Department of Endocrinology and Metabolism and Shanghai Research Center of Thyroid Diseases, School of Medicine, Shanghai Tenth People's Hospital of Tongji University, Shanghai, 200072, China.
National Metabolic Management Center, Shanghai, 200072, China.
Obes Surg. 2019 Dec;29(12):3954-3965. doi: 10.1007/s11695-019-04063-4.
Bariatric surgery has a significant impact on levels of thyroid hormones and various inflammatory markers in obesity. The relationship between changes in thyroid hormones and inflammatory markers after bariatric surgery is unknown. We aimed to investigate the changes in thyroid hormones and their relations to inflammatory changes after laparoscopic sleeve gastrectomy (LSG) in Chinese patients with morbid obesity.
Eighty-eight patients with morbid obesity (56.8% female; age 30.9 ± 9.5 years; BMI 39.9 ± 5.7 kg/m) submitted to LSG were selected. Patients were subdivided into euthyroid group and subclinical hypothyroidism (SH) group. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), inflammatory markers, and related metabolic indexes were analyzed pre- and 12 months post-LSG.
SH patients presented significantly higher interleukin (IL)-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP) than euthyroid patients. Twelve-month post-surgery, the SH incidence decreased from 31.8 to 2.3% (P < 0.001). TSH levels were declined significantly in both groups but were more pronounced in SH group (P < 0.001), whereas no change in FT4 in either group. Additionally, we observed marked reduction of IL-6, TNF-α, and CRP in SH group, as well as TNF-α and CRP in euthyroid group. After adjusting for age, baseline BMI, and changes in BMI, decrease in TSH correlated significantly with decreased HOMA-IR and TNF-α in euthyroid group and decreased fasting insulin (FINS), IL-6, TNF-α, and CRP in SH group.
LSG promotes TSH reduction in patients with morbid obesity that is more pronounced in patients with SH and correlated with improved inflammatory state after surgery.
减重手术对肥胖患者的甲状腺激素水平和各种炎症标志物有显著影响。减重手术后甲状腺激素和炎症标志物变化之间的关系尚不清楚。我们旨在研究中国肥胖患者腹腔镜袖状胃切除术（LSG）后甲状腺激素的变化及其与炎症变化的关系。
选择 88 例病态肥胖患者（女性占 56.8%；年龄 30.9±9.5 岁；BMI 39.9±5.7 kg/m）进行 LSG。患者分为甲状腺功能正常组和亚临床甲状腺功能减退症（SH）组。分析术前和术后 12 个月甲状腺刺激激素（TSH）、游离甲状腺素（FT4）、炎症标志物和相关代谢指标。
SH 患者的白细胞介素（IL）-6、肿瘤坏死因子（TNF）-α和 C 反应蛋白（CRP）明显高于甲状腺功能正常患者。术后 12 个月，SH 发生率从 31.8%降至 2.3%（P<0.001）。两组 TSH 水平均显著下降，但 SH 组下降更明显（P<0.001），而两组 FT4 均无变化。此外，我们观察到 SH 组 IL-6、TNF-α和 CRP 明显减少，甲状腺功能正常组 TNF-α和 CRP 减少。在校正年龄、基线 BMI 和 BMI 变化后，甲状腺功能正常组 TSH 下降与 HOMA-IR 和 TNF-α下降显著相关，SH 组 TSH 下降与空腹胰岛素（FINS）、IL-6、TNF-α和 CRP 下降显著相关。
LSG 可降低病态肥胖患者的 TSH，SH 患者更为明显，与术后炎症状态改善相关。
