using smooth curve fitting and multivariate regression model. The smoothing curve fitting between BMI and TSH exhibited a non-linear relationship, and the resulting curve exhibited a two-stage change and a breakpoint. By multivariate piecewise linear regression, we found that the TSH level was increased with the increase of BMI when the BMI was greater than 25.3 kg/m2 (β 0.06, 95% CI 0.02, 0.01; p = 0.0028). In contrast, the TSH level was decreased with the increase of BMI when the BMI was less than 25.3 kg/m2 (β -0.02, 95% CI -0.05, 0.00; p = 0.0573). Collectively, our study described a non-linear relationship between BMI and TSH level in infertile patients after adjustment of potential confounders. However, such causal relationship between BMI and TSH in infertile women still needs to be further clarified in future investigations.
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Affiliation(s)
- Huiying Dai
- School of Clinical Medicine of Jining Medical University, Jining, Shandong 272069, China
| | - Lin Zhang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China
| | - Xiao Han
- School of Clinical Medicine of Jining Medical University, Jining, Shandong 272069, China
| | - Hongyan Zhao
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China
| | - Jiali Guo
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China
| | - Zewu Li
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China
| | - Aijun Yang
- Center for Reproductive Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, China
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16
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Effect of Bariatric Surgery on Serum Inflammatory Factors of Obese Patients: a Systematic Review and Meta-Analysis. Obes Surg 2020; 29:2631-2647. [PMID: 31093862 DOI: 10.1007/s11695-019-03926-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obesity is one of the main causes of inflammation. Previous studies have reported inconclusive results regarding the effect of bariatric surgery on inflammatory markers. This systematic review and meta-analysis is aimed at describing the effect of bariatric surgery on C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α). PubMed/Medline and Scopus were systematically searched for all eligible studies from inception to June 2018. Results are expressed as weighted mean difference (MD) with 95% confidence intervals (CI) using a random effects model. Overall, 116 studies which evaluated serum CRP, IL-6, and TNF-α after bariatric surgery were included. Pooled effect size showed significant reduction in serum CRP (- 5.30 mg/l, 95% CI - 5.46, - 5.15, P < 0.001), IL-6 (- 0.58 pg/ml, 95% CI - 0.64, - 0.53, P < 0.001), and TNF-α (- 0.20 pg/ml, 95% CI - 0.39, - 0.02, P = 0.031) with significant heterogeneity across studies (> 95% for all factors). Bariatric surgery significantly lowered inflammatory factors; however, baseline BMI, follow-up duration and type of surgery could impact the extent of observed effects.
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17
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Outcome of bariatric surgery on hypothyroidism: experience from a tertiary care center in India. Surg Obes Relat Dis 2020; 16:1297-1301. [PMID: 32409116 DOI: 10.1016/j.soard.2020.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypothyroidism is frequently found to be associated with morbid obesity. Effect of bariatric surgery on type 2 diabetes, hypertension, and sleep apnea has been studied extensively but there is a dearth of literature on its impact on thyroid function. We had published our experience of laparoscopic sleeve gastrectomy and its effect on hypothyroidism in morbidly obese patients previously. In this study, we have tried to evaluate the impact of bariatric surgery on the whole cohort of hypothyroid patients and compare the effect of various bariatric procedures on thyroid hormone replacement dose. OBJECTIVE To assess outcome of bariatric surgery on the hypothyroid patients and to compare the outcomes of laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, and one-anastomosis gastric bypass in terms of reduction of thyroid hormone replacement dosage. SETTING Tertiary care University Hospital, India; Government Practice. METHODS This is a retrospective analysis of a database of all bariatric procedures done in a single unit at a tertiary care teaching hospital in India. Morbidly obese patients with hypothyroidism on thyroxine replacement were identified and their preoperative and postoperative thyroid hormone replacement dosage (THR) and thyroid stimulating hormone levels were compared. RESULTS Of 883 patients undergoing bariatric surgery, 180 patients were hypothyroid (on thyroxine replacement). Ninety-three patients were included in the final analysis. The mean age of the study population was 42.2 ± 10.4 years and the mean preoperative body mass index was 47.8 ± 8.3 kg/m2. Mean follow-up duration was 29.8 ± 19.6 months. The excess weight loss was 58.9%. Fifty-two (55.8%) patients had a decrease in the in THR dosage, 37 (39.8%) had no change in THR dosage, and 4 patients required an increase in THR dosage. Decrease of THR dose was observed in 61.7% patients in laparoscopic sleeve gastrectomy in comparison to 45.4% in bypass group. CONCLUSION Bariatric surgery might cause reduction of thyroid replacement dosage in hypothyroid, morbidly obese patients.
