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Laparoscopic Sleeve Gastrectomy Leads to Reduction in Thyroxine Requirement in Morbidly Obese Patients With Hypothyroidism

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Abstract

Background

The impact of laparoscopic sleeve gastrectomy (LSG) on various co-morbidities including type II diabetes mellitus, hypertension, and sleep apnea is well established. However, its effect on hypothyroidism has not been given due attention evidenced by the scant literature on the subject. The purpose of this report is to assess the change in thyroxine (T4) requirement in morbidly obese patients with clinical hypothyroidism after LSG.

Methods

We conducted a retrospective review of morbidly obese patients on T4 replacement therapy for clinical hypothyroidism who underwent LSG from August 2009 to July 2012 at our institution.

Results

Of the 200 patients who underwent LSG during this period, 21 (10.5 %) were on T4 replacement therapy preoperatively for clinical hypothyroidism. Two patients were lost to follow-up. The remaining 19 patients were categorized into two groups. Group 1 comprised 13 patients with decreased T4 requirements after LSG. Group 2 comprised six patients in whom the T4 dose remained unaltered. The mean change in T4 requirement in group 1 was 42.07 % (12–100 %). Group 1 patients had a significantly higher mean preoperative body mass index (48.7 vs. 43.0 kg/m2; p = 0.03) than the group 2 patients. There was a significant correlation between the percentage excess weight loss and the percentage change in T4 requirement in group 1 (r = 0.607, p = 0.028).

Conclusions

Sleeve gastrectomy has a favorable impact on hypothyroid status as seen by a reduction in T4 requirement in the majority of morbidly obese patients with overt hypothyroidism.

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References

  1. Fierabracci P, Pinchera A, Martinelli S et al (2011) Prevalence of endocrine diseases in morbidly obese patients scheduled for bariatric surgery: beyond diabetes. Obes Surg 21:54–60

    Article  PubMed  Google Scholar 

  2. Michalaki MA, Vagenakis AG, Leonardou AS et al (2006) Thyroid function in humans with morbid obesity. Thyroid 16:73–78

    Article  PubMed  CAS  Google Scholar 

  3. Danforth E Jr, Horton ES, O’Connell M et al (1979) Dietary-induced alterations in thyroid hormone metabolism during overnutrition. J Clin Investig 64:1336–1347

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Fazylov R, Soto E, Cohen S et al (2008) Laparoscopic Roux-en-Y gastric bypass surgery on morbidly obese patients with hypothyroidism. Obes Surg 18:644–647

    Article  PubMed  Google Scholar 

  5. Raftopoulos Y, Gagné DJ, Papasavas P et al (2004) Improvement of hypothyroidism after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 14:509–513

    Article  PubMed  Google Scholar 

  6. Gkotsina M, Michalaki M, Mamali I et al (2013) Improved levothyroxine pharmacokinetics after bariatric surgery. Thyroid 23:414–419

    Article  PubMed  CAS  Google Scholar 

  7. Pinkney JH, Goodrick SJ, Katz J et al (1998) Leptin and the pituitary thyroid axis: a comparative study in lean, obese, hypothyroid and hyperthyroid subjects. Clin Endocrinol (Oxf) 49:583–588

    Article  CAS  Google Scholar 

  8. Ortiga-Carvalho TM, Oliveira KJ, Soares BA et al (2002) The role of leptin in the regulation of TSH secretion in the fed state: in vivo and in vitro studies. J Endocrinol 174:121–125

    Article  PubMed  CAS  Google Scholar 

  9. Zimmermann-Belsing T, Brabant G, Holst JJ et al (2003) Circulating leptin and thyroid dysfunction. Eur J Endocrinol 149:257–271

    Article  PubMed  CAS  Google Scholar 

  10. Ortega FJ, Moreno-Navarrete JM, Ribas V et al (2009) Subcutaneous fat shows higher thyroid hormone receptor-alpha1 gene expression than omental fat. Obesity 17:2134–2141

    Article  PubMed  CAS  Google Scholar 

  11. Reinehr T (2010) Obesity and thyroid function. Mol Cell Endocrinol 316:165–171

    Article  PubMed  CAS  Google Scholar 

  12. Yashkov YI, Vinnitsky LI, Poroykova MV et al (2000) Some hormonal changes before and after vertical banded gastroplasty for severe obesity. Obes Surg 10:48–53

    Article  PubMed  CAS  Google Scholar 

  13. Dall’Asta C, Paganelli M, Morabito A et al (2010) Weight loss through gastric banding: effects on TSH and thyroid hormones in obese subjects with normal thyroid function. Obesity 18:854–857

    Article  PubMed  Google Scholar 

  14. Lips MA, Pijl H, van Klinken JB et al (2013) Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects. Eur J Endocrinol 169:339–347

    Article  PubMed  CAS  Google Scholar 

  15. Lacobellis G, Ribaudo MC, Zappaterreno A et al (2005) Relationship of thyroid function with body mass index, leptin, insulin sensitivity and adiponectin in euthyroid obese women. Clin Endocrinol (Oxf) 62:487–491

    Article  Google Scholar 

  16. Rosenbaum M, Hirsch J, Murphy E et al (2000) Effects of changes in body weight on carbohydrate metabolism, catecholamine excretion, and thyroid function. Am J Clin Nutr 71:1421–1432

    PubMed  CAS  Google Scholar 

  17. Ferguson DC, Caffall Z, Hoenig M (2007) Obesity increases free thyroxine proportionally to non-esterified fatty acid concentrations in adult neutered female cats. J Endocrinol 194:267–273

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that there are no areas of potential or real conflict.

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Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India

    Sandeep Aggarwal, Shrey Modi & Toney Jose

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  1. Sandeep Aggarwal
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  2. Shrey Modi
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  3. Toney Jose
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Correspondence to Sandeep Aggarwal.

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Aggarwal, S., Modi, S. & Jose, T. Laparoscopic Sleeve Gastrectomy Leads to Reduction in Thyroxine Requirement in Morbidly Obese Patients With Hypothyroidism. World J Surg 38, 2628–2631 (2014). https://doi.org/10.1007/s00268-014-2646-4

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  • DOI: https://doi.org/10.1007/s00268-014-2646-4

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