Levothyroxine dosing following bariatric surgery
Abstract
Background Based on the mechanisms of drug absorption, increased levothyroxine requirements are expected after bariatric surgery. However, there are conflicting data on this topic. This review evaluates the effects of bariatric surgery on levothyroxine dosing.Methods Data were obtained from PubMed, Scopus, and review of published bibliographies.Results Six of 10 studies demonstrated decreased postoperative requirements. Most demonstrated correlations between weight loss and dose. Only 3 case reports and 1 case series demonstrated increased levothyroxine requirements, attributed to malabsorption.Conclusions The loss of both fat and lean body mass may counteract malabsorptive effects from surgery, resulting in decreased postoperative levothyroxine requirements. In addition, the reversal of impaired levothyroxine pharmacokinetics and an altered set point of thyroid hormone homeostasis may also contribute to postoperative levothyroxine reductions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In bariatric malabsorptive procedures, such as jejunum-ileal bypass, a threefold to fourfold higher requirement of LT4 has been demonstrated compared to normal adult patients.
“Even in bariatric malabsorptive procedures, such as jejunum–ileal bypass, a threefold to fourfold higher requirement of LT4 has been demonstrated compared to normal adult patients (116).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [116]
Results from clinical trials comparing monotherapy and combined therapy are conflicting.
“Although combined treatment sounds promising, the results from clinical trials comparing monotherapy and combined therapy are conflicting (44, 158).”
From Levothyroxine: conventional and novel drug delivery formulations. (2023) · cites this paper as [158]
Cites
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
Patti, M., Houten, S. M., Bianco, A. C., Bernier, R., Larsen, P. R., Holst, J. J., Badman, M. K., Maratos‐Flier, E., Mun, E. C., Pihlajamaki, J., et al. (2009) · Obesity · doi:10.1038/oby.2009.102 · Cited by 591 · see citing works
Légrádi, G., Emerson, C. H., Ahima, R. S., Flier, J. S., & Lechan, R. M. (1997) · Endocrinology · doi:10.1210/en.138.6.2569 · Cited by 505 · see citing works
Lean Body Mass as a Predictor of Drug Dosage
Morgan, D. J., & Bray, K. M. (1994) · Clinical Pharmacokinetics · doi:10.2165/00003088-199426040-00005 · Cited by 301 · see citing works
Thyroid Function in Humans with Morbid Obesity
Michalaki, M. A., Vagenakis, A. G., Leonardou, A., Argentou, M. N., Habeos, I. G., Makri, M. G., Psyrogiannis, A. I., Kalfarentzos, F. E., & Kyriazopoulou, V. E. (2006) · Thyroid · doi:10.1089/thy.2006.16.73 · Cited by 295 · see citing works
Sleeve Gastrectomy—A “Food Limiting” Operation
Melissas, J., Daskalakis, M., Koukouraki, S., Askoxylakis, I., Metaxari, M., Dimitriadis, E., Stathaki, M., & Papadakis, J. (2008) · Obesity Surgery · doi:10.1007/s11695-008-9634-4 · Cited by 280 · see citing works
A systematic review of drug absorption following bariatric surgery and its theoretical implications
Padwal, R. S., Brocks, D. R., & Sharma, A. M. (2009) · Obesity Reviews · doi:10.1111/j.1467-789x.2009.00614.x · Cited by 264 · see citing works
Lean Body Mass Is a Major Determinant of Levothyroxine Dosage in the Treatment of Thyroid Diseases
Santini, F., Pinchera, A., Marsili, A., Ceccarini, G., Castagna, M. G., Valeriano, R., Giannetti, M., Taddei, D., Centoni, R., Scartabelli, G., et al. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1306 · Cited by 226 · see citing works
