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Thyroidectomy as Primary Treatment Optimizes Body Mass Index in Patients with Hyperthyroidism

  • Endocrine Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The purpose of this study was to determine how the timing of thyroidectomy influenced postoperative weight change.

Methods

We conducted a two-institution study, identifying patients treated with total thyroidectomy for hyperthyroidism. Patients were classified as ‘early’ if they were referred for surgery as the first treatment option, or ‘delayed’ if they were previously treated with radioactive iodine (RAI). Groups were compared with the Student’s t-test or χ 2 test where appropriate.

Results

There were 204 patients undergoing thyroidectomy for hyperthyroidism. Of these, 171 patients were classified as early and 33 were classified as delayed. Overall, patients gained 6.0 % ±0.8 of their preoperative body weight at last follow-up. Preoperative body mass indexes (BMIs) were similar between groups (p = 0.98), and the median follow-up time was 388 days (range 15–1,584 days). Both groups gained weight until they achieved a normal thyroid-stimulating hormone (TSH) postoperatively. After achieving a normal TSH, the early group stabilized or lost weight (−0.2 lbs/day), while the delayed group continued to gain weight (0.02 lbs/day; p = 0.61). At last follow-up, there were significantly more patients in the delayed group who increased their BMI category compared with the early group (42.4 vs. 21.6 %; p = 0.01). Twice as many patients in the delayed group moved up or into an unhealthy BMI category (overweight or obese) compared with the early group (39.4 vs. 19.3 %; p = 0.01).

Conclusions

Compared with patients initially treated with RAI, patients with hyperthyroidism who underwent surgery as the first treatment were less likely to become overweight or obese postoperatively.

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References

  1. Schussler-Fiorenza CM, Bruns CM, Chen H. The surgical management of Graves’ disease. J Surg Res. 2006;133(2):207–14.

    Article  PubMed  Google Scholar 

  2. Jacobsen R, Lundsgaard C, Lorenzen J, Toubro S, Perrild H, Krog-Mikkelsen I, et al. Subnormal energy expenditure: a putative causal factor in the weight gain induced by treatment of hyperthyroidism. Diabetes Obes Metab. 2006;8(2):220–7.

    Article  CAS  PubMed  Google Scholar 

  3. Astrup A, Buemann B, Christensen NJ, Madsen J, Gluud C, Bennett P, et al. The contribution of body composition, substrates, and hormones to the variability in energy expenditure and substrate utilization in premenopausal women. J Clin Endocrinol Metab. 1992;74(2):279–86.

    CAS  PubMed  Google Scholar 

  4. Toubro S, Sorensen TI, Ronn B, Christensen NJ, Astrup A. Twenty-four-hour energy expenditure: the role of body composition, thyroid status, sympathetic activity, and family membership. J Clin Endocrinol Metab. 1996;81(7):2670–4.

    CAS  PubMed  Google Scholar 

  5. Torring O, Tallstedt L, Wallin G, Lundell G, Ljunggren JG, Taube A, Thyroid Study Group, et al. Graves’ hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine—a prospective, randomized study. J Clin Endocrinol Metab. 1996;81(8):2986–93.

    CAS  PubMed  Google Scholar 

  6. Porterfield JR Jr, Thompson GB, Farley DR, Grant CS, Richards ML. Evidence-based management of toxic multinodular goiter (Plummer’s Disease). World J Surg. 2008;32(7):1278–84.

    Article  PubMed  Google Scholar 

  7. Hegedus L. Treatment of Graves’ hyperthyroidism: evidence-based and emerging modalities. Endocrinol Metab Clin North Am. 2009;38(2):355–71, ix.

    Google Scholar 

  8. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593–646.

    Article  PubMed  Google Scholar 

  9. Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, et al. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002;8(6):457–69.

    PubMed  Google Scholar 

  10. Liu J, Bargren A, Schaefer S, Chen H, Sippel RS. Total thyroidectomy: a safe and effective treatment for Graves’ disease. J Surg Res. 2011;168(1):1–4.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Annerbo M, Stalberg P, Hellman P. Management of Grave’s disease is improved by total thyroidectomy. World J Surg. 2012;36(8):1943–6.

