ETA2024 Poster Presentations Hypothyroidism (10 abstracts)
Effect of bariatric surgery on tsh levels and levothyroxine dosage in patients with thyroid disease: sleeve gastrectomy vs roux-en-y gastric bypass
Armando Patrizio 1 , Marianna Palumbo 2 , Brenno Astiarraga 3 , Giacomo Redi 4 , Federico Pagani 2 , Carlo Moretto 5 , Rosario Bellini 6 , Alessandro Antonelli 7 & Stefania Camastra 2
1University of Pisa, Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy, Pisa, Italy; 2University of Pisa, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, Italy; 3Pere Virgili Institute for Health Research (Iispv), Terragona, Spain, Spain; 4Neuroscience Institute, National Center for Research (Cnr), Pisa, Italy, Italy; 5Azienda Ospedaliero Universitaria Pisana, Bariatric Surgery Unit, Santa Chiara Hospital, Pisa, Italy, Italy; 6Azienda Ospedaliero-Universitaria Pisana, Bariatric Surgery Unit, Santa Chiara Hospital, Pisa, Italy, Italy; 7University of Pisa, Department of Surgery, Medical and Molecular Pathology and of Critical Area, University of Pisa, Pisa, Italy, Italy
Background: Some evidence indicates how bariatric surgery impacts the thyroid function test and, in hypothyroid patients, the dose of levothyroxine (LT4), but data are not univocal. Aim: To examine, in a single center retrospective analysis, the relationship between change in body weight, plasma levels of TSH and dosage of LT4 in patients with thyroid disease undergoing bariatric surgery and to compare the effects of Roux-en-Y gastric bypass (RYGB) vs sleeve gastrectomy (SG).
Methods: The data was collected from medical records of hospitalization of 235 patients (104 SG and 131 RYGB) who underwent pre-surgical work-up and from outpatient medical records of the same patients at 45 days, 3–6 months and 1-year visits after surgery. In the final analysis we included 69 patients on LT4 therapy (43 Th-RYGB and 26 Th-SG) and 85 patients without thyroid diseases with normal thyroid function (48 Ct-RYGB and 37 Ct-SG), who served as matched controls.
Results: The mean body weight reduction for al cohort was in 31.4±0.7% after 1 year from the surgery. In the two Ct groups, TSH levels remained stable throughout the observation period, without differences for type of surgery and without relationship with body weight. Free-T3 levels, decreased significantly at all follow-ups, in both CT groups and in Th-RYGB (P < 0.01). After bariatric surgery, the patients treated with LT-4, belonging to both Th-RYGB and Th-SG, needed to increase the dosage per body weight to achieve stable TSH. At 1 year, the increase of LT4/kg/die was higher in the Th-RYGB group than Th-SG group (0.44 vs 0.30 mg/kg/die, P = 0.032).
Conclusions: In patients with severe obesity with normal thyroid function, TSH levels are not related with body weight change. Patients treated with LT4, after bariatric surgery need to increase the dosage pro kg of body weight of the LT4 and the increase is higher after surgery with malabsorptive component (RYGB) compared to restrictive surgery (SG). These data support a major role of the impaired drug absorption consequence of bariatric surgery rather than of the new body weight in determining the subsequent LT4 dosage. The results should be confirmed on a larger sample.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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