Ponce, J., Nguyen, N. T., Hutter, M. M., Sudan, R., & Morton, J. M. (2015) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2015.08.496 · Cited by 220 · see citing works
Clinical Pharmacokinetics of Drugs in Obesity
CHEYMOL, G. (1993) · Clinical Pharmacokinetics · doi:10.2165/00003088-199325020-00003 · Cited by 184 · see citing works
Pinkney, J. H., Goodrick, S., Katz, J., Johnson, A. B., Lightman, S. L., Coppack, S. W., & Mohamed‐Ali, V. (1998) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1998.00573.x · Cited by 167 · see citing works
Localization of human thyroxine absorption
HAYS, M. T. (1991) · Thyroid · doi:10.1089/thy.1991.1.241 · Cited by 138 · see citing works
Improvement of Hypothyroidism after Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity
Raftopoulos, Y., Gagné, D. J., Papasavas, P. K., Hayetian, F. D., Maurer, J., Bononi, P. L., & Caushaj, P. F. (2004) · Obesity Surgery · doi:10.1381/096089204323013514 · Cited by 88 · see citing works
Basic Concepts in Medicinal Chemistry
Harrold, M. W., & Zavod, R. M. (2013) · Drug Development and Industrial Pharmacy · doi:10.3109/03639045.2013.789908 · Cited by 86 · see citing works
Pirola, I., Formenti, A. M., Gandossi, E., Mittempergher, F., Casella, C., Agosti, B., & Cappelli, C. (2013) · Obesity Surgery · doi:10.1007/s11695-013-1015-y · Cited by 74 · see citing works
Malabsorption of Thyroid Hormones After Jejunoileal Bypass for Obesity
AZIZI, F., BELUR, R., & ALBANO, J. (1979) · Annals of Internal Medicine · doi:10.7326/0003-4819-90-6-941 · Cited by 61 · see citing works
Rubio, I. G. S., Galrão, A. L., Santo, M. A., Zanini, A. C., & Medeiros-Neto, G. (2012) · Obesity Surgery · doi:10.1007/s11695-011-0452-8 · Cited by 58 · see citing works
Improved Levothyroxine Pharmacokinetics After Bariatric Surgery
Gkotsina, M., Michalaki, M., Mamali, I., Markantes, G., Sakellaropoulos, G. C., Kalfarentzos, F., Vagenakis, A. G., & Markou, K. B. (2013) · Thyroid · doi:10.1089/thy.2011.0526 · Cited by 57 · see citing works
Fierabracci, P., Martinelli, S., Tamberi, A., Piaggi, P., Basolo, A., Pelosini, C., Ricco, I., Magno, S., Querci, G., Ceccarini, G., et al. (2016) · Thyroid · doi:10.1089/thy.2015.0473 · Cited by 51 · see citing works
Thyroxine malabsorption following intestinal bypass surgery.
Js, B., & Jf, M. (1986) · PubMed · Cited by 51 · see citing works
Laparoscopic Roux-en-Y Gastric Bypass Surgery on Morbidly Obese Patients with Hypothyroidism
Fazylov, R. M., Soto, E., Cohen, S., & Merola, S. (2008) · Obesity Surgery · doi:10.1007/s11695-007-9279-8 · Cited by 44 · see citing works
Daylong pituitary hormones in morbid obesity: effects of bariatric surgery
Camastra, S., Manco, M., Frascerra, S., Iaconelli, A., Mingrone, G., & Ferrannini, E. (2008) · International Journal of Obesity · doi:10.1038/ijo.2008.226 · Cited by 43 · see citing works
Impaired Pharmacokinetics of Levothyroxine in Severely Obese Volunteers
Michalaki, M. A., Gkotsina, M. I., Mamali, I., Markantes, G. K., Faltaka, A., Kalfarentzos, F., Vagenakis, A. G., & Markou, K. B. (2011) · Thyroid · doi:10.1089/thy.2010.0149 · Cited by 34 · cited 1× · see citing works
“Resolution of impaired levothyroxine pharmacokinetics in obesity may be one weight-related determinant of lower postoperative levothyroxine requirements [14].”
BackgroundAggarwal, S., Modi, S., & Jose, T. (2014) · World Journal of Surgery · doi:10.1007/s00268-014-2646-4 · Cited by 25 · see citing works
Increased requirement for thyroid hormone after a jejunoileal bypass operation.
