肥胖患者甲状腺激素的改变与减重手术后身体成分变化相关。

Alterations in Thyroid Hormones in Obese Patients Are Associated With Body Composition Changes After Bariatric Surgery.

作者信息

Yan Yu, Chu Xuehui, Wang Jing, Kang Xing, Shan Xiaodong, Yu Hang, Zhang Xiaowen, Sun Xitai

机构信息

Department of Pancreatic and Metabolic Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, Jiangsu 210009, China.

Department of Pancreatic and Metabolic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China.

出版信息

J Clin Endocrinol Metab. 2025 May 19;110(6):e2008-e2017. doi: 10.1210/clinem/dgae605.

DOI:10.1210/clinem/dgae605

PMID:39222412

Abstract

CONTEXT

This article mainly explored the relationship between body composition and thyroid function in euthyroid obesity through correlation analysis, which showed the significant changes of thyroid function after bariatric surgery notably correlated with changes in body composition.

OBJECTIVE

This study investigates how metabolic/bariatric surgery (MBS) affects thyroid hormone (TH) levels and TH resistance in obese euthyroid individuals, focusing on their correlation with changes in body composition.

METHODS

We included 470 obese individuals and 118 controls for baseline assessment, and 125 obese patients receiving MBS for longitudinal study. Data on body composition and thyroid function were collected. Correlations between baseline and changes in thyroid function and body composition were assessed.

RESULTS

In the obese group, thyrotropin (TSH), free triiodothyronine (fT3) levels, and thyroid feedback quantile-based index (TFQI) were elevated and significantly decreased post MBS, along with visceral fat area (VFA) and body fat percentages, whereas skeletal muscle mass (SMM) percentage increased. Preoperative partial correlation analysis adjusted for age and sex revealed that TSH positively correlated with VFA (r = 0.109; P = .019), body fat percentage (r = 0.114; P = .013), and negatively correlated with SMM percentage (r = -0.104; P = .024). Similar correlations were observed between central TH resistance indices and body composition, but no statistically significant correlations were found in the control group. Post MBS, decreased TSH positively correlated with decreased VFA (r = 0.251; P = .006) and increased SMM percentage (r = 0.233; P = .011). While reductions in VFA and body fat percentage were linked to improved central TH resistance, a decrease in peripheral TH conversion was noted.

CONCLUSION

MBS significantly affects thyroid function and TH resistance, with notable correlations to changes in body composition.

摘要

背景

本文主要通过相关性分析探讨了正常甲状腺功能的肥胖人群的身体成分与甲状腺功能之间的关系，结果显示减肥手术后甲状腺功能的显著变化与身体成分的变化显著相关。

目的

本研究调查代谢/减肥手术（MBS）如何影响肥胖且甲状腺功能正常个体的甲状腺激素（TH）水平和TH抵抗，重点关注其与身体成分变化的相关性。

方法

我们纳入了470名肥胖个体和118名对照进行基线评估，以及125名接受MBS的肥胖患者进行纵向研究。收集了身体成分和甲状腺功能的数据。评估了甲状腺功能和身体成分的基线及变化之间的相关性。

结果

在肥胖组中，促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT3）水平和基于甲状腺反馈分位数的指数（TFQI）升高，MBS后显著降低，同时内脏脂肪面积（VFA）和体脂百分比降低，而骨骼肌质量（SMM）百分比增加。术前经年龄和性别校正的偏相关分析显示，TSH与VFA呈正相关（r = 0.109；P = 0.019）、与体脂百分比呈正相关（r = 0.114；P = 0.013），与SMM百分比呈负相关（r = -0.104；P = 0.024）。在中枢TH抵抗指数和身体成分之间也观察到类似的相关性，但在对照组中未发现统计学显著相关性。MBS后，TSH降低与VFA降低呈正相关（r = 0.251；P = 0.006），与SMM百分比增加呈正相关（r = 0.233；P = 0.011）。虽然VFA和体脂百分比的降低与中枢TH抵抗的改善有关，但外周TH转化有所下降。