Thyroid function tests after sleeve gastrectomy in euthyroid obese patients

Öz

Background and Aims: Obesity is a well-known clinical problem. It has secondary outcomes and complications that cause mortality and morbidity. The aim of this study is to define the alterations in thyroid function tests after sleeve gastrectomy. Materials and Methods: A total of 85 patients, 79 females and 6 males, were included in the study. Each patient’s body mass indexes, free triiodothyronine (freeT3), free thyroxine (freeT4), and thyroid stimulating hormone levels at preoperative and post-operative 6th and 12th month visits were recorded. Thyroid function tests of the patients grouped as group 0: preoperative, group 1: postoperative 6 months, group 2: postoperative 12-month for each test, respectively. All analyses were performed by means of the chemiluminescence method (Liaison®; DiaSorin S.p.A., Saluggia, Italy). Results: Serum freeT3 levels were decreased in all postoperative visits compared to the preoperative period. Median (25% - 75%) values for each visit were as follows: freeT30: 3.04 pg/mL (3.25 - 2.77), freeT31: 2.68 pg/mL (2.9 - 2.36), freeT32: 2.6 pg/mL (2.91 - 2.38). Serum freeT4 levels increased at the post-operative 6th month visit, and then decreased at the post-operative 6th month visit. Median (25% - 75%) values at each visit for were as follows, freeT40: 1.04 ng/dL (1.15 - 0.99), freeT41: 1.06 ng/dL (1.15 - 0.99), freeT42: 1.03 ng/dL (1.3 - 0.94). Serum thyroid stimulating hormone levels were decreased at post operative all visits compared to preoperative period. Median (25% - 75%) values at each visit were as follows: thyroid stimulating hormone0: 2.16 µIU/L (2.81 - 1.49), thyroid stimulating hormone1: 1.48 µIU/L (2.46 - : 0.93), thyroid stimulating hormone2: 1.47 µIU/L (2.3 - 0.92). There was no correlation between the decrease in thyroid stimulating hormone levels and the body mass index decrement after sleeve gastrectomy. Conclusions: We determined a significant decrease in thyroid stimulating hormone and freeT3 levels, and there was a fluctuating pattern in freeT4 levels after sleeve gastrectomy.

Anahtar Kelimeler

• Obesity
• sleeve gastrectomy
• thyroid function tests

Ötiroid obez hastalarda sleeve gastrektomi sonrası tiroid fonksiyon testleri

Öz

Giriş ve Amaç: Obezite, dünya genelinde bilinen bir klinik problemdir. Mortalite ve morbiditeye yol açan sekonder sonuçları ve komplikasyonları vardır. Bu çalışmanın amacı, sleeve gastrektomi sonrası tiroid fonksiyon testlerindeki değişiklikleri tanımlamaktır. Gereç ve Yöntem: Toplamda 85 hasta; 79 kadın ve 6 erkek çalışmaya dahil edilmiştir. Her hastanın, preoperatif ve postoperatif 6. ve 12. ay ziyaretlerinde vücut kitle indeksi, serbest T3, serbest T4, tiroid uyarıcı hormon seviyeleri kaydedilmiştir. Hastaların tiroid fonksiyon testleri, her test için sırasıyla grup 0: preoperatif, grup 1: postoperatif 6. ay, grup 2: postoperatif 12. ay olarak gruplandırılmıştır. Tüm analizler, kemilüminesans yöntemi (Liaison®; DiaSorin S.p.A., Saluggia, İtalya) ile gerçekleştirilmiştir. Bulgular: Serum serbest T3 seviyeleri, postoperatif tüm vizitlerde preoperatif döneme göre azalmıştır. Her vizit için medyan (25% - 75%) değerleri aşağıdaki gibidir: serbest T30: 3.04 pg/mL (3.25 - 2.77), serbest T31: 2.68 pg/mL (2.9 - 2.36), serbest T32: 2.6 pg/mL (2.91 - 2.38). Serum serbest T4 seviyeleri, postoperatif 6. ay vizitte artmış, ardından postoperatif 12. ay vizitte azalmıştır. Her vizit için medyan (25% - 75%) değerleri aşağıdaki gibidir: serbest T40: 1.04 ng/dL (1.15 - 0.99), serbest T41: 1.06 ng/dL (1.15 - 0.99), serbest T42: 1.03 ng/dL (1.3 - 0.94). Serum tiroid uyarıcı hormon seviyeleri, postoperatif tüm vizitlerde preoperatif döneme göre azalmıştır. Her vizit için medyan (25% - 75%) değerleri aşağıdaki gibidir: tiroid uyarıcı hormon0: 2.16 µIU/L (2.81 - 1.49), tiroid uyarıcı hormon1: 1.48 µIU/L (2.46 - 0.93), tiroid uyarıcı hormon2: 1.47 µIU/L (2.3 - 0.92). Sleeve gastrektomi sonrası tiroid uyarıcı hormon seviyelerindeki azalma ile vücut kitle indeksi düşüşü arasında bir korelasyon tespit edilmemiştir. Sonuç: Sleeve gastrektomi sonrası tiroid uyarıcı hormon ve serbest T3 seviyelerinde önemli bir azalma tespit ettik ve serbest T4 seviyelerinde dalgalı bir patern gözlemlendi.

