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Levothyroxine malabsorption following sleeve gastrectomy.

Elodie Gruneisen1,2, Ji Wei Yang1, Melissa-Rosina Pasqua1

  • 1Division of Endocrinology, McGill University Health Centre, Montreal, Canada.

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|January 27, 2025
PubMed
Summary

Patients undergoing sleeve gastrectomy may experience levothyroxine (LT4) malabsorption, leading to refractory hypothyroidism. Intramuscular LT4 and oral liothyronine (T3) can effectively manage this condition.

Keywords:
gastrectomylevothyroxinemalabsorptionmetabolismsleeve

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Area of Science:

  • Endocrinology
  • Bariatric Surgery
  • Thyroidology

Background:

  • Oral levothyroxine (LT4) is a standard treatment for hypothyroidism.
  • Bariatric surgery, including sleeve gastrectomy, leads to significant weight loss and improves obesity-related conditions.
  • Levothyroxine malabsorption is a known complication, particularly after malabsorptive bariatric procedures, but is less studied after sleeve gastrectomy.

Purpose of the Study:

  • To investigate a case of refractory hypothyroidism following sleeve gastrectomy due to LT4 malabsorption.
  • To highlight the importance of monitoring thyroid function post-sleeve gastrectomy.
  • To discuss management strategies for LT4 malabsorption after bariatric surgery.

Main Methods:

  • Case report of a 47-year-old woman with obesity and a history of thyroid cancer who underwent sleeve gastrectomy.
  • Assessment of thyroid function and LT4 absorption using a T4 absorption test.
  • Initiation of intramuscular LT4 and oral liothyronine (T3) for treatment.

Main Results:

  • The patient developed refractory hypothyroidism despite high-dose oral LT4 and confirmed compliance.
  • A T4 absorption test indicated gastrointestinal LT4 malabsorption.
  • Treatment with intramuscular LT4 and oral T3 led to symptom improvement and normalized thyroid-stimulating hormone levels.

Conclusions:

  • Sleeve gastrectomy can lead to oral LT4 malabsorption and refractory hypothyroidism.
  • Thyroid function monitoring is crucial after sleeve gastrectomy.
  • Parenteral LT4 and combination therapy with T3 may be effective for managing LT4 malabsorption post-bariatric surgery.