The Effect of the Bariatric Surgery Type on the Levothyroxine Dose of Morbidly Obese Hypothyroid Patients

Overview

Journal Obes Surg

Date 2018 Jul 16

PMID 30008061

Citations 11

Authors

Jorge Pedro

Filipe Cunha

Pedro Souteiro

Joao Sergio Neves

Vanessa Guerreiro

Daniela Magalhaes

Rita Bettencourt-Silva

Sofia Castro Oliveira

Maria Manuel Costa

Joana Queiros

Paula Freitas

Ana Varela

Davide Carvalho

Affiliations

Soon will be listed here.

Abstract

Background: Doubts exist about the effect of different bariatric surgery (BS) types on levothyroxine (Lt4) absorption. We compared Lt4 doses and their variation (ΔLt4) in patients with hypothyroidism that underwent malabsorptive (MS) or restrictive (RS) surgery and studied predictors of Lt4 dose change.

Methods: Retrospective study of morbidly obese hypothyroid patients submitted to BS. We compared RS ("sleeve" gastrectomy or adjustable gastric banding) with MS (Roux-en-Y gastric bypass) patients. We built a multivariable logistic regression and a linear regression model to study predictors of Lt4 dose changes and ΔLt4, respectively.

Results: Fifty-seven patients: 35 MS and 22 RS. Mean age 47 years; 7% men. Patients submitted to MS had lower BMI at 1 year than those submitted to RS. Lt4 dose remained unchanged in 61.4%, increased in 12.3%, and decreased in 26.3% of patients. Initial and 1-year Lt4 dose were not different between surgical groups. Relative Lt4 dose, but not absolute (p = 0.07), increased at 1 year (p < 0.001). Neither BS nor BMI variation were predictors of Lt4 dose variation. BMI variation was associated with relative Lt4 dose change independently of initial BMI and BS type: β (95%CI) - 0.03 (- 0.05; 0.00); p = 0.03.

Conclusions: There were no differences in Lt4 dose and its variation between restrictive and malabsorptive techniques 1 year after surgery. Malabsorptive procedures may not affect Lt4 absorption differently from restrictive ones. Bariatric surgery type was not predictive of Lt4 dose changes. BMI variation is associated with relative Lt4 dose (dose per weight) variation and its association was independent of bariatric surgery type.

Citing Articles

Insight of the Biopharmaceutical Implication of Sleeve Gastrectomy on Levothyroxine Absorption in Hypothyroidism Patients.

Almukainzi M, ALQahtani R, Alanazi R, Alamri R, Alayed H Obes Surg. 2023; 34(1):192-197.

PMID: 38091193 DOI: 10.1007/s11695-023-06970-z.

Effectiveness of Bariatric Surgery for Improving Thyroid Function and Reducing Levothyroxine Dose in Patients With Obesity and Overt Hypothyroidism.

Alfaifi H, Altowairgi M, Algethami R, Altowairqi A, Althomali H, Almalki O Cureus. 2023; 15(5):e38780.

PMID: 37303346 PMC: 10249914. DOI: 10.7759/cureus.38780.

Thyroid Function Alteration in Obesity and the Effect of Bariatric Surgery.

Cordido M, Juiz-Valina P, Urones P, Sangiao-Alvarellos S, Cordido F J Clin Med. 2022; 11(5).

PMID: 35268429 PMC: 8911439. DOI: 10.3390/jcm11051340.

Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults.

Caron P, Grunenwald S, Persani L, Borson-Chazot F, Leroy R, Duntas L Rev Endocr Metab Disord. 2021; 23(3):463-483.

PMID: 34671932 PMC: 8528480. DOI: 10.1007/s11154-021-09691-9.

Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss.

Juiz-Valina P, Cordido M, Outeirino-Blanco E, Pertega S, Urones P, Garcia-Brao M J Clin Med. 2021; 10(16).

PMID: 34441981 PMC: 8396870. DOI: 10.3390/jcm10163685.

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