Anahtar Kelimeler

• Obezite
• sleeve gastrektomi
• tiroid fonksiyon testleri

Kaynakça

1. 1. Garvey WT, Mechanick JI, Brett EM, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITYEXECUTIVE SUMMARY. Complete Guidelines available at https://www.aace.com/publications/guidelines. Endocr Pract. 2016;22(7):842-84. doi: 10.4158/EP161356.ESGL.
2. 2. Koshy AA, Bobe AM, Brady MJ. Potential mechanisms by which bariatric surgery improves systemic metabolism. Transl Res. 2013;161(2):63-72. doi: 10.1016/j.trsl.2012.09.004.
3. 3. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138-44. doi: 10.1381/096089206778392275.
4. 4. Lamounier RN, Pareja JC, Tambascia MA, Geloneze B. Incretins: clinical physiology and bariatric surgery--correlating the entero-endocrine system and a potentially anti-dysmetabolic procedure. Obes Surg. 2007;17(5):569-76. doi: 10.1007/s11695-007-9098-y.
5. 5. Waters GS, Pories WJ, Swanson MS, et al. Long-term studies of mental health after the Greenville gastric bypass operation for morbid obesity. Am J Surg. 1991;161(1):154-7; discussion 157-8. doi: 10.1016/0002-9610(91)90377-p.
6. 6. Greenberg I. Psychological aspects of bariatric surgery. Nutr Clin Pract. 2003;18(2):124-30. doi: 10.1177/0115426503018002124.
7. 7. Motamedi MAK, Khalaj A, Mahdavi M, Valizadeh M, Hosseinpanah F, Barzin M. Longitudinal Comparison of the Effect of Gastric Bypass to Sleeve Gastrectomy on Liver Function in a Bariatric Cohort: Tehran Obesity Treatment Study (TOTS). Obes Surg. 2019;29(2):511-8. doi: 10.1007/s11695-018-3537-9.
8. 8. Neff KJ, Baud G, Raverdy V, et al. Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study. Obes Surg. 2017;27(3):613-9. doi: 10.1007/s11695-016-2333-7.