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18
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Huang YS, Zheng Q, Yang H, Fu X, Zhang X, Xia C, Zhu Z, Liu YN, Liu WJ. Efficacy of Intermittent or Continuous Very Low-Energy Diets in Overweight and Obese Individuals with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analyses. J Diabetes Res 2020; 2020:4851671. [PMID: 32090119 PMCID: PMC7008267 DOI: 10.1155/2020/4851671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/07/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE This study is aimed at investigating the efficacy of a very low-energy diet (VLED) in overweight and obese individuals with type 2 diabetes mellitus (T2DM). METHODS We thoroughly searched eight electronic resource databases of controlled studies concerning the efficacy and acceptability of intermittent or continuous VLEDs in patients with T2DM compared with other energy restriction interventions. RESULTS Eighteen studies (11 randomized and seven nonrandomized controlled trials) with 911 participants were included. The meta-analyses showed that compared with a low-energy diet (LED) and mild energy restriction (MER), VLED is superior in the reduction of body weight (mean difference (MD) MDLED = -2.77, 95% confidence interval (CI) CILED = -4.81 to - 0.72, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, I 2 = 0%) and TG level (MD = -0.25, 95%CI = -0.55 to 0.06, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, I 2 = 0%) and TG level (MD = -0.25, 95%CI = -0.55 to 0.06, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39, P LED = 0.008; MDMER = -6.72, 95%CIMER = -10.05 to - 3.39. CONCLUSION Dietary intervention through VLEDs is an effective therapy for rapid weight loss, glycemic control, and improved lipid metabolism in overweight and obese individuals with T2DM. Thus, VLEDs should be encouraged in overweight and obese individuals with T2DM who urgently need weight loss and are unsuitable or unwilling to undergo surgery. As all outcome indicators have low or extremely low quality after GRADE evaluation, further clinical trials that focus on the remission effect of VLEDs on T2DM are needed.
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Affiliation(s)
- Yi Shan Huang
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Qiyan Zheng
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Huisheng Yang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Xinwen Fu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xueqin Zhang
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Chenhui Xia
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Zebing Zhu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yu Ning Liu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Department of Endocrinology Nephropathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Wei Jing Liu
- Renal Research Institution of Beijing University of Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100700, China
- Institute of Nephrology, Zhanjiang Key Laboratory of Prevention and Management of Chronic Kidney Disease, Guangdong Medical University, Zhanjiang, Guangdong 524001, China
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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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Granzotto PCD, Mesa Junior CO, Strobel R, Radominski R, Graf H, de Carvalho GA. Thyroid function before and after Roux-en-Y gastric bypass: an observational study. Surg Obes Relat Dis 2019; 16:261-269. [PMID: 31924503 DOI: 10.1016/j.soard.2019.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Population studies have shown a positive association between thyroid-stimulating hormone (TSH) and body mass index. Recent studies have shown a significant increase in the prevalence of subclinical hypothyroidism (SCH) in obesity. Weight reduction after Roux-en-Y gastric bypass (RYGB) seems to significantly decrease TSH levels. OBJECTIVES The purpose of this study was to evaluate the prevalence of SCH in obese patients (class II and III) and to observe the behavior of thyroid hormones (TSH, hormone triiodothyronine, thyroxine, free thyroxine) with significant weight loss after RYGB. SETTING Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil. METHODS We retrospectively reviewed the medical records of 215 obese patients who underwent RYGB between 2005 and 2012 with a follow-up of at least 2 years. The study was observational and descriptive. The selected times for clinical and laboratory evaluations were preoperative, 3, 6, 12, and 24 months after the procedure. Association, correlation, and variance analyses were performed. RESULTS The prevalence of SCH preoperatively was 9.3%. SCH was corrected in 89.5% of patients 12 months after RYGB. We did not find an association between TSH and BMI (r = .002, P = .971). There was a positive impact of bariatric surgery on all metabolic variables. We showed that serum TSH level had no positive correlation with the presence or absence of metabolic syndrome. CONCLUSIONS Weight loss after bariatric surgery leads to normalization of TSH levels in most patients and none developed overt hypothyroidism. Obese patients with SCH should not be treated with thyroid hormone replacement. Serial monitoring of thyroid function after obesity therapy seems to be a reasonable approach.