(1980) · PubMed Central · Cited by 24 · see citing works
Sundaram, U., McBride, C. L., Shostrom, V., Meza, J. L., & Goldner, W. S. (2013) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2013.0006 · Cited by 13 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2020) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.10.025 · Cited by 608 · see citing works
Mechanick, J. I., Apovian, C., Brethauer, S., Garvey, W. T., Joffe, A. M., Kim, J., Kushner, R. F., Lindquist, R., Pessah-Pollack, R., Seger, J., et al. (2019) · Endocrine Practice · doi:10.4158/gl-2019-0406 · Cited by 510 · see citing works
Mechanick, J. I., Apovian, C. M., Brethauer, S. A., Garvey, W. T., Joffe, A. M., Kim, J. J., Kushner, R. F., Lindquist, R., Pessah‐Pollack, R., Seger, J., et al. (2020) · Obesity · doi:10.1002/oby.22719 · Cited by 410 · see citing works
Gastrointestinal malabsorption of thyroxine
Virili, C., Antonelli, A., Santaguida, M. G., Benvenga, S., & Centanni, M. (2019) · Endocrine Reviews · doi:10.1210/er.2018-00168 · Cited by 164 · see citing works
Thyroid hormone therapy for hypothyroidism
Biondi, B., & Cooper, D. S. (2019) · Endocrine · doi:10.1007/s12020-019-02023-7 · Cited by 110 · see citing works
Subclinical Hypothyroidism in Patients with Obesity and Metabolic Syndrome: A Narrative Review
Biondi, B. (2023) · Nutrients · doi:10.3390/nu16010087 · Cited by 122 · see citing works
Levothyroxine Dose Adjustment to Optimise Therapy Throughout a Patient’s Lifetime
Duntas, L. H., & Jonklaas, J. (2019) · Advances in Therapy · doi:10.1007/s12325-019-01078-2 · Cited by 94 · see citing works
Optimal thyroid hormone replacement
Jonklaas, J. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab031 · Cited by 89 · see citing works
Levothyroxine: conventional and novel drug delivery formulations.
Liu, H., Li, W., Zhang, W., Sun, S., & Chen, C. (2023) · Endocrine Reviews · doi:10.1210/endrev/bnac030 · Cited by 63 · see citing works
Levothyroxine therapy in gastric malabsorptive disorders
Virili, C., Brusca, N., Capriello, S., & Centanni, M. (2021) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.621616 · Cited by 52 · see citing works
Oral levothyroxine therapy postbariatric surgery: Biopharmaceutical aspects and clinical effects
Azran, C., Porat, D., Fine‐Shamir, N., Hanhan, N., & Dahan, A. (2019) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2019.01.001 · Cited by 42 · see citing works
de Carvalho, G. A., Paz-Filho, G., Mesa, C. O., & Graf, H. (2018) · European Journal of Endocrinology · doi:10.1530/eje-17-0947 · Cited by 41 · see citing works
Miedziaszczyk, M., Ciabach, P., & Szałek, E. (2021) · Pharmaceutics · doi:10.3390/pharmaceutics13122111 · Cited by 35 · see citing works
Centanni, M., Duntas, L., Feldt-Rasmussen, U., Koehrle, J., Peeters, R. P., Razvi, S., Trimboli, P., & Virili, C. (2025) · European Thyroid Journal · doi:10.1530/etj-25-0123 · Cited by 38 · see citing works
“Even in bariatric malabsorptive procedures, such as jejunum – ileal bypass, a threefold to fourfold higher requirement of LT4 has been demonstrated compared to normal adult patients (116).”
