TSH Normalization in Bariatric Surgery Patients After the Switch from l-Thyroxine in Tablet to an Oral Liquid Formulation

Fallahi, Poupak; Ferrari, Silvia; Camastra, Stefania; Politti, U; Ruffilli, Ilaria; Vita, Roberto; Navarra, Giuseppe; Benvenga, Salvatore; Antonelli, Alessandro

doi:10.1007/s11695-016-2247-4

Cited by 68 publications

(68 citation statements)

References 33 publications

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“…Centanni et al have in fact demonstrated that patients with impaired acid secretion require an increased dose of thyroxine, confirming that normal acid gastric secretion is necessary for the effective absorption of oral L-T4 [25]. Many recent reports have clearly demonstrated that liquid L-T4 formulation circumvents this problem in patients taking proton pump inhibitors, those suffering from gastric-related T4 malabsorption, those ingesting T4 with coffee or fed by enteral tube, and also those submitted to bariatric surgery [26–32]. Recently, Giusti et al showed that, in patients affected by DTC, the risk of inadequate TSH levels seems to be more reduced in patients on liquid L-T4 than in those on tablets [17].…”

Section: Discussionmentioning

confidence: 97%

TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

Cappelli

Pirola

Gandossi

et al. 2017

International Journal of Endocrinology

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Background Recent guidelines from the American Thyroid Association (ATA) indicate that, in many patients affected by differentiated thyroid cancer (DTC), the serum TSH should be maintained between 0.1 and 0.5 mU/L. The purpose of this study was to evaluate the TSH variability of patients affected by DTC treated with liquid L-T4 formulation or in tablet form. Patients and Methods Patients were eligible if (a) they were submitted to a total thyroidectomy and 131I remnant ablation for DTC in our institution and (b) they were classified low-risk patients according to ATA guidelines 2009. Patients were randomized (1 : 1) to receive treatment of hypothyroidism with liquid L-T4 or tablet form. The first check-up evaluation was made from 8 to 12 months after 131I remnant ablation. TSH values were established again after further 12 months. Results A significant increase in TSH values (median) was observed in patients taking tablets [TSH (min–max): 0.28 (0.1–0.45) versus 0.34 (0.01–0.78) mIU/L, p = 0.041] as compared to those taking liquid formulation [TSH (min–max): 0.28 (0.1–0.47) versus 0.30 (0.1–0.55) mIU/L, p = 0.345]. Conclusions The use of L-T4 liquid formulation, as compared to that of tablets, resulted in a significantly higher number of DTC patients maintaining TSH values in range for the ATA risk score, reducing TSH variability over the time.

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Section: Discussionmentioning

confidence: 97%

TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

Cappelli

Pirola

Gandossi

et al. 2017

International Journal of Endocrinology

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“…The liquid formulation has been shown to overcome: 1) the food and beverages interference with L‐T4 tablets absorption, caused by food at breakfast; 2) malabsorption induced by the increased gastric pH, resulting from atrophic gastritis, or due to proton‐pump inhibitors; 3) malabsorption after bariatric surgery; and 4) malabsorption induced by lactose intolerance, or drug interference …”

Section: Introductionmentioning

confidence: 99%

Oral L‐thyroxine liquid versus tablet in patients submitted to total thyroidectomy for thyroid cancer (without malabsorption): A prospective study

