The effect of bariatric surgery on hypothyroidism: Sleeve gastrectomy versus gastric bypass

Rudnicki, Yaron; Slavin, Moran; Keidar, Andrei; Kent, Ilan; Berkovich, Liron; Tiomkin, V.; Inbar, Roye; Avital, Shmuel

doi:10.1016/j.soard.2018.06.008

Cited by 21 publications

(22 citation statements)

References 23 publications

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“…On the contrary, other studies have described a reduction in LT4 requirements after RYGBP or SG [20,41]. In the study of Rudnicki et al [42], BS improved thyroid function in hypothyroid obese patients. Zendel et al [43] and Aggarwal et al [41] have found that BS has a favorable impact on hypothyroid patients as seen by a reduction in LT4 dose.…”

Section: Discussionmentioning

confidence: 89%

“…Conversely, and in agreement with Pedro et al [24], we did not find BS type to be a predictor of either LT4 dose changes or its variation. Similarly, Rudnicki et al [42] have found that SG and RYGB both improved thyroid function in hypothyroid obese patients and no procedure was superior [42]. This suggests that both procedures appear to have very similar effects on the hormone absorption.…”

Section: Discussionmentioning

confidence: 91%

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Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss

Juiz-Valiña

Cordido

Outeiriño-Blanco

et al. 2021

JCM

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The most frequent endocrine disease in obese patients is hypothyroidism. To date, there are no clear data regarding what happens to the dose of levothyroxine (LT4) after bariatric surgery (BS). The objective of the present study was to evaluate thyroid hormone replacement dose in morbidly obese hypothyroid patients after BS-induced weight loss. We explore the best type of measured or estimated body weight for LT4 dosing. We performed an observational study evaluating patients with morbid obesity and hypothyroidism who underwent BS. We included 48 patients (three men). In morbidly obese hypothyroid patients 12 months after BS-induced weight loss, the total LT4 dose or the LT4 dose/kg ideal body weight did not change, while there was a significant increase in LT4 dose/body surface area, LT4 dose/kg weight, LT4 dose/kg adjusted body weight, LT4 dose/kg body fat, and LT4 dose/kg lean body weight. There were no differences in LT4 dose and its variation between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The present study strongly suggests that LT4 dosing in obese hypothyroid patients can be individually adapted more precisely if it is based on ideal body weight.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss

Juiz-Valiña

Cordido

Outeiriño-Blanco

et al. 2021

JCM

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“…This has significant implications for levothyroxine absorption (Table 1). 1,[7][8][9] Levothyroxine is a synthetic lipophilic drug administered in tablet form to patients with hypothyroidism. For efficacious absorption, it is ideally taken on an empty stomach with a wait of 4 hours before resuming other medications.…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism following gastric sleeve surgery resolved by ingesting crushed thyroxine tablets

Fain

Rojas

Peiris

2019

Baylor University Medical Center Proceedings

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Bariatric procedures for weight loss have increased in the past few decades. Levothyroxine malabsorption has been reported following gastric bypass; however, few studies have addressed this issue after gastric sleeve procedures. Levothyroxine dosing is usually weight based and administered at approximately 1.6 μg/kg body weight. Absorption occurs mainly in the jejunum and upper ileum, which can be altered by gastric pH, other drugs, food, and other factors. We present a 35-year-old woman with longstanding iatrogenic hypothyroidism treated with thyroxine, whose thyroid-stimulating hormone level rose following a gastric sleeve procedure despite taking levothyroxine daily.

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“…THR doses were reduced significantly in the rest of the patients (p < 0.02) [114]. Rudnicki et al (2018) reported similar results in 90 patients treated with either LSG or RYGB. In their observational study of 1581 patients with hypothyroidism and obesity mainly treated with LSG and RYGB, Matute et al (2018) also observed a significant reduction in BMI (p < 0.0001) and THR doses (p = 0.071) after one year post-surgery.…”

Section: Impact Of Bariatric Surgery On Thyroid Functionmentioning

confidence: 59%

“…The mean TSH decline is directly related to the baseline TSH value and does not correlate with BMI reduction. This shows that the improvement in thyroid function has a hormonal component and is not related to weight loss [114,115]. A study from China showed that decrease in leptin levels was associated with improved thyroid function in patients with obesity, T2DM, and euthyroidism [116].…”

Section: Impact Of Bariatric Surgery On Thyroid Functionmentioning

confidence: 98%

Barocrinology: The Endocrinology of Obesity from Bench to Bedside

et al. 2020

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Obesity has reached pandemic proportions. Hormonal and metabolic imbalances are the key factors that lead to obesity. South Asian populations have a unique phenotype, peculiar dietary practices, and a high prevalence of consanguinity. Moreover, many lower middle-income countries lack appropriate resources, super-specialists, and affordability to manage this complex disorder. Of late, there has been a substantial increase in both obesity and diabesity in India. Thus, many more patients are being managed by different types of bariatric procedures today than ever before. These patients have many types of endocrine and metabolic disturbances before and after bariatric surgery. Therefore, these patients should be managed by experts who have knowledge of both bariatric surgery and endocrinology. The authors propose “Barocrinology”, a novel terminology in medical literature, to comprehensively describe the field of obesity medicine highlighting the role of knowing endocrine physiology for understating its evolution, insights into its complications and appreciating the changes in the hormonal milieu following weight loss therapies including bariatric surgery. Barocrinology, coined as a portmanteau of “baro” (weight) and endocrinology, focuses upon the endocrine and metabolic domains of weight physiology and pathology. This review summarizes the key pointers of bariatric management from an endocrine perspective.

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The effect of bariatric surgery on hypothyroidism: Sleeve gastrectomy versus gastric bypass

Cited by 21 publications

References 23 publications

Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss

Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss

Hypothyroidism following gastric sleeve surgery resolved by ingesting crushed thyroxine tablets

Barocrinology: The Endocrinology of Obesity from Bench to Bedside

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