Neves João Sérgio, Castro Oliveira Sofia, Souteiro Pedro, Pedro Jorge, Magalhães Daniela, Guerreiro Vanessa, Bettencourt-Silva Rita, Costa Maria Manuel, Cristina Santos Ana, Queirós Joana, Varela Ana, Freitas Paula, Carvalho Davide
Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.
Department of Surgery and Physiology, Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal.
Obes Surg. 2018 Jan;28(1):97-103. doi: 10.1007/s11695-017-2792-5.
Several studies have reported that morbid obesity is associated with increased thyroid-stimulating hormone (TSH) levels. However, it is not clear what is the impact of bariatric surgery on postoperative thyroid function. The aim of this study was to evaluate the effect of weight loss after bariatric surgery on TSH levels in euthyroid patients with morbid obesity.
We performed a retrospective observational study of 949 euthyroid patients (86.1% female; age 42.0 ± 10.3 years, BMI 44.3 ± 5.7 kg/m) with morbid obesity submitted to bariatric surgery (laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, or sleeve gastrectomy). Patients were subdivided in two groups: normal TSH group (TSH <2.5 mU/L) and high-normal TSH group (TSH ≥2.5 mU/L). The impact of anthropometric parameters, comorbidities, TSH, free thyroxine (FT4), free triiodothyronine (FT3), type of surgery, and excessive body weight loss (EBWL) on TSH variation 12 months after surgery was evaluated.
The high-normal TSH group (24.3% of patients) included more women, presented a higher BMI, higher systolic blood pressure, and higher FT3 levels. There was a significant decrease of TSH 12 months after surgery that was more marked in the high-normal TSH group (normal TSH group: 1.57 ± 0.49 to 1.53 ± 0.69 mIU/L, p = 0.063; high-normal TSH group: 3.23 ± 0.59 to 2.38 ± 0.86 mIU/L, p < 0.001). In a multivariate analysis, after adjusting for relevant covariates, EBWL, baseline BMI, and baseline FT3 were significantly associated with TSH decrease 12 months after bariatric surgery.
Bariatric surgery promotes a decrease of TSH that is significantly greater in patients with high-normal TSH and is independently associated with EBWL after surgery.
多项研究报告称，病态肥胖与促甲状腺激素（TSH）水平升高有关。然而，减肥手术对术后甲状腺功能的影响尚不清楚。本研究的目的是评估减肥手术后体重减轻对病态肥胖的甲状腺功能正常患者TSH水平的影响。
我们对949例接受减肥手术（腹腔镜可调节胃束带术、Roux-en-Y胃旁路术或袖状胃切除术）的病态肥胖甲状腺功能正常患者进行了一项回顾性观察研究（86.1%为女性；年龄42.0±10.3岁，BMI 44.3±5.7kg/m）。患者分为两组：TSH正常组（TSH<2.5mU/L）和TSH高正常组（TSH≥2.5mU/L）。评估了人体测量参数、合并症、TSH、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、手术类型和过度体重减轻（EBWL）对术后12个月TSH变化的影响。
TSH高正常组（占患者的24.3%）女性更多，BMI更高，收缩压更高，FT3水平更高。术后12个月TSH显著下降，在TSH高正常组中更为明显（TSH正常组：1.57±0.49至1.53±0.69mIU/L，p=0.063；TSH高正常组：3.23±0.59至2.38±0.86mIU/L，p<0.001）。在多变量分析中，在调整相关协变量后，EBWL、基线BMI和基线FT3与减肥手术后12个月TSH下降显著相关。
减肥手术可促进TSH下降，在TSH高正常的患者中下降更为显著，且与术后EBWL独立相关。