Sasaki, A., Yokote, K., Naitoh, T., Fujikura, J., Hayashi, K., Hirota, Y., Inagaki, N., Ishigaki, Y., Kasama, K., Kikkawa, E., et al. (2021) · Diabetology International · doi:10.1007/s13340-021-00551-0 · Cited by 33 · see citing works
Care of the Patient After Metabolic and Bariatric Surgery
Bramante, C., Wise, E., & Chaudhry, Z. (2022) · Annals of Internal Medicine · doi:10.7326/aitc202205170 · Cited by 28 · see citing works
Thyroid Function Alteration in Obesity and the Effect of Bariatric Surgery
Cordido, M., Juiz-Valiña, P., Urones, P., Sangiao‐Alvarellos, S., & Cordido, F. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11051340 · Cited by 27 · see citing works
Pedro, J. M. P., Cunha, F. M., Souteiro, P., Neves, J. S., Guerreiro, V. A., Magalhães, D. M. D. S., Bettencourt‐Silva, R., Oliveira, S. C., Costa, M. M., Queirós, J. C., et al. (2018) · Obesity Surgery · doi:10.1007/s11695-018-3388-4 · Cited by 25 · see citing works
The performance of levothyroxine tablet is impaired by bariatric surgery
Trimboli, P., Ossola, N., Torre, A., Mongelli, F., Quarenghi, M., Camponovo, C., Lucchini, B., Rotondi, M., Ruinelli, L., & Garofalo, F. (2022) · Endocrine · doi:10.1007/s12020-022-03289-0 · Cited by 17 · see citing works
Trotta, M., Broi, J. D., Salerno, A., Testa, R. M., & Marinari, G. M. (2017) · Updates in Surgery · doi:10.1007/s13304-017-0425-0 · Cited by 17 · see citing works
Julià, H., Benaiges, D., Roig, P. M., Pedro‐Botet, J., Villatoro, M., Fontané, L., Ramón, J. M., Climent, E., Roux, J. A. F., & Goday, A. (2019) · Obesity Surgery · doi:10.1007/s11695-019-03890-9 · Cited by 16 · see citing works
Impact of Bariatric Surgery in the Short and Long Term: A Need for Time-Dependent Dosing of Drugs
Lau, C., van Kesteren, C., Smeenk, R. M., Huitema, A. D. R., & Knibbe, C. A. J. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06770-5 · Cited by 13 · see citing works
Long-term Effect of Bariatric Surgery on the Use of Levothyroxine and Thyroid Levels
Yska, J. P., Arfman, I. J., van Oijen, M. A., de Heide, L. J. M., Emous, M., Veeger, N. J. G. M., & van Roon, E. N. (2021) · Obesity Surgery · doi:10.1007/s11695-021-05810-2 · Cited by 12 · see citing works
Change in levothyroxine requirements after bariatric surgery in patients with hypothyroidism
García‐Moreno, R. M., Cos-Blanco, A. I., Viñuela, I. C., Zapatero-Larrauri, M., & Herranz, L. (2022) · Endocrine Regulations · doi:10.2478/enr-2022-0009 · Cited by 11 · see citing works
Juiz-Valiña, P., Cordido, M., Outeiriño-Blanco, E., Pértega-Díaz, S., Urones, P., García-Brao, M. J., Mena, E., Pena-Bello, L., Sangiao‐Alvarellos, S., & Cordido, F. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10163685 · Cited by 9 · see citing works
Thyroid surgery in obese patients: A review of the literature
Frey, S., Blanchard, C. L., Caillard, C., Drui, D., Hamy, A., Trésallet, C., & Mirallié, É. (2020) · Journal of Visceral Surgery · doi:10.1016/j.jviscsurg.2020.06.002 · Cited by 6 · see citing works
Wu, T., He, W., Dharmasena, I., Prior, H. J., Vergis, A. S., & Hardy, K. M. (2023) · Surgical Endoscopy · doi:10.1007/s00464-023-10294-5 · Cited by 4 · see citing works
Clinical Practice Recommendations for Assessment and Management of Hypothyroidism
Alsifri, S. N., Aljuhani, N. R., Al-Jedai, A. H., Nasser, T., Alsabaan, F., Almudaiheem, H., Amir, A., Baissa, E., Ghannam, N., Aldawish, M., et al. (2022) · International Journal of Clinical Medicine · doi:10.4236/ijcm.2022.1312046 · Cited by 4 · see citing works
Hassan, M. M., Ahmad, Z., Hassan, M. B., Tasawar, Z., Hassan, Q., & Rahman, S. U. (2025) · Cureus · doi:10.7759/cureus.88354 · Cited by 4 · see citing works
Major imbalance of thyroid function after laparoscopic sleeve gastrectomy
Brutus, L., Poupard, A., & Glatin, C. L. (2019) · BMJ Case Reports · doi:10.1136/bcr-2019-230515 · Cited by 1 · see citing works
Bariatric Surgery: Can It Perform Benefits or Risks?
