Weight Loss and variation of levothyroxine requirements in hypothyroid obese patients after bariatric surgery
Abstract
BACKGROUND: Obesity and hypothyroidism are both common disorders within the general population. Obese hypothyroid subjects require higher doses of levothyroxine (LT4) compared with normal weight individuals. Previous studies on the effects of bariatric surgery on LT4 dose requirements in hypothyroid subjects have provided conflicting results. The aim of this study was to evaluate the LT4 requirements in a group of obese subjects with acquired hypothyroidism, before and after weight loss achieved by bariatric surgery. METHODS: Ninety-three obese hypothyroid subjects (mean age = 48 ± 9 years; mean body mass index = 45.9 ± 5.6 kg/m(2)), were evaluated before and 28 ± 8 months after bariatric surgery. Changes in the LT4 dose, anthropometric measures, and hormone values were evaluated. In 20 patients, data of body composition, assessed by dual energy X-ray absorptiometry, were also analyzed. RESULTS: On average, after weight loss, a significant reduction of the total dose of LT4 was documented (from 130.6 ± 48.5 to 116.2 ± 38.6 μg/day; p < 0.001). The LT4 dose had to be reduced in 47 patients, was unchanged in 34, and had to be increased in 12 patients affected by autoimmune thyroiditis. Reduction of the LT4 dose was proportional to reduction of the lean body mass. CONCLUSIONS: The weight loss achieved with modern surgical bariatric procedures is associated with a reduction of LT4 requirements in most hypothyroid subjects, which appears to be related to a decrease of the lean body mass. Occasionally, a concurrent decline of residual thyroid function, as it occurs in autoimmune thyroiditis, can counteract this phenomenon and eventually produce an increase of LT4 needs. It is believed that during the weight loss phase that follows bariatric surgery, there is no need for preventive adjustments of the LT4 dose, but serum thyroid hormones and thyrotropin should be periodically monitored in order to detect possible variations of LT4 requirements and to allow proper corrections of the therapy.
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The reduction in TSH and LT4 requirements after bariatric surgery may be due to changes in lean body mass.
“Bariatric surgery can impact LT4 pharmacokinetics, and systematic reviews show that it is correlated with a reduction in TSH levels and daily LT4 requirements, 101,102 possibly due to changes in lean body mass.103”
From Refractory hypothyroidism: unraveling the complexities of diagnosis and management (2023) · cites this paper as [103]
Fierabracci et al. reported a drop in BMI and a significant downward adjustment in mean total dose of LT4 after bariatric surgery.
“Fierabracci et al. reported a drop in BMI and a significant downward adjustment in the mean total dose of LT4 after surgery [ 56 ]”
From Factors influencing the levothyroxine dose in the hormone replacement therapy of primary hypothyroidism in adults (2022) · cites this paper as [56]
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- Authors
- Fierabracci, P., Martinelli, S., Tamberi, A., Piaggi, P., Basolo, A., Pelosini, C., Ricco, I., Magno, S., Querci, G., Ceccarini, G., Scartabelli, G., Salvetti, G., Vitti, P., & Santini, F.
- Affiliations
- Azienda Ospedaliera Universitaria Pisana (IT)
- ORCID
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2016-04
- Volume
- 26
- Issue
- 4
- Pages
- 499-503
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2305269526
- Cited by
- 51
- References
- 26
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 4 · 2017: 2 · 2016: 3
- FWCI
- 5.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- levothyroxine dose, hypothyroidism, obesity, bariatric surgery, weight loss, lean body mass, autoimmune thyroiditis, thyroid function monitoring, body composition
- MeSH terms
- Adult, Anthropometry, Body Weight, Female, Humans, Hypothyroidism, Male, Middle Aged, Obesity, Retrospective Studies, Thyroxine, Weight Loss, Body Mass Index, Treatment Outcome, Bariatric Surgery
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