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Levothyroxine Dosing Following Bariatric Surgery.

Silpa Gadiraju1, Clare J Lee2, David S Cooper2

  • 1Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA. silpa.gadiraju@gmail.com.

Obesity Surgery
|August 1, 2016
PubMed
Summary

Bariatric surgery typically decreases levothyroxine (thyroid hormone) requirements due to weight loss and improved absorption, despite concerns about malabsorption. This review clarifies the impact of weight loss surgery on thyroid hormone dosing.

Keywords:
Bariatric surgeryBiliopancreatic diversionDrug absorptionGastric bandingJejunoileal bypassLevothyroxinePharmacokineticsRoux-en-Y gastric bypassSleeve gastrectomyThyroid hormone

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Area of Science:

  • Endocrinology
  • Bariatric Surgery
  • Pharmacokinetics

Background:

  • Bariatric surgery alters drug absorption, potentially increasing levothyroxine needs.
  • Conflicting data exists regarding postoperative levothyroxine requirements.
  • This review synthesizes current evidence on the topic.

Purpose of the Study:

  • To evaluate the impact of bariatric surgery on levothyroxine dosing.
  • To reconcile conflicting findings in the literature.
  • To understand the relationship between weight loss and thyroid hormone replacement therapy.

Main Methods:

  • Comprehensive literature search of PubMed and Scopus databases.
  • Inclusion of relevant published bibliographies.
  • Systematic review and synthesis of study findings.

Main Results:

  • Six out of ten studies reported decreased postoperative levothyroxine requirements.
  • Significant correlations were observed between weight loss and reduced levothyroxine dosage.
  • Only a minority of studies (3 case reports, 1 case series) indicated increased levothyroxine needs due to malabsorption.

Conclusions:

  • Decreased postoperative levothyroxine requirements are common after bariatric surgery.
  • Weight loss, loss of fat and lean mass, improved pharmacokinetics, and altered thyroid hormone homeostasis likely contribute to reduced dosing.
  • Malabsorptive effects are generally outweighed by other physiological changes.