Bian Nannan, Sun Xiaomeng, Zhou Biao, Zhang Lin, Wang Qiu, An Yu, Li Xiaohui, Li Yinhui, Liu Jia, Meng Hua, Wang Guang
Department of Endocrinology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Departments of General Surgery and Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China.
Endocr Connect. 2021 Oct 13;10(10):1326-1336. doi: 10.1530/EC-21-0360.
Bariatric surgery has become the most effective treatment for morbid obesity. Increasing evidence showed that bariatric surgery can alleviate insulin resistance and influence thyroid function. This study aimed to investigate the relationship between changes in thyroid function and adipose tissue insulin resistance (adipo-IR) after bariatric surgery.
A total of 287 non-diabetic participants with regular thyroid function were recruited and divided into the lean, overweight and obese groups. Among them, 50 morbidly obese patients submitted to bariatric surgery.
The obese group had a higher level of adipo-IR, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), FT3/free thyroxine (FT4) and metabolism disorders than the lean and overweight groups. BMI was correlated with TSH, FT3, FT3/FT4 and adipo-IR (r = 0.309, 0.315, 0.322 and 0.651, respectively, all P < 0.001). Adipo-IR was significantly correlated with TSH (r = 0.402, P < 0.001), FT3 (r = 0.309, P < 0.001), and FT3/FT4 (r = 0.228, P < 0.05). Bariatric surgery resulted in a sharp decline in BMI, adipo-IR, TSH, FT3 and FT3/FT4 levels, meanwhile, metabolic disorders improved. The decrease in BMI after bariatric surgery was significantly correlated with reductions in adipo-IR (r = 0.577, P < 0.001) and TSH (r = 0.401, P = 0.005). Interestingly, the fasting blood glucose, fasting insulin, adipo-IR and TSH in the higher TSH group decreased more remarkably than in the lower TSH group.
Obese individuals with higher TSH levels had an obvious metabolic improvement after bariatric surgery.
减重手术已成为治疗病态肥胖最有效的方法。越来越多的证据表明，减重手术可减轻胰岛素抵抗并影响甲状腺功能。本研究旨在探讨减重手术后甲状腺功能变化与脂肪组织胰岛素抵抗（脂肪性胰岛素抵抗）之间的关系。
共招募了287名甲状腺功能正常的非糖尿病参与者，并将其分为瘦组、超重组和肥胖组。其中，50例病态肥胖患者接受了减重手术。
与瘦组和超重组相比，肥胖组的脂肪性胰岛素抵抗、促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、FT3/游离甲状腺素（FT4）水平及代谢紊乱程度更高。BMI与TSH、FT3、FT3/FT4及脂肪性胰岛素抵抗相关（r分别为0.309、0.315、0.322和0.651，均P<0.001）。脂肪性胰岛素抵抗与TSH（r=0.402，P<0.001）、FT3（r=0.309，P<0.001）及FT3/FT4（r=0.228，P<0.05）显著相关。减重手术导致BMI、脂肪性胰岛素抵抗、TSH、FT3及FT3/FT4水平急剧下降，同时代谢紊乱得到改善。减重手术后BMI的降低与脂肪性胰岛素抵抗（r=0.577，P<0.001）和TSH（r=0.401，P=0.005）的降低显著相关。有趣的是，高TSH组的空腹血糖、空腹胰岛素、脂肪性胰岛素抵抗及TSH下降比低TSH组更显著。
TSH水平较高的肥胖个体在减重手术后代谢有明显改善。