Fallahi

Ferrari

Materazzi

et al. 2018

Laryngoscope Investig Oto

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ObjectiveNo consistent data are present in literature about the effectiveness of Levothyroxine (L‐T4) liquid formulation in patients without malabsorption after thyroidectomy. The aim of this study is to compare the effectiveness of L‐T4 liquid formulation, with L‐T4 tablets, in thyroid cancer patients after thyroidectomy (without malabsorption or drug interference).MethodsOne hundred five patients were recruited; 52 patients were treated with liquid L‐T4 formulation, while 53 with L‐T4 tablets, at the same dosage (1.5 mcg/kg/day). Patients started to assume the drug the day after surgery, 30 min before breakfast. In both groups circulating levels of thyrotropic hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were dosed at week 6 (first control), and then at week 12 (second control).ResultsWe obtained significantly lower TSH values in the liquid L‐T4 group patients, compared to the tablet L‐T4 group, at the first control (P < .05), and at the second control (P < .01), while FT4 and FT3 levels were not significantly different. Hypothyroid range (TSH > 3.6 mcU/mL) was significantly more prevalent in the patients treated with L‐T4 tablet.ConclusionsA better control of TSH was observed in thyroidectomized patients (without malabsorption, gastric disorders, or drug interference) with liquid L‐T4 regimen.Level of Evidence2c–Outcomes Research

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“…Roux-en-Y gastric bypass (RYGB) surgery, a commonly performed operation, can bring about long-term weight loss and excellent remission of associated comorbidities and metabolic disorders [7, 8]. Inconsistent thyroid hormone level alterations in patients with obesity after bariatric surgery were observed in several studies mainly due to different study populations, sample sizes, and surgical procedures [9, 10], emphasizing the need for further research.…”

Section: Introductionmentioning

confidence: 99%

Decreased Leptin Is Associated with Alterations in Thyroid-Stimulating Hormone Levels after Roux-en-Y Gastric Bypass Surgery in Obese Euthyroid Patients with Type 2 Diabetes

Zhang

et al. 2019

Obes Facts

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Background: Leptin has been shown to stimulate the hypothalamus-pituitary-thyroid (HPT) axis in vivo and vitro. Its role in thyroid axis regulation after weight loss induced by bariatric surgery is still unknown. The aim of this study was to evaluate the influence of leptin on weight loss and thyroid function variation induced by Roux-en-Y gastric bypass (RYGB) surgery in euthyroid individuals with obesity and type 2 diabetes mellitus (T2DM). Methods: 65 Chinese individuals with obesity and T2DM who underwent RYGB, and 27 healthy volunteers were enrolled in this retrospective study. Participants were evaluated for changes in anthropometric parameters, metabolic indexes, thyroid function, and leptin levels before and 12 months after surgery. Results: After RYGB, all of these patients experienced significant weight reduction and improved glucose control. Metabolic parameters were significantly ameliorated after surgery compared with baseline. Thyroid hormones including free triiodothyronine (FT₃), free thyroxine (FT₄), and thyroid-stimulating hormone (TSH) declined in parallel. Median (IQR) plasma leptin levels decreased from 33.7 ng/mL (17.9–63.1) to 10.3 ng/mL (4.0–18.5). Pearson correlation analysis showed that TSH was significantly positively correlated with body mass index, C-reactive protein (CRP), and leptin. Multiple stepwise linear regression indicated that leptin and CRP were independent factors affecting TSH. The β coefficients were 0.38 (p = 0.001) and 0.32 (p = 0.004), respectively. There was a significant positive correlation between ΔTSH and Δleptin (r = 0.33, p = 0.01). Conclusion: Decreased or normalized TSH levels after weight loss induced by RYGB might be mediated by the decline in leptin. There could be cross talk between adipose tissue and the HPT axis.

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TSH Normalization in Bariatric Surgery Patients After the Switch from l-Thyroxine in Tablet to an Oral Liquid Formulation

Abstract: These results first show that liquid L-T4 could prevent the problem of malabsorption in patients with BPD and confirm those of previous studies in patients submitted to RYGB, suggesting that the L-T4 oral liquid formulation could circumvent malabsorption after bariatric surgery.

Cited by 68 publications

References 33 publications

TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

TSH Variability of Patients Affected by Differentiated Thyroid Cancer Treated with Levothyroxine Liquid Solution or Tablet Form

Oral L‐thyroxine liquid versus tablet in patients submitted to total thyroidectomy for thyroid cancer (without malabsorption): A prospective study

Decreased Leptin Is Associated with Alterations in Thyroid-Stimulating Hormone Levels after Roux-en-Y Gastric Bypass Surgery in Obese Euthyroid Patients with Type 2 Diabetes

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