Obesity Surgery

, Volume 27, Issue 1, pp 78–82 | Cite as

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

  • Poupak Fallahi
  • Silvia Martina Ferrari
  • Stefania Camastra
  • Ugo Politti
  • Ilaria Ruffilli
  • Roberto Vita
  • Giuseppe Navarra
  • Salvatore Benvenga
  • Alessandro AntonelliEmail author
Original Contributions



Drug malabsorption is one of the potential troubles after bariatric surgery. Evidence for diminished levothyroxine (L-T4) absorption has been reported in patients after bariatric surgery.


This study reports 17 cases of hypothyroid patients [who were well replaced with thyroxine tablets (for >1 year) to euthyroid thyrotropin (TSH) levels before surgery (13 Roux-en-Y gastric bypasses (RYGB); 4 biliary pancreatic diversions (BPD))]. From 3 to 8 months after surgery, these patients had elevated TSH levels. Patients were then switched from oral tablets to a liquid L-T4 formulation (with the same dosage, 30 min before breakfast).


Two–three months after the switch, TSH was significantly reduced both in patients treated with RYGB, as in those treated with BPD, while FT4 and FT3 levels were not significantly changed (RYGB group, TSH μIU/mL: 7.58 ± 3.07 vs 3.808 ± 1.83, P < 0.001; BPD group, TSH μIU/mL: 8.82 ± 2.76 vs 3.12 ± 1.33, P < 0.01).


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.


Bariatric surgery Roux-en-Y gastric bypass Biliary pancreatic diversion Levothyroxine malabsorption Liquid L-T4 Hypothyroidism 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Poupak Fallahi
    • 1
  • Silvia Martina Ferrari
    • 1
  • Stefania Camastra
    • 1
  • Ugo Politti
    • 1
  • Ilaria Ruffilli
    • 1
  • Roberto Vita
    • 2
  • Giuseppe Navarra
    • 3
  • Salvatore Benvenga
    • 2
  • Alessandro Antonelli
    • 1
    Email author
  1. 1.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
  2. 2.Department of Clinical and Experimental Medicine, Section of EndocrinologyUniversity of MessinaMessinaItaly
  3. 3.Department of Human PathologyUniversity Hospital of MessinaMessinaItaly

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