9. 9. de Barros F, Setubal S, Martinho JM, Monteiro AB. Early Endocrine and Metabolic Changes After Bariatric Surgery in Grade III Morbidly Obese Patients: A Randomized Clinical Trial Comparing Sleeve Gastrectomy and Gastric Bypass. Metab Syndr Relat Disord. 2015;13(6):264-71. doi: 10.1089/met.2014.0152.
10. 10. Lascaris B, Pouwels S, Houthuizen P, et al. Cardiac structure and function before and after bariatric surgery: a clinical overview. Clin Obes. 2018;8(6):434-43. doi: 10.1111/cob.12278.
11. 11. Abu-Ghanem Y, Inbar R, Tyomkin V, et al. Effect of sleeve gastrectomy on thyroid hormone levels. Obes Surg. 2015;25(3):452-6. doi: 10.1007/s11695-014-1415-7.
12. 12. Zendel A, Abu-Ghanem Y, Dux J, Mor E, Zippel D, Goitein D. The Impact of Bariatric Surgery on Thyroid Function and Medication Use in Patients with Hypothyroidism. Obes Surg. 2017;27(8):2000-4. doi: 10.1007/s11695-017-2616-7.
13. 13. Michalaki MA, Vagenakis AG, Leonardou AS, et al. Thyroid function in humans with morbid obesity. Thyroid. 2006;16(1):73-8. doi: 10.1089/thy.2006.16.73.
14. 14. Neves JS, Castro Oliveira S, Souteiro P, et al; AMTCO Group. Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function. Obes Surg. 2018;28(1):97-103. doi: 10.1007/s11695-017-2792-5.
15. 15. Al-Musa HM. Impact of Obesity on Serum Levels of Thyroid Hormones among Euthyroid Saudi Adults. J Thyroid Res. 2017;2017:5739806. doi: 10.1155/2017/5739806.
16. 16. Ahima RS, Prabakaran D, Mantzoros C, et al. Role of leptin in the neuroendocrine response to fasting. Nature. 1996;382(6588):250-2. doi: 10.1038/382250a0.
17. 17. Nomura E, Toyoda N, Harada A, et al. Type 2 iodothyronine deiodinase is expressed in human preadipocytes. Thyroid. 2011;21(3):305-10. doi: 10.1089/thy.2010.0068.
18. 18. Mebis L, van den Berghe G. The hypothalamus-pituitary-thyroid axis in critical illness. The Netherlands journal of medicine. 2009;67(10):332-40.
19. 19. Pontikides N, Krassas GE. Basic endocrine products of adipose tissue in states of thyroid dysfunction. Thyroid. 2007;17(5):421-31. doi: 10.1089/thy.2007.0016.
20. 20. Valcavi R, Zini M, Peino R, Casanueva FF, Dieguez C. Influence of thyroid status on serum immunoreactive leptin levels. J Clin Endocrinol Metab. 1997;82(5):1632-4. doi: 10.1210/jcem.82.5.3954.
21. 21. Svare A, Nilsen TI, Bjoro T, Asvold BO, Langhammer A. Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway. Clin Endocrinol (Oxf). 2011;74(6):769-75. doi: 10.1111/j.1365-2265.2011.04009.x.
22. 22. Alagna S, Cossu ML, Masala A, et al. Evaluation of serum leptin levels and thyroid function in morbidly obese patients treated with bariatric surgery. Eat Weight Disord. 2003;8(2):95-9. doi: 10.1007/BF03324997.
23. 23. Chikunguwo S, Brethauer S, Nirujogi V, et al. Influence of obesity and surgical weight loss on thyroid hormone levels. Surg Obes Relat Dis. 2007;3(6):631-5; discussion 635-6. doi: 10.1016/j.soard.2007.07.011.
24. 24. MacCuish A, Razvi S, Syed AA. Effect of weight loss after gastric bypass surgery on thyroid function in euthyroid people with morbid obesity. Clin Obes. 2012;2(1-2):25-8. doi: 10.1111/j.1758-8111.2012.00036.x.
25. 25. Lips MA, Pijl H, van Klinken JB, et al. Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects. Eur J Endocrinol. 2013;169(3):339-47. doi: 10.1530/EJE-13-0339.
26. 26. Yang J, Gao Z, Yang W, et al. Effect of Sleeve Gastrectomy on Thyroid Function in Chinese Euthyroid Obese Patients. Surg Laparosc Endosc Percutan Tech. 2017;27(4):e66-e68. doi: 10.1097/SLE.0000000000000432.
27. 27. Ozsoy Z, Kutluturk F. Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Hormones in Euthyroid Obese Patients. Endocr Metab Immune Disord Drug Targets. 2018;18(4):407-11. doi: 10.2174/1871530318666180327114131.