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Long-term Effect of Bariatric Surgery on the Use of Levothyroxine and Thyroid Levels

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Abstract

Background

The aim of this study was to evaluate the effect of bariatric surgery on the defined daily dose of levothyroxine (DDD LT4), thyroid-stimulating hormone (TSH), and free thyroxine (fT4) in female patients with hypothyroidism until 48 months after surgery.

Methods

A retrospective observational study of hypothyroid patients who underwent bariatric surgery. Changes in DDD LT4, TSH, and fT4 over a 48 month period after surgery were analyzed.

Results

Thirty-seven patients were included: 27 Roux-en-Y gastric bypass (RYGB), 6 sleeve gastrectomy (SG), 3 adjustable gastric band, and 1 one anastomosis gastric bypass. The median DDD LT4 decreased from 125 µg at baseline to 100 µg 12 months after surgery. From 24 to 48 months after surgery, the median DDD LT4 was stable at 125 µg. Most dose adjustments occurred during the first 24 months after surgery. In the time period of 24–48 months after surgery, the dose remained stable in 73.1% of the RYGB patients and in 60.0% of the SG patients. After 48 months in the RYGB group, no significant change in TSH and fT4 levels was observed.

Conclusions

Bariatric surgery led to frequent dose adjustments during the first 2 years after surgery. However, 24–48 months after surgery in the majority of patients, the dosage remained stable. No significant change in TSH and fT4 was observed 48 months after RYGB. In the first 2 years after surgery, clinicians should frequently monitor TSH and fT4 for individual dose adjustment of levothyroxine. Thereafter, the frequency of monitoring may be decreased.

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References

  1. Chang SH, Stoll CRT, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012. JAMA Surg. 2014;149:275–87.

    Article  Google Scholar 

  2. Yska JP, van Roon EN, de Boer A, et al. Remission of type 2 diabetes mellitus in patients after different types of bariatric surgery: a population-based cohort study in the United Kingdom. JAMA Surg. 2015;150:1126–33.

    Article  Google Scholar 

  3. Padwal R, Brocks D, Sharma AM. A systematic review of drug absorption following bariatric surgery and its theoretical complications. Obes Rev. 2010;11:41–50.

    Article  CAS  Google Scholar 

  4. Gadiraju S, Lee CJ, Cooper DS. Levothyroxine dosing following bariatric surgery. Obes Surg. 2016;26:2538–42.

    Article  Google Scholar 

  5. Zendel A, Abu-Ghanem Y, Dux J, et al. The impact of bariatric surgery on thyroid function and medication use in patients with hypothyroidism. Obes Surg. 2017;27:2000–4.

    Article  Google Scholar 

  6. Rudnicki Y, Slavin M, Keidar A. The effect of bariatric surgery on hypothyroidism: sleeve gastrectomy versus gastric bypass. Surg Obes Relat Dis. 2018;14:1297–303.

    Article  Google Scholar 

  7. Yska JP, van der Meer DH, Dreijer AR, et al. Influence of bariatric surgery on the use of medication. Eur J Clin Pharmacol. 2016;72:203–9.

    Article  CAS  Google Scholar 

  8. Guan B, Chen YY, Yang J, et al. Effect of bariatric surgery on thyroid function in obese patients: a systematic review and meta-analysis. Obes Surg. 2017;27:3292–305.

    Article  Google Scholar 

  9. Gokosmanoglu F, Aksoy E, Onmez A, et al. Thyroid homeostasis after bariatric surgery in obese cases. Obes Surg. 2020;30:274–8.

    Article  Google Scholar 

  10. Julià H, Benaiges D, Mollà P, et al. Changes in thyroid replacement therapy after bariatric surgery: differences between laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Obes Surg. 2019;29:2593–9.

    Article  Google Scholar 

  11. Pedro J, Cunha F, Souteiro P, et al. The effect of the bariatric surgery type on the levothyroxine dose of morbidly obese hypothyroid patients. Obes Surg. 2018;28:3538–43.

    Article  Google Scholar 

  12. Raftopoulos Y, Gagné DJ, Papasavas P, et al. Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2004;14:509–13.

    Article  Google Scholar 

  13. Szomstein S, Avital S, Brasesco O, et al. Laparoscopic gastric bypass in patients on thyroid replacement therapy for subnormal thyroid function - prevalence and short-term outcome. Obes Surg. 2004;14:95–7.

    Article  Google Scholar 

  14. Michalaki MA, Vagenakis AG, Leonardou AS, et al. Thyroid function in humans with morbid obesity. Thyroid. 2006;16:73–8.

    Article  CAS  Google Scholar 

  15. Azran C, Porat D, Fine-Shamir N, et al. Oral levothyroxine therapy postbariatric surgery: biopharmaceutical aspects and clinical effects. Surg Obes Relat Dis. 2019;15:333–41.

    Article  Google Scholar 

  16. Gkotskina M, Michalaki M, Mamai I, et al. Improved levothyroxine pharmacokinetics after bariatric surgery. Thyroid. 2013;23:414–9.

    Article  Google Scholar 

  17. Rubio IGS, Galrão AL, Santo MA, et al. Levothyroxine absorption in morbidly obese patients before and after Roux-en-Y gastric bypass (RYGB) surgery. Obes Surg. 2012;22:253–8.

    Article  Google Scholar 

  18. Fierabracci P, Martinelli S, Tamberi A, et al. Weight loss and variation of levothyroxine requirements in hypothyroid patients after bariatric surgery. Thyroid. 2016;26:499–503.

    Article  CAS  Google Scholar 

  19. Fazylov R, Soto E, Cohen S, et al. Laparoscopic Roux-en-Y gastric bypass surgery on morbidly obese patients with hypothyroidism. Obes Surg. 2008;18:644–7.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Clinical Pharmacy and Clinical Pharmacology, Medical Center Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, the Netherlands

    Jan Peter Yska, Inge J. Arfman, Maarten A. van Oijen & Eric N. van Roon

  2. Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands

    Loek J. M. de Heide & Marloes Emous

  3. Department of Epidemiology, Medical Center Leeuwarden, MCL Academy, Leeuwarden, the Netherlands

    Nic J. G. M. Veeger

  4. Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, the Netherlands

    Eric N. van Roon

Authors
  1. Jan Peter Yska
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  2. Inge J. Arfman
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  3. Maarten A. van Oijen
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  4. Loek J. M. de Heide
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  6. Nic J. G. M. Veeger
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  7. Eric N. van Roon
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Contributions

All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Jan Peter Yska.

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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.

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The authors declare no competing interests.

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Key Points

• Study on the long-term effect of bariatric surgery on the use of levothyroxine.

• Most dose changes of levothyroxine occurred in the first 2 years after surgery.

• Twenty-four to 48 months after surgery, most patients had a stable dosage of levothyroxine.

• Frequent monitoring of TSH and fT4 is advised in the first 2 years after surgery.

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Yska, J.P., Arfman, I.J., van Oijen, M.A. et al. Long-term Effect of Bariatric Surgery on the Use of Levothyroxine and Thyroid Levels. OBES SURG 32, 742–748 (2022). https://doi.org/10.1007/s11695-021-05810-2

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  • DOI: https://doi.org/10.1007/s11695-021-05810-2

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