    Article  PubMed  Google Scholar 

  12. Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of Graves’ disease in the United States. World J Surg. 2010;34(6):1261–4.

    Article  PubMed  Google Scholar 

  13. Hoogwerf BJ, Nuttall FQ. Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med. 1984;76(6):963–70.

    Article  CAS  PubMed  Google Scholar 

  14. Abid M, Billington CJ, Nuttall FQ. Thyroid function and energy intake during weight gain following treatment of hyperthyroidism. J Am Coll Nutr. 1999;18(2):189–93.

    Article  CAS  PubMed  Google Scholar 

  15. De la Rosa RE, Hennessey JV, Tucci JR. A longitudinal study of changes in body mass index and total body composition after radioiodine treatment for thyrotoxicosis. Thyroid. 1997;7(3):401–5.

    Article  PubMed  Google Scholar 

  16. Greenlund LJ, Nair KS, Brennan MD. Changes in body composition in women following treatment of overt and subclinical hyperthyroidism. Endocr Pract. 2008;14(8):973–8.

    Article  PubMed  Google Scholar 

  17. Dale J, Daykin J, Holder R, Sheppard MC, Franklyn JA. Weight gain following treatment of hyperthyroidism. Clin Endocrinol (Oxf). 2001;55(2):233–9.

    Article  CAS  PubMed  Google Scholar 

  18. Jonklaas J, Nsouli-Maktabi H. Weight changes in euthyroid patients undergoing thyroidectomy. Thyroid. 2011;21(12):1343–51.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.

    Article  CAS  PubMed  Google Scholar 

  20. Tenconi SM, Boni L, Colombo EM, Dionigi G, Rovera F, Cassinotti E. Laparoscopic cholecystectomy as day-surgery procedure: current indications and patients’ selection. Int J Surg. 2008;6 Suppl 1:S86–8.

    Article  PubMed  Google Scholar 

  21. Kitahara CM, Platz EA, Ladenson PW, Mondul AM, Menke A, Berrington de Gonzalez A. Body fatness and markers of thyroid function among U.S. men and women. PLoS One. 2012;7(4):e34979.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Pearce EN. Thyroid hormone and obesity. Curr Opin Endocrinol Diabetes Obes. 2012;19(5):408–13.

    Article  CAS  PubMed  Google Scholar 

  23. Zimmermann-Belsing T, Feldt-Rasmussen U. Obesity: the new worldwide epidemic threat to general health and our complete lack of effective treatment. Endocrinology. 2004;145(4):1501–2.

    Article  CAS  PubMed  Google Scholar 

  24. Adult obesity facts. Available from: http://www.cdc.gov/obesity/data/adult.html. Accessed 4 Apr 2013.

  25. Feldt-Rasmussen U. Thyroid and leptin. Thyroid. 2007;17(5):413–9.

    Article  CAS  PubMed  Google Scholar 

  26. Nguyen DM, El-Serag HB. The epidemiology of obesity. Gastroenterol Clin North Am. 2010;39(1):1–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Christakis NA, Fowler JH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357(4):370–9.

    Article  CAS  PubMed  Google Scholar 

  28. Dixon JB. Obesity and diabetes: the impact of bariatric surgery on type-2 diabetes. World J Surg. 2009;33(10):2014–21.

    Article  PubMed  Google Scholar 

  29. Lonn L, Stenlof K, Ottosson M, Lindroos AK, Nystrom E, Sjostrom L. Body weight and body composition changes after treatment of hyperthyroidism. J Clin Endocrinol Metab. 1998;83(12):4269–73.

    CAS  PubMed  Google Scholar 

  30. Jansson S, Berg G, Lindstedt G, Michanek A, Nystrom E. Overweight: a common problem among women treated for hyperthyroidism. Postgrad Med J. 1993;69(808):107–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Svare A, Nilsen TI, Bjoro T, Asvold BO, Langhammer A. Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway. Clin Endocrinol (Oxf). 2011;74(6):769–75.

