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甲状腺功能减退症患者行减重手术后左甲状腺素需求量的变化。

Change in levothyroxine requirements after bariatric surgery in patients with hypothyroidism.

机构信息

Department of Endocrinology and Nutrition, La Paz University Hospital, Madrid, Spain.

出版信息

Endocr Regul. 2022 Apr 30;56(2):81-86. doi: 10.2478/enr-2022-0009.

DOI:10.2478/enr-2022-0009
PMID:35489047
Abstract

This study aims to evaluate the need to modify the total and weight-adjusted doses of levothyroxine after bariatric surgery, identify predictors, and assess the influence of the weight loss on the levothyroxine requirements. A retrospective study in patients with treated hypothyroidism that underwent bariatric surgery. The modification of the levothyroxine dose and its association with the weight loss and other potential predictors were evaluated at 6, 12, and 24 months post-surgery. Among the 63 patients included, 82.54% needed an adjustment of levothyroxine dose during the follow-up. The total weekly dose of levothyroxine (µg) decreased post-surgery at 6 months (β= -49.1; 95%CI-93.7 to -4.5; p=0.031) and 12 months (β=-54.9; 95%CI-102 to -7.8; p=0.022), but did not significantly change at 24 months (p=0.114). The weekly weight-adjusted dose (µg/k) increased at 6 months (β=1.37; 95%CI 0.91 to 1.83; p<0.001), 12 months (β=2.05; 95%CI 1.43 to 2.67; p<0.001), and 24 months (β=2.52; 95%CI 1.74 to 3.30; p<0.001). The weight loss showed association with the weight-adjusted dose (OR=1.07; 95%CI 1.02 to 1.12; p=0.004), but not the total dose (p=0.320). This study shows a significant decrease in the total dose of levothyroxine requirements change after bariatric surgery during the first year of the follow-up and an increase in the weight-adjusted dose over the first two years. No predictors of modification of the total dose of levothyroxine were identified.

摘要

这项研究旨在评估减重手术后是否需要调整左甲状腺素的总剂量和体重校正剂量,确定预测因素,并评估体重减轻对左甲状腺素需求的影响。这是一项对接受减重手术的治疗性甲状腺功能减退症患者进行的回顾性研究。在术后 6、12 和 24 个月时,评估了左甲状腺素剂量的调整及其与体重减轻和其他潜在预测因素的关系。在纳入的 63 例患者中,82.54%在随访期间需要调整左甲状腺素剂量。术后 6 个月(β=-49.1;95%CI-93.7 至-4.5;p=0.031)和 12 个月(β=-54.9;95%CI-102 至-7.8;p=0.022)时,左甲状腺素的总每周剂量(μg)下降,但在 24 个月时无显著变化(p=0.114)。每周体重校正剂量(μg/kg)在术后 6 个月(β=1.37;95%CI 0.91 至 1.83;p<0.001)、12 个月(β=2.05;95%CI 1.43 至 2.67;p<0.001)和 24 个月(β=2.52;95%CI 1.74 至 3.30;p<0.001)时增加。体重减轻与体重校正剂量呈正相关(OR=1.07;95%CI 1.02 至 1.12;p=0.004),但与总剂量无关(p=0.320)。这项研究表明,在随访的第一年,减重手术后左甲状腺素总剂量的需求明显减少,并且在前两年体重校正剂量增加。未发现总剂量调整的预测因素。

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Effect of Laparoscopic Sleeve Gastrectomy on Thyroid Function Tests and Levothyroxine Doses in People With Obesity.
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Front Endocrinol (Lausanne). 2024 Jan 30;15:1333033. doi: 10.3389/fendo.2024.1333033. eCollection 2024.