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Affiliation(s)
| | - Cleo Otaviano Mesa Junior
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Rodrigo Strobel
- Bariatric and Metabolic Surgery Center, Hospital Nossa Senhora das Graças, Curitiba, Paraná, Brazil
| | - Rosana Radominski
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Hans Graf
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
| | - Gisah Amaral de Carvalho
- Endocrinology and Metabolism Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil
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21
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Jonklaas J, Razvi S. Reference intervals in the diagnosis of thyroid dysfunction: treating patients not numbers. Lancet Diabetes Endocrinol 2019; 7:473-483. [PMID: 30797750 DOI: 10.1016/s2213-8587(18)30371-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022]
Abstract
Although assigning a diagnosis of thyroid dysfunction appears quite simple, this is often not the case. Issues that make it unclear whether thyroid function is normal include transient changes in thyroid parameters, inter-individual and intra-individual differences in thyroid parameters, age-related differences, and ethnic variations. In addition, a statistically calculated distribution of thyroid analytes does not necessarily coincide with intervals or cutoffs that have predictive value for beneficial or adverse health outcomes. Based on current clincial trial data, it is unclear which individuals with mild thyroid-stimulating hormone elevations will benefit from levothyroxine treatment. For example, only a small number of patients with thyroid-stimulating hormone values of more than 10 mIU/L have been studied in a randomised manner. Even if therapy is initiated for abnormal thyroid function, not all treated individuals are maintained at the desired treatment target, and therefore might still be at risk. The consequence of this is that each patient's thyroid function needs to be assessed on an individual basis with the entire clinical picture in mind. Monitoring also needs to be vigilant, and the targets for treatment reassessed continually.
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Affiliation(s)
| | - Salman Razvi
- Department of Endocrinology, University of Newcastle, Newcastle, UK
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22
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Kouidrat Y, Diouf M, Desailloud R, Louhou R. Effects of a diet plus exercise program on thyroid function in patients with obesity. Metabol Open 2019; 2:100008. [PMID: 32812913 PMCID: PMC7424834 DOI: 10.1016/j.metop.2019.100008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 01/05/2023] Open
Abstract
Background Studies of thyroid function after diet-induced weight loss in patients with obesity have yielded conflicting results. It is not known whether adding exercise to diet affects thyroid function in this patient population. The aim of the study was to prospectively evaluate the effects of a rehabilitation program on weight, body composition and thyroid function in euthyroid patients with obesity. Methods Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in euthyroid patients with severe obesity were analyzed before and at the end of a 3-month rehabilitation program. Relationships between body weight or composition and changes in thyroid function were also investigated. Each study participant acted as his/her own control. Results The study population consisted of 34 euthyroid patients with obesity (18 men and 16 women; mean ± SD age: 51 ± 12). The mean BMI was 49.3 ± 12.4 kg/m2 before the program and 46 ± 10.8 (p < 0.005) at the end, with a mean body weight loss of 11 kg (p < 0.05) and a mean fat mass loss of 6.8 kg (p < 0.05). The weight and fat mass losses were not significantly correlated with the serum concentrations of TSH, FT3 and FT4 measured at the end of the program. Conclusion A 3-month rehabilitation program combining diet and exercise produced weight and fat mass losses without inducing thyroid dysfunction in patients with obesity. Obesity is closely linked to thyroid dysfunction. Weight change interventions on thyroid function yielded mixed results. A normal calorie diet plus exercise improve body composition and insulin resistance. Maintenance of protein and nutritional status has beneficial effects on thyroid function.
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Affiliation(s)
- Youssef Kouidrat
- Department of Rehabilitation, Nutrition and Obesity, Berck Maritime Hospital, AP-HP, Berck, France
- Department of Endocrinology-Nutrition, Amiens University Medical Center, Amiens, France
- Corresponding author. Department of Rehabilitation, Nutrition and Obesity, Maritime Hospital, AP-HP, F-62600, Berck, France.
