Change in levothyroxine requirements after bariatric surgery in patients with hypothyroidism

Garcia-Moreno, Rosa Maria; Cos-Blanco, Ana Isabel; Calvo-Vinuela, Isabel; Zapatero-Larrauri, Miriam; Herranz, Lucrecia

doi:10.2478/enr-2022-0009

Cited by 6 publications

(3 citation statements)

References 18 publications

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“…In addition, Khan et al [ 18 ] evaluated postoperative levothyroxine doses in LSG and gastric bypass patients with hypothyroidism and observed that 61% of LSG patients and 45% of gastric bypass patients had a lower levothyroxine dose. In their study following metabolic and bariatric surgery (MBS), Garcia-Moreno et al [ 14 ] reported statistically significant increases in the weekly weight-adjusted levothyroxine dose at the 6th and 12th month. In the study by Zendel et al [ 19 ], the mean weekly levothyroxine dose was significantly decreased in people with obesity with hypothyroidism after MBS.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Function Tests and Levothyroxine Doses in People With Obesity

Demirpolat,

Sisik

2024

Cureus

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Introduction: We investigated how laparoscopic sleeve gastrectomy (LSG) affected serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) in obese patients with hypothyroidism. We additionally examined whether the dose of levothyroxine decreases as a result of weight loss in this study. Materials and methods: Fifty-one people with obesity who received levothyroxine treatment for hypothyroidism and underwent LSG between January 2017 and January 2023 were retrospectively examined. Weight, body mass index (BMI), TSH, FT4, FT3, weekly levothyroxine dose changes, and weight-adjusted levothyroxine doses before surgery and the sixth month after surgery were compared. Results: Among the 51 patients included in this study, 50.98% ceased the use of levothyroxine, and nearly half (41.18%) required an adjustment of their levothyroxine dose during the follow-up period (sixth month). Notably, the total weekly dose of levothyroxine (mcg) decreased in the sixth month following surgery (p<0.001). The weekly weight-adjusted dose (mcg/kg) decreased during the same time frame (p<0.001). The preoperative total weekly dose of levothyroxine, EWL% and absence of hyperlipidemia were found to be the independent predictors of the weight-adjusted weekly levothyroxine dose change (p<0.001, p=0.038, and p=0.044, respectively). Conclusions: Thyroid function tests in people with obesity can show improvement after LSG. LSG may reduce the weight-adjusted dose of levothyroxine at six months postoperatively and therefore patients should be monitored for possible levothyroxine dose readjustments based on weight loss.

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Section: Discussionmentioning

confidence: 99%

“…Weekly total dose (mcg) was calculated with the formula: Total levothyroxine dose used per week/total number of patients. Weekly dose adjusted to weight (mcg/kg) was calculated with the formula: Total levothyroxine dose used per week/total weight of patients [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Function Tests and Levothyroxine Doses in People With Obesity

Demirpolat,

Sisik

2024

Cureus

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“…However, changes in thyroid-stimulating hormone (TSH) after bariatric surgery reported by different studies varied dramatically. TSH levels were found to decline significantly following bariatric surgery in the majority of studies involving patients with subclinical or overt hypothyroidism ( 10 – 12 ). Similar results have been noted in a number of researches involving patients with normal thyroid function ( 13 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

Total weight loss induces the alteration in thyroid function after bariatric surgery

Tian,

Nie,

et al. 2024

Front. Endocrinol.

