Thyroid Hormone Replacement Dosing after Bariatric Surgery in Patients with Primary Hypothyroidism And Severe Obesity: Tehran Obesity Treatment Study
Authors' conclusion
Most hypothyroid patients experienced either a reduction or no change in LT4 (μg/day) dosage after 36 months in both surgical groups. The LT4/FM (μg/kg) was significantly increased in patients undergoing either SG or OAGB with greater alterations in the latter.
Study context
- Population
- Patients with primary hypothyroidism and severe obesity undergoing bariatric surgery; Sleeve gastrectomy (SG) 88.3% women, one anastomosis gastric bypass (OAGB) 92% women
- Participants
- 1,030 patients
- Exposure
- SG vs OAGB
- SGn = 707
- OAGBn = 323
- Outcome
- Postsurgery LT4 requirements with attention to body composition changes
- Follow-up
- 36 months
Methodological detailsthree-year follow-up, generalized estimating equation (GEE) adjusted for weight as time-varying covariate
- Three-year follow-up
- GEE adjusted for weight as time-varying covariate
Main finding
As reported in the abstract
LT4/fat mass (FM) ratio (μg/kg), baseline to 36 months
| Group | Value | Baseline | Ptrend |
|---|---|---|---|
| SG | 2.7 (unspecified interval 2.0–3.5) μg/kg | 1.8 (1.5-2.2) | 0.039 |
| OAGB | 3.2 (unspecified interval 2.7–4.8) μg/kg | 1.7 (1.4-2.2) | <0.001 |
Value
SG2.7 (unspecified interval 2.0–3.5) μg/kg
OAGB3.2 (unspecified interval 2.7–4.8) μg/kg
Baseline
SG1.8 (1.5-2.2)
OAGB1.7 (1.4-2.2)
Ptrend
SG0.039
OAGB<0.001
- OAGB vs SG: pbetween = 0.060 — greater levothyroxine (LT4)/FM dose adjustments with OAGB
Observational data: associations, not effects.
Further findings
LT4 (μg/day) dose reduction · third year
LT4 (μg/day) dose increment · third year
TSH and T4 over time · 36 months
- TSH decreased over time in SG
- P for trend = <0.001
- TSH and T4 did not significantly change over time in OAGB
Original publication
Thyroid Hormone Replacement Dosing after Bariatric Surgery in Patients with Primary Hypothyroidism And Severe Obesity: Tehran Obesity Treatment Study. Thyroid. Published 4 September 2024. doi:10.
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