Improved Levothyroxine Pharmacokinetics After Bariatric Surgery
Abstract
BACKGROUND: The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointestinal tract where LT4 is absorbed in patients with severe obesity before and after surgery. METHODS: We studied 32 severely obese nonhypothyroid patients who underwent sleeve gastrectomy (SG; n=10), Roux-en-Y gastric bypass (RYGBP; n=7), or biliopancreatic diversion with long limbs (BPD-LL; n=15). Before surgery, from 8:00 a.m., blood samples were collected before and every 30 minutes after the oral administration of a solution of 600 μg of LT4. The same procedure was repeated 35 days after surgery. We estimated the pharmacokinetic parameters of LT4 before and after surgery, including the area under the curve (AUC), the peak thyroxine concentration (Cmax), and the time to peak thyroxine concentration (Tmax). RESULTS: Following surgery, in the SG group, the mean AUC was higher than it was before surgery (18.97±6.01 vs. 25.048±6.47 [μg/dL]·h; p<0.01), whereas the values of Cmax and Tmax were similar to those before surgery. In the RYGBP group, mean AUC, Cmax, and Tmax were similar before and after surgery. In the BPD-LL group, mean AUC and Cmax were higher after surgery than before (14.18±5.64 vs. 25.51±9.1 [μg/dL]·h, p<0.001; 5.62±1.34 vs. 8.16±2.57 μg/dL, p<0.001, respectively), whereas Tmax was similar. CONCLUSIONS: The pharmacokinetic parameters of LT4 absorption are improved following SG and BPD-LL types of bariatric procedures. We conclude that the stomach, the duodenum, and the upper part of the jejunum are not sites for LT4 absorption, because in the above-mentioned bariatric procedures these are bypassed or removed.
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Although case reports suggest increased LT4 requirements after intestinal bypass surgery, direct study showed LT4 absorption appeared preserved after Roux-en-Y surgery and in 32 patients undergoing other gastric bypass procedures.
“Although there are case reports of increased LT4 requirements after intestinal bypass surgery (164-166), when studied directly LT4 absorption appeared to be preserved after Roux-en-Y surgery (167) and in 32 patients undergoing various other gastric bypass procedures (168).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [168]
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- Authors
- Gkotsina, M., Michalaki, M., Mamali, I., Markantes, G., Sakellaropoulos, G. C., Kalfarentzos, F., Vagenakis, A. G., & Markou, K. B.
- Affiliations
- General University Hospital of Patras (GR)
- Corresponding author
- Markou, Kostas B.
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2013-04
- Volume
- 23
- Issue
- 4
- Pages
- 414-419
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2044803513
- Cited by
- 57
- References
- 31
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 7 · 2019: 5 · 2018: 4 · 2017: 4 · 2016: 8 · 2015: 4 · 2014: 4 · 2013: 4
- FWCI
- 3.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- 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, pharmacokinetics, bariatric surgery, morbid obesity, drug absorption, sleeve gastrectomy, Roux-en-Y gastric bypass, area under the curve, peak concentration, gastrointestinal bypass
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Obesity, Thyroid Hormones, Thyroxine, Treatment Outcome, Bariatric Surgery
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