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BackgroundBariatric surgery is an effective approach to weight loss, which may also affect thyroid function. However, alteration in thyroid-stimulating hormone (ΔTSH) and thyroid hormones after bariatric surgery and the relationship between thyroid function and postoperative weight loss still remains controversial.MethodsData were collected from euthyroid patients with obesity who underwent sleeve gastrectomy and Roux-en-Y gastric bypass from 2017 to 2022. The alterations of free thyroxine (FT4), free triiodothyronine (FT3), total thyroxine (TT4), total triiodothyronine (TT3), and TSH were calculated 1 year after surgery. Pearson correlation analysis was used to assess the correlation between the percentage of total weight loss (%TWL) and ΔTSH. Multivariable linear regression was utilized to determine the association between %TWL and ΔTSH.ResultsA total of 256 patients were included in our study. The mean %TWL was 28.29% after 1 year. TSH decreased from 2.33 (1.67, 3.04) uIU/mL to 1.82 (1.21, 2.50) uIU/mL (P < 0.001), FT3 decreased from 3.23 ± 0.42 pg/mL to 2.89 ± 0.41 pg/mL (P < 0.001), FT4 decreased from 1.11 ± 0.25 ng/dL to 1.02 ± 0.25 ng/dL (P < 0.001), TT3 decreased from 1.13 (1.00, 1.25) ng/mL to 0.89 (0.78, 1.00) ng/mL (P < 0.001), and TT4 decreased from 8.28 ± 1.69 ug/mL to 7.82 ± 1.68 ug/mL 1 year postoperatively (P < 0.001). %TWL was found to be significantly correlated to ΔTSH by Pearson correlation analysis (Pearson correlation coefficient = 0.184, P = 0.003), indicating that the more weight loss, the more TSH declined. After adjusting for covariates in multivariable linear regression, %TWL was found to be independently associated with ΔTSH (β = 0.180 [95% confidence interval (CI), 0.048 – 0.312], P = 0.008). Moreover, %TWL was divided into 3 categorical groups (%TWL ≤ 25%, 25% < %TWL ≤ 35%, and %TWL > 35%) for further exploration, and was also found to be an independent predictor for ΔTSH after adjusting for covariates in multivariable linear regression (β = 0.153 [95% CI, 0.019 – 0.287], P = 0.025).ConclusionTSH, FT4, FT3, TT4, and TT3 decrease significantly 1 year after bariatric surgery. The decline in TSH is independently mediated by postoperative weight loss; the more the weight loss, the more the TSH decrease.

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One sip of water with LT-4 supplementation—a key to euthyroidism in Hashimoto’s thyroiditis

Schnedl,

Michaelis,

Mangge

et al. 2024

Endocrine

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Purpose Recommended pharmacotherapy for hypothyroidism in Hashimoto’s thyroiditis (HT) is oral supplementation with levothyroxine (LT-4). However, serum thyrotropin (TSH) levels within normal range are not consistently achieved with LT-4 medication. Patients and methods We report on 35 HT patients with LT-4 therapy in this retrospective evaluation. In general, we recommend that a maximum of two sips of water, which would then amount to < 50 mL, be ingested at the same time as LT-4. We report on follow up examinations measuring TSH and antibodies against thyroid peroxidase (TPOAb) after 6 months to five years. Results After median time of 643 days (range 98-1825) we found in 35 HT patients a statistical significant reduction of serum TSH (p < 0.001) and TPOAb (p = 0.006). The patients median body weight was 71 kg (range 48–98) and a daily LT-4 dosage was used with median 69.1 µg (range 25–150). This results in a daily LT-4 dose of median 1.01 µg/kg bodyweight (range 0.3–2.3). Conclusions The reduction of water ingestion to a maximum of two sips, which is <50 mL, combined with LT-4 supplementation helps to achieve euthyroidism in HT. In addition, it reduces the L-T4 medication dosage needed to lower TSH serum levels and decreases TPO antibodies in HT.

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Change in levothyroxine requirements after bariatric surgery in patients with hypothyroidism

Cited by 6 publications

References 18 publications

Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Function Tests and Levothyroxine Doses in People With Obesity

Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Function Tests and Levothyroxine Doses in People With Obesity

Total weight loss induces the alteration in thyroid function after bariatric surgery

One sip of water with LT-4 supplementation—a key to euthyroidism in Hashimoto’s thyroiditis

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