| | - Momar Diouf
- Department of Biostatistics and Clinical Research, Amiens University Medical Center, Amiens, France
| | - Rachel Desailloud
- Department of Endocrinology-Nutrition, Amiens University Medical Center, Amiens, France
| | - Rufin Louhou
- Department of Rehabilitation, Nutrition and Obesity, Berck Maritime Hospital, AP-HP, Berck, France
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23
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Wang B, Song R, He W, Yao Q, Li Q, Jia X, Zhang JA. Sex Differences in the Associations of Obesity With Hypothyroidism and Thyroid Autoimmunity Among Chinese Adults. Front Physiol 2018; 9:1397. [PMID: 30337885 PMCID: PMC6180185 DOI: 10.3389/fphys.2018.01397] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
There is an intensive link between obesity and thyroid dysfunction, but this relationship in Asians is still unclear. This study was conducted to define the impact of obesity on risk of hypothyroidism and thyroid autoimmunity among Chinese adults. A population-based, cross-sectional study was carried out, which enrolled a total of 2,808 Chinese adults. To assess the associations of obesity with hypothyroidism and thyroid autoimmunity, odds ratio (ORs) with 95% confidence intervals (95%CIs) were calculated through logistic regression model, and the correlations of body mass index (BMI) with TPOAb and TGAb were also analyzed. Obese females had higher risk of hypothyroidism (22.7 vs. 15.0%; OR = 1.66, 95%CI 1.10–2.53; P = 0.02) and higher risk of subclinical hypothyroidism (22.1 vs. 13.4%; OR = 1.83, 95%CI 1.20–2.80; P = 0.005) than non-obese females. Multivariate logistic regression analysis found significant associations of obesity with hypothyroidism (Adjusted OR = 1.54, 95%CI 1.00–2.38; P = 0.05) and subclinical hypothyroidism (Adjusted OR = 1.69, 95%CI 1.09–2.63; P = 0.02) in females after adjustment for confounding factors. No association between obesity and hypothyroidism was observed in male participants. Spearman's correlation analysis suggested BMI was significantly and positively correlated with TPOAb (Spearman's r = 0.062, P = 0.022) in men but not in women. Linear regression analysis suggested an obviously positive correlation of BMI with TPOAb in men (β = 0.018, P = 0.015) and an obviously negative correlation of BMI with TGAb in women (β = −0.025, P = 0.012), respectively. The study suggests sex differences in the associations of obesity with hypothyroidism and thyroid autoimmunity among Chinese adults. Further studies are needed to better understand the exact mechanism of sex difference in the obesity-thyroid relationship.
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Affiliation(s)
- Bin Wang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Ronghua Song
- Department of Endocrinology & Rheumatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Weiwei He
- Department of Endocrinology, Affiliated Hospital of Yanan Medical University, Shaanxi, China
| | - Qiuming Yao
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Qian Li
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Xi Jia
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jin-An Zhang
- Department of Endocrinology, Jinshan Hospital of Fudan University, Shanghai, China
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Guan B, Chen Y, Yang J, Yang W, Wang C. Effect of Bariatric Surgery on Thyroid Function in Obese Patients: a Systematic Review and Meta-Analysis. Obes Surg 2018; 27:3292-3305. [PMID: 29039052 DOI: 10.1007/s11695-017-2965-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We aimed to make a meta-analysis regarding the effect of bariatric surgery on thyroid function in obese patients. PubMed, EMBASE, CENTRAL, and four Chinese databases were searched for clinical studies. Data were pooled using Review Manager 5.3, and subgroup and sensitivity analyses were performed if necessary and feasible. As a result, 24 articles were included into meta-analysis. Bariatric surgery was associated with significant decrease in TSH, FT3, and T3 levels. However, FT4, T4, and rT3 levels were not significantly changed postoperatively. In addition, bariatric surgery had a favorable effect on overt and subclinical hypothyroid, with reduction of thyroid hormone requirements postoperatively. In conclusion, TSH, FT3, and T3 decrease are expected following bariatric surgery, as well as non-significant change of T4, FT4, and rT3 levels.
