Weight Changes in Euthyroid Patients Undergoing Thyroidectomy

Abstract

Background: Thyroidectomized patients frequently report weight gain resistant to weight loss efforts, identifying their thyroidectomy as the event precipitating subsequent weight gain. We wished to determine whether recently thyroidectomized euthyroid patients gained more weight over 1 year than matched euthyroid patients with preexisting hypothyroidism. Methods: We performed a retrospective chart review of subjects receiving medical care at an academic medical center. One hundred twenty patients had their weight and thyroid status documented after thyroidectomy and achievement of euthyroidism on thyroid hormone replacement, and one year later. Three additional groups of 120 patients with preexisting hypothyroidism, no thyroid disease, and thyroid cancer were matched for age, gender, menopausal status, height, and weight. Anthropometric data were documented at two time points 1 year apart. We compared the weight changes and body mass index changes occurring over a 1-year period in the four groups. Results: Patients with recent postsurgical hypothyroidism gained 3.1 kg during the year, whereas matched patients with preexisting hypothyroidism gained 2.2 kg. The patients without thyroid disease and those with iatrogenic hyperthyroidism gained 1.3 and 1.2 kg, respectively. The weight gain in the thyroidectomized group was significantly greater than that in the matched hypothyroid group ( p-value 0.004), the group without thyroid disease ( p-value 0.001), and the patients with iatrogenic hyperthyroidism ( p-value 0.001). Within the thyroidectomized group, the weight gain in menopausal women was greater than in either premenopausal women (4.4 vs. 2.3 kg, p-value 0.007) or men (4.4 vs. 2.5 kg, p-value 0.013). Conclusion: Patients who had undergone thyroidectomy in the previous year did, in fact, gain more weight than their matched counterparts with preexisting hypothyroidism. In addition, all patients with hypothyroidism, even though treated to achieve euthyroidism, experienced more weight gain than both subjects without hypothyroidism and subjects with iatrogenic hyperthyroidism. The greatest weight gain in the thyroidectomized group was in menopausal women. These data raise the question of an unidentified factor related to taking thyroid hormone replacement that is associated with weight gain, with an additional intriguing effect of thyroidectomy itself. Menopausal status confers additional risk. These groups should be targeted for diligent weight loss efforts.

Quality of life in patients with primary hypothyroidism related to BMI

“…Even after therapy is started and the excess body water that is associated with myxedema in hypothyroidism is lost (32), the weight often remains a problem. Several studies have indeed demonstrated that body weight of patients with primary or iatrogenic hypothyroidism increases over the years (33,34,35). The greater weight gain described in the studied subjects compared to age-and gender-matched (36), it is difficult to mimic normal hormone secretion by hormonal substitution therapy in hypothyroid patients (37).…”

Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement

“…One of these examined weight changes in individuals after either replacement or suppressive doses of L-T4 for post-surgical hypothyroidism and found no significant weight changes (382). A second study compared weight changes during a one-year period in patients who had just undergone thyroidectomy without ever becoming hypothyroid with patients already taking L-T4 for primary hypothyroidism or thyroid cancer, and also patients without a diagnosis of hypothyroidism (383).…”

Effects of Levothyroxine Replacement or Suppressive Therapy on Energy Expenditure and Body Composition

“…These studies are concordant with the present results. However, one study did show greater one-year weight gain in LT4-treated subjects after thyroidectomy or with pre-existing hypothyroidism compared with euthyroid subjects (49). Subjects were well matched for age, sex, menopausal status, TSH levels, and baseline BMI.…”