Pre-operative evaluation of obese patients admitted for bariatric surgery: observations suggesting the introduction of a detailed screening for thyroid diseases

Daniela Gallo; Silvia Ippolito; Jessica Sabatino; Giovanni Veronesi; Francesco Frattini; Eugenia Dozio; Eugenia Trotti; Valeria Cortinovis; Federico Giussani; Adriana Lai; Lorenza Sassi; Maria Laura Tanda; Marco Ferrario; Luigi Bartalena; Eliana Piantanida

doi:10.1530/endoabs.56.P587

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Endocrine Abstracts (2018) 56 P587 | DOI: 10.1530/endoabs.56.P587

ECE2018 Poster Presentations: Diabetes, Obesity and Metabolism Obesity (78 abstracts)

Pre-operative evaluation of obese patients admitted for bariatric surgery: observations suggesting the introduction of a detailed screening for thyroid diseases

Daniela Gallo ¹ , Silvia Ippolito ¹ , Jessica Sabatino ¹ , Giovanni Veronesi ² , Francesco Frattini ³ , Eugenia Dozio ¹ , Eugenia Trotti ¹ , Valeria Cortinovis ⁴ , Federico Giussani ⁴ , Adriana Lai ¹ , Lorenza Sassi ¹ , Maria Laura Tanda ¹ , Marco Ferrario ² , Luigi Bartalena ¹ & Eliana Piantanida ¹

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Background: So far, guidelines for bariatric surgery do no recommend the universal screening for thyroid diseases, except the TSH measurement in selected patients. However, a possible interplay between obesity (possibly complicated by obesity-related comorbidities) and thyroid diseases has been postulated.

Objective: Aim of the study was to investigate the prevalence of thyroid diseases in a cohort of obese patients, evaluated for bariatric surgery. Methods in the study period 2014–2017, 88 patients (72 women and 16 men, mean age 43±11 years), with second or third class obesity, were consecutively screened at the Outpatients Clinic for the study of Obesity, University of Insubria. All patients had preliminary psychosocial tests, nutritional, surgical and endocrinological evaluations. Beyond the pre-operative analysis recommended by the international and national guidelines, serum TSH, TPOAb and TgAb levels and neck ultrasound were assessed. When clinically appropriate, further tests, such as calcitonin determination and thyroid fine needle aspiration were performed. Thyroid diseases were classified as thyroid autoimmune disease, nodular disease, goiter, primitive hypothyroidism or hyperthyroidism.

Results: 45/88 patients were eligible for bariatric surgery. Data were collected on the whole study-population (88 patients). Interestingly, patients that fulfilled the diagnosis of metabolic syndrome (34%) had higher incidence of thyroid diseases (P=0.002). Forty patients out of eighty-eight patients (45.5%) had thyroid diseases (17 new cases, 42.5%). Among patients with known thyroid diseases, 23% were treated with levothyroxine (mean dose 0.86 mcg/Kg body weight/day). Mean thyroid volume was 16.7±6.5 ml in women and 17.5±2.9 ml in men; mean TSH level was 2.1±1.2 μU/ml. According to the results of thyroid ultrasound, 78% of patients had hypoecogenic pattern, 24% (21/88) had goiter (52% previously undiagnosed), while 35% had nodular disease (31/88, new diagnosis in 55% of cases). Fifteen patients had autoimmune thyroiditis (17%), of which 40% was newly discovered. Two patients had differentiated thyroid carcinoma (one new case).

Conclusion: Prevalence of thyroid diseases, especially goiter (24% vs 10% in the general population), was higher in the study-population than that observed in normal-weight patients. Interestingly a high proportion of thyroid diseases were undiagnosed. Moreover the incidence of thyroid diseases was higher in patients with metabolic syndrome. Consistent evidences from large trials are warranted. According to these preliminary data, we suggest the introduction of detailed thyroid screening in pre-operative evaluation of obese patients admitted for bariatric surgery.