Central Resistance to Thyroid Hormones in Morbidly Obese Subjects Is Reversed after Bariatric Surgery-Induced Weight Loss

Juiz-Valiña, Paula; Cordido, María; Outeiriño-Blanco, Elena; Pértega, Sonia; Varela-Rodríguez, Bárbara María; García-Brao, María Jesús; Mena, Enrique; Pena-Bello, Lara; Sangiao‐Alvarellos, Susana; Cordido, Fernando

doi:10.3390/jcm9020359

Cited by 32 publications

(34 citation statements)

References 48 publications

(78 reference statements)

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“…In our previous study we observed that TSH levels decreased in correlation with insulin resistance following bariatric surgery [6]. Juiz-Valiña et al [7] also reported similar findings. We therefore think that L-T4 requirements decreased through a similar pathway to the decrease in insulin resistance occurring with weight loss in association with thyroid hormone resistance in obese patients.…”

Section: Discussionsupporting

confidence: 67%

Changes in levothyroxine pharmacokinetics following bariatric surgery in obese hypothyroid patients

Gökosmanoğlu

Önmez

2021

j-ebr

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Levothyroxine (L-T4) requirements in obese hypothyroid patients receiving L-T4 therapy decrease following bariatric surgery. L-T4 absorption is also thought to decrease after surgery. The purpose of this study was to evaluate L-T4 requirements in hypothyroidism cases before and after weight loss through bariatric surgery. Methods: Seventy-six cases of hypothyroidism receiving L-T4 replacement therapy and with a body mass index over 40 kg/m2 were included in the study. Patients losing at least 10% of basal body weight following bariatric surgery were assessed in terms of thyroid hormone levels and L-T4 requirements over follow-up of at least one year. The L-T4 requirements of patients in whom euthyroidism was achieved were compared in terms of bariatric surgery procedures and hypothyroidism etiology. Results: Seventy-six patients (56 women, 20 men) with a mean age of 38 years (18-51) were included in the study. Mean weight before bariatric surgery was 121.6 ± 6.8 kg, and mean body mass index was 49.5 ± 1.6 kg/m 2 . Euthyroidism was confirmed at pre-and post-bariatric surgery evaluation. No statistically significant postoperative changes were determined in thyroid-stimulating hormone or free thyroxine-3 and -4 (p > 0.05). A statistically insignificant decrease was observed in L-T4 dosages after surgery in cases of Hashimoto's thyroiditis (p = 0.064). A statistically significant decrease was determined in L-T4 dosages in cases of non-Hashimoto hypothyroidism (p = 0.001). L-T4 requirements decreased in both surgical procedures (p = 0.001) Conclusion: Postoperative L-T4 requirements decrease with weight loss. In addition, no decrease appeared to occur in L-T4 absorption following the surgical procedures in this study.

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Section: Discussionsupporting

confidence: 67%

Changes in levothyroxine pharmacokinetics following bariatric surgery in obese hypothyroid patients

Gökosmanoğlu

Önmez

2021

j-ebr

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“…first proposed the calculation of TSHI for estimating the sensitivity of pituitary to thyroid hormones ( 20 ). Impaired HPT sensitivity to thyroid hormones has been suggested to be related to multiple unfavorable clinical outcomes, including obesity ( 21 ), T2DM ( 10 , 22 ), and decreased estimated glomerular filtration rate (eGFR) ( 22 ). In 2019, Laclaustra et al.…”

Section: Discussionmentioning

confidence: 99%

Sensitivity to Thyroid Hormones and Risk of Prediabetes: A Cross-Sectional Study

Liu

Wang

et al. 2021

Front. Endocrinol.

