减肥手术后的左甲状腺素剂量
Levothyroxine Dosing Following Bariatric Surgery.
作者信息
Gadiraju Silpa, Lee Clare J, Cooper David S
机构信息
Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA.
出版信息
Obes Surg. 2016 Oct;26(10):2538-42. doi: 10.1007/s11695-016-2314-x.
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.
背景
基于药物吸收机制，预计减肥手术后左甲状腺素的需求量会增加。然而，关于这一主题的数据存在矛盾。本综述评估了减肥手术对左甲状腺素剂量的影响。
方法
数据来自PubMed、Scopus以及已发表文献目录的综述。
结果
10项研究中有6项表明术后需求量降低。大多数研究表明体重减轻与剂量之间存在相关性。只有3例病例报告和1例病例系列表明左甲状腺素需求量增加，归因于吸收不良。
结论
脂肪和瘦体重的减少可能抵消手术引起的吸收不良效应，导致术后左甲状腺素需求量降低。此外，左甲状腺素药代动力学受损的逆转以及甲状腺激素稳态设定点的改变也可能导致术后左甲状腺素需求量减少。
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