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Affiliation(s)
- Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - YanYa Chen
- Department of Nursing Science, School of Medicine, Jinan University, Guangzhou, 510630, China
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Wah Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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25
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Atkin SL, Ramachandran V, Yousri NA, Benurwar M, Simper SC, McKinlay R, Adams TD, Najafi-Shoushtari SH, Hunt SC. Changes in Blood microRNA Expression and Early Metabolic Responsiveness 21 Days Following Bariatric Surgery. Front Endocrinol (Lausanne) 2018; 9:773. [PMID: 30687230 PMCID: PMC6338028 DOI: 10.3389/fendo.2018.00773] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Early metabolic responses following bariatric surgery appear greater than expected given the initial weight loss and coincide with improvement in diabetes. We hypothesized that small non-coding microRNA changes might contribute to regulating mechanisms for metabolic changes and weight loss in patients with severe obesity and diabetes. Methods: Twenty-nine type 2 patients with severe obesity (mean BMI 46.2 kg/m2) and diabetes underwent Roux-en-Y gastric bypass (RYGB) surgery. Clinical measurements and fasting blood samples were taken preoperatively and at day 21 postoperatively. Normalization of fasting glucose and HbA1c following bariatric surgery (short-term diabetes remission) was defined as withdrawal of anti-diabetic medication and fasting glucose < 100 mg/dL (5.6 mmol/L) or HbA1c < 6.0%. MicroRNA expression was determined by quantitative polymerase chain reaction and tested for significant changes after surgery. Results: BMI decreased by 3.8 kg/m2 21 days postoperatively. Eighteen of 29 RYGB (62%) had short-term diabetes remission. Changes from pre- to post-surgery in 32 of 175 microRNAs were nominally significant (p < 0.05). Following multiple comparison adjustment, changes in seven microRNAs remained significant: miR-7-5p, let-7f-5p, miR-15b-5p, let-7i-5p, miR-320c, miR-205-5p, and miR-335-5p. Four pathways were over-represented by these seven microRNAs, including diabetes and insulin resistance pathways. Conclusion: Seven microRNAs showed significant changes 21 days after bariatric surgery. Functional pathways of the altered microRNAs were associated with diabetes-, pituitary-, and liver-related disease, with expression in natural killer cells, and pivotal intestinal pathology suggesting possible mechanistic roles in early diabetes responses following bariatric surgery.
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Affiliation(s)
- Stephen L. Atkin
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
- *Correspondence: Stephen L. Atkin
| | - Vimal Ramachandran
- Department of Cell and Developmental Biology, Weill Cornell Medicine, Doha, Qatar
- MicroRNA Core Laboratory, Weill Cornell Medicine, Doha, Qatar
| | - Noha A. Yousri
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Manasi Benurwar
- Department of Cell and Developmental Biology, Weill Cornell Medicine, Doha, Qatar
- MicroRNA Core Laboratory, Weill Cornell Medicine, Doha, Qatar
| | - Steven C. Simper
- Rocky Mountain Associated Physicians, Inc., Salt Lake City, UT, United States
| | - Rodrick McKinlay
- Rocky Mountain Associated Physicians, Inc., Salt Lake City, UT, United States
| | - Ted D. Adams
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
- Intermountain LiveWell Center, Intermountain Healthcare, Salt Lake City, UT, United States
| | - S. Hani Najafi-Shoushtari
- Department of Cell and Developmental Biology, Weill Cornell Medicine, Doha, Qatar
- MicroRNA Core Laboratory, Weill Cornell Medicine, Doha, Qatar
| | - Steven C. Hunt
- Department of Genetic Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
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Farias G, Netto BDM, Bettini SC, Dâmaso AR, de Freitas ACT. Neuroendocrine regulation of energy balance: Implications on the development and surgical treatment of obesity. Nutr Health 2017; 23:131-146. [PMID: 28838280 DOI: 10.1177/0260106017719369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Obesity, a serious public health problem, occurs mainly when food consumption exceeds energy expenditure. Therefore, energy balance depends on the regulation of the hunger-satiety mechanism, which involves interconnection of the central nervous system and peripheral signals from the adipose tissue, pancreas and gastrointestinal tract, generating responses in short-term food intake and long-term energy balance. Increased body fat alters the gut- and adipose-tissue-derived hormone signaling, which promotes modifications in appetite-regulating hormones, decreasing satiety and increasing hunger senses. With the failure of conventional weight loss interventions (dietary treatment, exercise, drugs and lifestyle modifications), bariatric surgeries are well-accepted tools for the treatment of severe obesity, with long-term and sustained weight loss. Bariatric surgeries may cause weight loss due to restriction/malabsorption of nutrients from the anatomical alteration of the gastrointestinal tract that decreases energy intake, but also by other physiological factors associated with better results of the surgical procedure. OBJECTIVE This review discusses the neuroendocrine regulation of energy balance, with description of the predominant hormones and peptides involved in the control of energy balance in obesity and all currently available bariatric surgeries. CONCLUSIONS According to the findings of our review, bariatric surgeries promote effective and sustained weight loss not only by reducing calorie intake, but also by precipitating changes in appetite control, satiation and satiety, and physiological changes in gut-, neuro- and adipose-tissue-derived hormone signaling.