Mostafa, T. A.-H., Abdel-Hameed, A. M., & Ahmed, S. A.-K. (2024) · IntechOpen eBooks · doi:10.5772/intechopen.1006090 · Cited by 1 · see citing works
La chirurgie thyroïdienne chez le patient obèse : une revue de la littérature
Frey, S., Blanchard, C. L., Caillard, C., Drui, D., Hamy, A., Trésallet, C., & Mirallié, É. (2020) · Journal de Chirurgie Viscérale · doi:10.1016/j.jchirv.2020.03.011
Thyroxine replacement by colonic route and absorption kinetics: case report
Peña-González, R.-R., Quiroz-Alvarez, J., Sánchez-Paredes, J., Juárez-Vanegas, J.-C., Aguilera-Callejas, D.-E., Segovia, A., Etchegaray-Dondé, A., & Higuera-Hidalgo, F. R. (2024) · International Surgery Journal · doi:10.18203/2349-2902.isj20240004
Replacement Therapy for Hypothyroidism: Purpose and Indication for Correction
Степановна, М. Н., Алексеевич, Т. А., Matveyeva, Y. О., Олеговна, Щ. А., Кузина, И. А., Валерьевна, Г. Е., Эдуардовна, Т. М., & Petunina, N. A. (2024) · Effective Pharmacotherapy · doi:10.33978/2307-3586-2024-20-8-64-69
Effect of bariatric surgery on TSH levels and levothyroxine dosage in patients with thyroid diseasePreprint
Camastra, S., Patrizio, A., Palumbo, M. A., Astiarraga, B., Redi, G., Moretto, C., Bellini, R., & Antonelli, A. (2024) · Research Square · doi:10.21203/rs.3.rs-5285577/v1
Pharmacological Interactions of Levothyroxine in Multiple-Treated Patients
Marco, F. D., & Cusini, C. (2025) · Springer eBooks · doi:10.1007/978-3-032-01700-0_14
Nominé-Criqui, C., Bihain, F., Bachelin, L., Scheyer, N., Brunaud, L., & Meyre, D. (2026) · medRxiv · doi:10.64898/2026.04.30.26352121
Patrizio, A., Palumbo, M., Astiarraga, B., Redi, G., Moretto, C., Bellini, R., Antonelli, A., & Camastra, S. (2026) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-026-01873-1
El‐Sehrawy, A. A. M. A., Gameil, M. A., Nakib, A. M. E., Aseeri, A. A., Alanazi, M. A., Alharbi, S. S., Taki-Eldin, A., Maashi, M. S., Elmazny, G. M., Almansour, H., et al. (2026) · BMC Endocrine Disorders · doi:10.1186/s12902-026-02599-y
- Authors
- Gadiraju, S., Lee, C. J., & Cooper, D. S.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Gadiraju, Silpa
- Venue
- Obesity Surgery
- Published
- 2016-07-30
- Volume
- 26
- Issue
- 10
- Pages
- 2538-2542
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2480153760
- Cited by
- 39
- References
- 26
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 3 · 2019: 7 · 2018: 3 · 2017: 1
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- NO FUNDING
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine, bariatric surgery
- MeSH terms
- Dose-Response Relationship, Drug, Humans, Hypothyroidism, Obesity, Morbid, Postoperative Period, Thyroid Hormones, Thyroxine, Weight Loss, Bariatric Surgery
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
