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26. Thyroid Hormone Replacement Dosing after Bariatric Surgery in Patients with Primary Hypothyroidism And Severe Obesity: Tehran Obesity Treatment Study.

Author

Barzin, Maryam, Molavizadeh, Danial, Mahdavi, Maryam, Khalaj, Alireza, Sadeghi, Sara, Valizadeh, Majid, Azizi, Fereidoun, and Hosseinpanah, Farhad

Subjects
GENERALIZED estimating equations, SLEEVE gastrectomy, BODY composition, BIOELECTRIC impedance, BARIATRIC surgery
Abstract

Background: Obesity and hypothyroidism are common medical conditions that are associated with each other. Bariatric surgery (BS) is a common approach used to achieve substantial weight loss in obese patients. However, there is limited evidence regarding the need for postsurgery levothyroxine (LT4) dose adjustment in patients with hypothyroidism undergoing BS. Methods: This was a three-year prospective cohort study assessing postsurgery LT4 requirements with attention to body composition changes. The current study included 1030 patients with hypothyroidism, who underwent sleeve gastrectomy (SG) (n = 707, 88.3% women) or one anastomosis gastric bypass (OAGB) (n = 323, 92% women). Patients were followed for 36 months after surgery. A bioelectrical impedance analyzer was used for body composition assessment. LT4 requirements were assessed by generalized estimating equation (GEE) methods adjusted for weight as a time-varying covariate. Results: During the follow-up, TSH (mIU/L) and T4 (ng/dL) measurements did not significantly change in the OAGB group over time. However, in the SG group, TSH measurement decreased over time (ptrend = <0.001). In the third year of the follow-up, 56.1% and 33.3% of patients in the SG and OAGB groups experienced LT4 (μg/day) dose reduction, while 24.4% and 9.1% of the participants experienced LT4 dose increments, respectively. GEE analysis showed a significant increase in the LT4/fat mass (FM) (μg/kg) ratio after 36 months of follow-up compared with the baseline in both the SG [1.8 (1.5–2.2) to 2.7 (2.0–3.5), ptrend = 0.039)] and OAGB [1.7 (1.4–2.2) to 3.2 (2.7–4.8), ptrend = <0.001)] groups. Moreover, patients who underwent OAGB experienced greater LT4/FM (μg/kg) dose adjustments compared to those undergoing SG (pbetween = 0.060). In both groups, after the first year, the increase in LT4/FM (μg/kg) plateaued (pinteraction = 0.009). Conclusion: Most hypothyroid patients experienced either a reduction or no change in LT4 (μg/day) dosage after 36 months in both surgical groups. The LT4/FM (μg/kg) was significantly increased in patients undergoing either SG or OAGB with greater alterations in the latter. Further studies on larger populations and with longer duration of follow-up are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Remission and relapse of diabetes after sleeve gastrectomy and one‐anastomosis gastric bypass: The Tehran Obesity Treatment Study.

Author

Sadeghi, Sara, Hosseinpanah, Farhad, Khalaj, Alireza, Ebadinejad, Amir, Mahdavi, Maryam, Valizadeh, Majid, and Barzin, Maryam

Abstract

Aims: To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one‐anastomosis gastric bypass (OAGB). Methods: An observational prospective study with 5 years of follow‐up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose‐lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy. Results: After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person‐months (95% confidence interval [CI] 56.8–66.4) and 5.7 per 1000 person‐months (95% CI 4.1–7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose‐lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB. Conclusion: After 5 years of follow‐up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose‐lowering agents, despite possible remission, were at a higher risk of experiencing late relapse. [ABSTRACT FROM AUTHOR]

Published
2024
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