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Affiliation(s)
- Gisele Farias
- 1 Department of Surgery, Universidade Federal do Paraná, UFPR, Curitiba-Pr, Brazil
| | | | - Solange Cravo Bettini
- 3 Federal University of Paraná (UFPR), Gastrointestinal Surgery Service of Hospital de Clínicas, Curitiba-PR, Brazil
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Rehackova L, Arnott B, Araujo-Soares V, Adamson AA, Taylor R, Sniehotta FF. Efficacy and acceptability of very low energy diets in overweight and obese people with Type 2 diabetes mellitus: a systematic review with meta-analyses. Diabet Med 2016; 33:580-91. [PMID: 26490082 DOI: 10.1111/dme.13005] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/28/2015] [Accepted: 10/16/2015] [Indexed: 02/06/2023]
Abstract
AIMS To explore the efficacy and acceptability of very low energy diets in overweight or obese adults with Type 2 diabetes. METHODS Controlled trials and qualitative studies of individuals with Type 2 diabetes that compared very low energy diets with standard care, minimal interventions, other weight loss interventions, less intensive very low energy diet interventions and very low energy diets with additional components were eligible for inclusion. Meta-analyses of changes in weight, blood glucose levels and attrition rates were performed. Acceptability of very low energy diets was assessed by attrition rates, number and severity of side effects, and by qualitative evaluations of the interventions. RESULTS Four randomized, five non-randomized controlled trials and no qualitative studies (21 references, 9 studies, 346 participants) were identified. Meta-analyses showed that very low energy diets induced greater weight losses than minimal interventions, standard care or low energy diets at 3 and 6 months. No conclusive evidence for differences in outcomes between very low energy diets and Roux-en-Y gastric bypass surgery was found. Greater differences in energy prescription between intervention and comparator arms were associated with greater differences in weight loss and fasting blood glucose levels at 3 months. Attrition rates did not differ between the very low energy diets and the comparator arms at any measurement point. CONCLUSIONS Very low energy diets are effective in substantial weight loss among people with Type 2 diabetes. Levels of adherence to very low energy diets in controlled studies appear to be high, although details about behaviour support provided are usually poorly described.
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Affiliation(s)
- L Rehackova
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - B Arnott
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - A A Adamson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - R Taylor
- Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - F F Sniehotta
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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28
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Kyriacou A, McLaughlin J, Syed AA. Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review. Eur J Intern Med 2015; 26:563-71. [PMID: 26260744 DOI: 10.1016/j.ejim.2015.07.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 12/19/2022]
Abstract
Thyroid disorders commonly impact on the gastrointestinal system and may even present with gastrointestinal symptoms in isolation; for example, metastatic medullary thyroid carcinoma typically presents with diarrhoea. Delays in identifying and treating the underlying thyroid dysfunction may lead to unnecessary investigations and treatment, with ongoing morbidity, and can potentially be life-threatening. Similarly, gastrointestinal diseases can impact on thyroid function tests, and an awareness of the concept and management of non-thyroidal illness is necessary to avoid giving unnecessary thyroid therapies that could potentially exacerbate the underlying gastrointestinal disease. Dual thyroid and gastrointestinal pathologies are also common, with presentations occurring concurrently or sequentially, the latter after a variable time lag that can even extend over decades. Such an association aetiologically relates to the autoimmune background of many thyroid disorders (e.g. Graves' disease and Hashimoto's thyroiditis) and gastrointestinal disorders (e.g. coeliac disease and inflammatory bowel disease); such autoimmune conditions can sometimes occur in the context of autoimmune polyglandular syndrome. Emphasis should also be given to the gastrointestinal side effects of some of the medications used for thyroid disease (e.g. anti-thyroid drugs causing hepatotoxicity) and vice versa (e.g. interferon therapy causing autoimmune thyroid dysfunction). In this review, we discuss disorders of the thyroid-gut axis and identify the evidence base behind the management of such disorders.
