Different impact of sleeve gastrectomy and Roux-en-Y gastric bypass on thyroid function and levothyroxine requirements.

IF 3.5 3区医学 Q2 PSYCHIATRY

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Pub Date : 2026-06-19 DOI:10.1007/s40519-026-01873-1

Armando Patrizio, Maria Palumbo, Brenno Astiarraga, Giacomo Redi, Carlo Moretto, Rosario Bellini, Alessandro Antonelli, Stefania Camastra

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引用次数: 0

Abstract

Purpose: Bariatric surgery might impact the thyroid function test and, in hypothyroid patients, the dose of levothyroxine (LT4), but data are not univocal. We evaluated changes in thyroid function during the first year following bariatric surgery in patients without pre-existing thyroid disease, as well as adjustments in LT4 dosage in those with thyroid disorders, comparing the effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods: A retrospective observational study including 69 patients on LT4 therapy (Tr) and 85 patients with normal thyroid function (Nt) at pre-surgical work-up and at regular follow-up at 45 days, 3-6 months and 1-year visits after surgery.

Results: The mean body weight reduction for the entire cohort was in 31.4 ± 0.7% 1 year after surgery. In the two Nt groups, TSH levels remained stable throughout the observation period, without differences for type of surgery and without relationship with body weight. After bariatric surgery, the patients treated with LT4, belonging to both Tr-RYGB and Tr-SG, needed to increase the dosage per kg body weight to achieve stable TSH. At 1 year, the increase of LT4/kg/die was higher in the Tr-RYGB group than Tr-SG group (0.44 vs 0.30 mcg/kg/die, p = 0.032).

Conclusion: In patients with severe obesity and normal thyroid function, TSH levels are not related with body weight change. Patients treated with LT4, after bariatric surgery need to in-crease the dosage per kg of body weight of the LT4 especially after surgery with malabsorptive component (RYGB) compared to restrictive surgery (SG).

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袖式胃切除术和Roux-en-Y胃旁路术对甲状腺功能和左旋甲状腺素需求的不同影响。

目的：减肥手术可能会影响甲状腺功能测试，在甲状腺功能低下的患者中，左旋甲状腺素（LT4）的剂量，但数据并非单一。我们评估了没有甲状腺疾病的患者在减肥手术后第一年甲状腺功能的变化，以及甲状腺疾病患者LT4剂量的调整，比较了Roux-en-Y胃旁路术（RYGB）和袖式胃切除术（SG）的效果。方法：回顾性观察研究69例接受LT4治疗（Tr）的患者和85例甲状腺功能正常（Nt）的患者，术前随访，术后45天、3-6个月和1年定期随访。结果：手术后1年，整个队列的平均体重减轻了31.4±0.7%。在两个Nt组中，TSH水平在整个观察期间保持稳定，没有手术类型的差异，也与体重无关。在减肥手术后，接受LT4治疗的患者，无论是Tr-RYGB还是Tr-SG，都需要增加每公斤体重的剂量以达到稳定的TSH。1年时，Tr-RYGB组LT4/kg/die的增加量高于Tr-SG组（0.44 vs 0.30 mcg/kg/die, p = 0.032）。结论：在甲状腺功能正常的重度肥胖患者中，TSH水平与体重变化无关。与限制性手术（SG）相比，接受LT4治疗的患者在减肥手术后需要增加每公斤体重LT4的剂量，特别是在有吸收不良成分（RYGB）的手术后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity 医学-精神病学

CiteScore

6.50

自引率

10.30%

发文量

170

审稿时长

>12 weeks

期刊介绍： Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity is a scientific journal whose main purpose is to create an international forum devoted to the several sectors of eating disorders and obesity and the significant relations between them. The journal publishes basic research, clinical and theoretical articles on eating disorders and weight-related problems: anorexia nervosa, bulimia nervosa, subthreshold eating disorders, obesity, atypical patterns of eating behaviour and body weight regulation in clinical and non-clinical populations.