    Article  CAS  Google Scholar 

  32. Fox CS, Pencina MJ, D’Agostino RB, Murabito JM, Seely EW, Pearce EN, et al. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med. 2008;168(6):587–92.

    Article  PubMed  Google Scholar 

  33. Morley JE. Neuropeptide regulation of appetite and weight. Endocr Rev. 1987;8(3):256–87.

    Article  CAS  PubMed  Google Scholar 

  34. Brennan AM, Mantzoros CS. Drug insight: the role of leptin in human physiology and pathophysiology–emerging clinical applications. Nat Clin Pract Endocrinol Metab. 2006;2(6):318–27.

    Article  CAS  PubMed  Google Scholar 

  35. Carleton RA, Lasater TM, Assaf AR, Feldman HA, McKinlay S. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. Am J Public Health. 1995;85(6):777–85.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Dubuc GR, Phinney SD, Stern JS, Havel PJ. Changes of serum leptin and endocrine and metabolic parameters after 7 days of energy restriction in men and women. Metabolism. 1998;47(4):429–34.

    Article  CAS  PubMed  Google Scholar 

  37. Hsieh CJ, Wang PW, Wang ST, Liu RT, Tung SC, Chien WY, et al. Serum leptin concentrations of patients with sequential thyroid function changes. Clin Endocrinol (Oxf). 2002;57(1):29–34.

    Article  CAS  PubMed  Google Scholar 

  38. Inui A, Asakawa A, Bowers CY, Mantovani G, Laviano A, Meguid MM, et al. Ghrelin, appetite, and gastric motility: the emerging role of the stomach as an endocrine organ. FASEB J. 2004;18(3):439–56.

    Article  CAS  PubMed  Google Scholar 

  39. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402(6762):656–60.

    Article  CAS  PubMed  Google Scholar 

  40. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364(25):2392–404.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Rojdmark S, Calissendorff J, Danielsson O, Brismar K. Hunger-satiety signals in patients with Graves’ thyrotoxicosis before, during, and after long-term pharmacological treatment. Endocrine. 2005;27(1):55–61.

    Article  PubMed  Google Scholar 

  42. Hallgrimsson P, Nordenstrom E, Bergenfelz A, Almquist M. Hypocalcaemia after total thyroidectomy for Graves’ disease and for benign atoxic multinodular goitre. Langenbecks Arch Surg. 2012;397(7):1133–7.

    Article  PubMed  Google Scholar 

  43. Welch KC, McHenry CR. Total thyroidectomy: is morbidity higher for Graves’ disease than nontoxic goiter? J Surg Res. 2011;170(1):96–9.

    Article  PubMed  Google Scholar 

  44. Wong KP, Lang BH. Graves’ ophthalmopathy as an indication increased the risk of hypoparathyroidism after bilateral thyroidectomy. World J Surg. 2011;35(10):2212–8.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Solomon B, Glinoer D, Lagasse R, Wartofsky L. Current trends in the management of Graves’ disease. J Clin Endocrinol Metab. 1990;70(6):1518–24.

    Article  CAS  PubMed  Google Scholar 

  46. Khadra M, Delbridge L, Reeve TS, Poole AG, Crummer P. Total thyroidectomy: its role in the management of thyroid disease. Aust N Z J Surg. 1992;62(2):91–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by National Institutes of Health (NIH) T32 CA009614-23.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin, Madison, WI, USA

    David F. Schneider MD, MS, Taylor J. Jaraczewski, Herbert Chen MD & Rebecca S. Sippel MD

  2. Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Ratnam Nookala MBBS & Carmen C. Solorzano MD

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  1. David F. Schneider MD, MS
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  2. Ratnam Nookala MBBS
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  3. Taylor J. Jaraczewski
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  6. Rebecca S. Sippel MD
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Correspondence to David F. Schneider MD, MS.

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Schneider, D.F., Nookala, R., Jaraczewski, T.J. et al. Thyroidectomy as Primary Treatment Optimizes Body Mass Index in Patients with Hyperthyroidism. Ann Surg Oncol 21, 2303–2309 (2014). https://doi.org/10.1245/s10434-014-3542-8

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  • DOI: https://doi.org/10.1245/s10434-014-3542-8

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