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Affiliation(s)
- Angelos Kyriacou
- Endocrinology and Diabetes, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK.
| | - John McLaughlin
- Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, the University of Manchester, Manchester, UK; Gastroenterology, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK
| | - Akheel A Syed
- Endocrinology and Diabetes, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, Greater Manchester, UK; Manchester Medical School, Faculty of Medical and Human Sciences, the University of Manchester, Manchester, UK
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29
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Aggarwal S, Modi S, Jose T. Laparoscopic sleeve gastrectomy leads to reduction in thyroxine requirement in morbidly obese patients with hypothyroidism. World J Surg 2015; 38:2628-31. [PMID: 24844659 DOI: 10.1007/s00268-014-2646-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of laparoscopic sleeve gastrectomy (LSG) on various co-morbidities including type II diabetes mellitus, hypertension, and sleep apnea is well established. However, its effect on hypothyroidism has not been given due attention evidenced by the scant literature on the subject. The purpose of this report is to assess the change in thyroxine (T4) requirement in morbidly obese patients with clinical hypothyroidism after LSG. METHODS We conducted a retrospective review of morbidly obese patients on T4 replacement therapy for clinical hypothyroidism who underwent LSG from August 2009 to July 2012 at our institution. RESULTS Of the 200 patients who underwent LSG during this period, 21 (10.5 %) were on T4 replacement therapy preoperatively for clinical hypothyroidism. Two patients were lost to follow-up. The remaining 19 patients were categorized into two groups. Group 1 comprised 13 patients with decreased T4 requirements after LSG. Group 2 comprised six patients in whom the T4 dose remained unaltered. The mean change in T4 requirement in group 1 was 42.07 % (12-100 %). Group 1 patients had a significantly higher mean preoperative body mass index (48.7 vs. 43.0 kg/m(2); p = 0.03) than the group 2 patients. There was a significant correlation between the percentage excess weight loss and the percentage change in T4 requirement in group 1 (r = 0.607, p = 0.028). CONCLUSIONS Sleeve gastrectomy has a favorable impact on hypothyroid status as seen by a reduction in T4 requirement in the majority of morbidly obese patients with overt hypothyroidism.
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Affiliation(s)
- Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India,
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30
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Aggarwal S, Modi S, Jose T. Laparoscopic sleeve gastrectomy leads to reduction in thyroxine requirement in morbidly obese patients with hypothyroidism. World J Surg 2015. [PMID: 24844659 DOI: 10.1007/s0026801426464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The impact of laparoscopic sleeve gastrectomy (LSG) on various co-morbidities including type II diabetes mellitus, hypertension, and sleep apnea is well established. However, its effect on hypothyroidism has not been given due attention evidenced by the scant literature on the subject. The purpose of this report is to assess the change in thyroxine (T4) requirement in morbidly obese patients with clinical hypothyroidism after LSG. METHODS We conducted a retrospective review of morbidly obese patients on T4 replacement therapy for clinical hypothyroidism who underwent LSG from August 2009 to July 2012 at our institution. RESULTS Of the 200 patients who underwent LSG during this period, 21 (10.5 %) were on T4 replacement therapy preoperatively for clinical hypothyroidism. Two patients were lost to follow-up. The remaining 19 patients were categorized into two groups. Group 1 comprised 13 patients with decreased T4 requirements after LSG. Group 2 comprised six patients in whom the T4 dose remained unaltered. The mean change in T4 requirement in group 1 was 42.07 % (12-100 %). Group 1 patients had a significantly higher mean preoperative body mass index (48.7 vs. 43.0 kg/m(2); p = 0.03) than the group 2 patients. There was a significant correlation between the percentage excess weight loss and the percentage change in T4 requirement in group 1 (r = 0.607, p = 0.028). CONCLUSIONS Sleeve gastrectomy has a favorable impact on hypothyroid status as seen by a reduction in T4 requirement in the majority of morbidly obese patients with overt hypothyroidism.
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Affiliation(s)
- Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India,
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Abstract
BACKGROUND AND AIMS Accurate diagnosis and treatment of subclinical hypothyroidism (SCH) is challenging in clinical practice because of differing upper limits of normal (ULN) for thyroid-stimulating hormone (TSH). This review summarises the various definitions of SCH and their impact on reported SCH prevalence. METHODOLOGY Articles reporting the prevalence of SCH in relation to the ULN of TSH in human studies were identified through an English-language PubMed search for 'subclinical hypothyroidism,' 'prevalence,' and 'TSH' within the title and/or abstract. Relevant articles and related literature were selected for inclusion. RESULTS Estimates for the prevalence of SCH varied by sex, age, race/ethnicity, and geographic location (range, 0.4-16.9%). Higher rates of SCH were consistently reported in women (0.9-16.9%) and older individuals (2.7-16.9%). However, the ULN of TSH in those considered free of thyroid disease and not at risk increased progressively with age, suggesting that reports of SCH prevalence in elderly people may be overestimated. Multiple studies reported an increased risk of progression to overt hypothyroidism among individuals with elevated TSH and antithyroid antibodies. CONCLUSIONS Given the variable definition of SCH based on an inconsistent ULN for TSH, it is currently difficult to ascertain the true prevalence of SCH and to correctly label and treat patients with SCH; use of age-adjusted definitions may be considered when assessing prevalence. A diagnosis of SCH does not necessarily merit treatment, especially if TSH elevations are transient (i.e. not persistent for > 3-6 months) and the patient lacks other risk factors for developing overt hypothyroidism.