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ContextThyroid hormone influences glucose homeostasis through central and peripheral regulations. To date, the link between sensitivity to thyroid hormones and prediabetes remains unknown. We aimed to investigate the association between thyroid hormones sensitivity and risk of prediabetes in both general and euthyroid populations.MethodsParticipants with serum free triiodothyronine (FT3), free thyroxine (FT4), and thyrotropin (TSH) measurements from the health checkup programs of the First Hospital of China Medical University were collected. We measured the parameters representing central and peripheral sensitivities to thyroid hormones (central sensitivity, assessed by calculating Thyroid Feedback Quantile-based Index (TFQI), TSH Index (TSHI), and Thyrotroph Thyroxine Resistance Index (TT4RI); peripheral sensitivity, evaluated by FT3/FT4 ratio). Associations between thyroid hormones sensitivities and risk of prediabetes were assessed with logistic regression.ResultsA total of 4378 participants (mean age ± SD, 49 ± 11 years) were included, with 1457 (33%) subjects had prediabetes. The risk of prediabetes was negatively associated with levels of TSHI (odds ratio [OR] 0.91; 95% confidence interval [CI], 0.85–0.97), TT4RI (OR 0.91; 95% CI, 0.84–0.99) and Parametric TFQI (PTFQI) (OR 0.89; 95% CI, 0.83–0.95) among all subjects. The association remained significant in euthyroid subjects and euthyroid subjects with negative thyroid autoimmunity. Higher FT3/FT4 ratio was associated with a mild increased risk of prediabetes (95% CI 1.09; 1.02–1.16). Compared with subjects in the lowest quartile of PTFQI, those in the highest quartile had lower risk of prediabetes (0.70; 95% CI, 0.58–0.84).ConclusionsDecreased central sensitivity to thyroid hormones is associated with lower risk of prediabetes. This demonstrates the complex interaction between thyroid system and glucose metabolism. Future studies are warranted to confirm our findings and underlying mechanisms.

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“…Treatment with GH in a large group of adult GH-deficient patients has been found to induce a significant reduction in FT4 [ 47 ]. The increased TSH and central resistance to thyroid hormones of obesity [ 7 , 8 ] could be a contributory factor to the altered GH–IGF-1 axis. A positive synchronous serum concentration correlation between TSH and GH assessed from 24-h hormone concentrations measured at 10-min intervals has been found in healthy older subjects [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…This sample size allows the estimation of change in GH and IGF-1 values after bariatric surgery with a 95% confidence and a precision of ±0.6 µg/L and ±20.5 µg/L, respectively. For this sample size estimation, standard deviation values obtained from a previous study was used [ 8 ]. The inclusion criteria for bariatric surgery were to be between 18 and 65 years old, have a BMI > 40 kg/m 2 (or >35 kg/m 2 and at least one serious obesity-related health problem, such as diabetes, high blood pressure or sleep apnea), failure of previous nonsurgical attempts at weight reduction, expectation that patient will adhere to postoperative care and follow-up visits with team members.…”

Section: Methodsmentioning

confidence: 99%

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Altered GH-IGF-1 Axis in Severe Obese Subjects is Reversed after Bariatric Surgery-Induced Weight Loss and Related with Low-Grade Chronic Inflammation

Juiz-Valiña

Pena-Bello

Cordido

et al. 2020

JCM

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Endocrine disorders are common in obesity, including altered somatotropic axis. Obesity is characterized by reduced growth hormone (GH) secretion, although the insulin-like growth factor-1 (IGF-1) values are controversial. The aim of this study was to evaluate the effect of weight loss after bariatric surgery in the GH–IGF-1 axis in extreme obesity, in order to investigate IGF-1 values and the mechanism responsible for the alteration of the GH–IGF-1 axis in obesity. We performed an interventional trial in morbidly obese patients who underwent bariatric surgery. We included 116 patients (97 women) and 41 controls (30 women). The primary endpoint was circulating GH and IGF-1 values. Circulating IGF-1 values were lower in the obese patients than in the controls. Circulating GH and IGF-1 values increased significantly over time after surgery. Post-surgery changes in IGF-1 and GH values were significantly negatively correlated with changes in C-reactive protein (CRP) and free T4 values. After adjusting for preoperative body mass index (BMI), free T4 and CRP in a multivariate model, only CRP was independently associated with IGF-1 values in the follow-up. In summary, severe obesity is characterized by a functional hyposomatotropism at central and peripheral level that is progressively reversible with weight loss, and low-grade chronic inflammation could be the principal mediator.

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Central Resistance to Thyroid Hormones in Morbidly Obese Subjects Is Reversed after Bariatric Surgery-Induced Weight Loss

Cited by 32 publications

References 48 publications

Changes in levothyroxine pharmacokinetics following bariatric surgery in obese hypothyroid patients

Changes in levothyroxine pharmacokinetics following bariatric surgery in obese hypothyroid patients

Sensitivity to Thyroid Hormones and Risk of Prediabetes: A Cross-Sectional Study

Altered GH-IGF-1 Axis in Severe Obese Subjects is Reversed after Bariatric Surgery-Induced Weight Loss and Related with Low-Grade Chronic Inflammation

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