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Affiliation(s)
- J V Hennessey
- Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Espaillat
- Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA
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Musil F, Blaha V, Ticha A, Hyspler R, Haluzik M, Lesna J, Smahelova A, Sobotka L. Effects of body weight reduction on plasma leptin and adiponectin/leptin ratio in obese patients with type 1 diabetes mellitus. Physiol Res 2014; 64:221-8. [PMID: 25317681 DOI: 10.33549/physiolres.932723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to explore the changes in the adipokines leptin and adiponectin in obese patients with type 1 diabetes mellitus (T1DM) who underwent seven days of fasting and 21 days of low-calorie diet (LCD). The plasma leptin and adiponectin concentrations were measured in 14 obese patients with T1DM at baseline, immediately after 7 days of fasting, and after 21 days of LCD. 13 non-obese patients with T1DM were studied only after an overnight fasting. Bioimpedance technique was used for determination of body composition. Obese T1DM patients lost 6.0 kg (6.0; 6.8) (median, 25 %; 75 %) and decreased their fat tissue after fasting and LCD. Plasma leptin in obese T1DM was significantly higher than in non-obese T1DM patients: 9.10 (5.06; 25.89) vs. 1.71 (1.12; 7.08) microg . l(-1) and transiently decreased immediately after fasting: 3.45 microg . l(-1) (1.47; 7.00), (P<0.05). Adiponectin/leptin ratio in obese T1DM was significantly lower than in non-obese T1DM patients: 0.67 (0.57; 1.49) vs. 3.50 (2.46; 6.30) . 10(3) and transiently increased immediately after fasting: 2.22 (1.26; 3.24) . 10(3), (P<0.05). We conclude that obese patients with T1DM are characterized by hyperleptinemia that is reduced by prolonged fasting, but only slightly affected by low calorie diet.
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Affiliation(s)
- F Musil
- Department of Metabolic Care and Gerontology, University Hospital Hradec Králové and Medical Faculty Charles University in Hradec Králové, Hradec Králové, Czech Republic.
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Sweeney TE, Morton JM. Metabolic surgery: action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature. Best Pract Res Clin Gastroenterol 2014; 28:727-40. [PMID: 25194186 PMCID: PMC4399638 DOI: 10.1016/j.bpg.2014.07.016] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 01/31/2023]
Abstract
Obesity and type 2 diabetes remain epidemic problems. Different bariatric surgical techniques causes weight loss and diabetes remission to varying degrees. The underlying mechanisms of the beneficial effects of bariatric surgery are complex, and include changes in diet and behaviour, as well as changes in hormones, bile acid flow, and gut bacteria. We summarized the effects of multiple different bariatric procedures, and their resulting effects on several hormones (leptin, ghrelin, adiponectin, glucagon-like peptide 1 (GLP-1), peptide YY, and glucagon), bile acid changes in the gut and the serum, and resulting changes to the gut microbiome. As much as possible, we have tried to incorporate multiple studies to try to explain underlying mechanistic changes. What emerges from the data is a picture of clear differences between restrictive and metabolic procedures. The latter, in particular the roux-en-Y gastric bypass, induces large and distinctive changes in most measured fat and gut hormones, including early and sustained increase in GLP-1, possible through intestinal bile acid signalling. The changes in bile flow and the gut microbiome are causally inseparable so far, but new studies show that each contributes to the effects of weight loss and diabetes resolution.
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Affiliation(s)
- Timothy E Sweeney
- Stanford University, Department of General Surgery, Section of Bariatric and Minimally Invasive (BMI) Surgery, 300 Pasteur Drive, H3680, Stanford, CA 94025, USA
| | - John M Morton
- Stanford University, Department of General Surgery, Section of Bariatric and Minimally Invasive (BMI) Surgery, 300 Pasteur Drive, H3680, Stanford, CA 94025, USA.
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