Does Bariatric Surgery Impact Hypothyroidism and Vice Versa? Results of a Prospective Comparative Study

The imbalanced basal metabolic rate and energy expenditure proportion is an essential etiology of obesity. Thyroid hormones are vital in managing energy expenditure and body mass index (BMI). Hypothyroidism is associated with a decreased metabolic rate and increased prevalence of obesity.

We aimed to analyze the outcomes of bariatric surgery among patients who underwent bariatric surgery with hypothyroidism and morbid obesity.

We performed a prospective comparative analysis of 314 patients who underwent bariatric surgery between September 2019 and November 2022 and completed 1-year follow-up. Patients were divided into control and test groups, comprising 158 euthyroid and 156 hypothyroid patients living with obesity, respectively.

Among 156 hypothyroid patients,131 (83.9%) were females. The mean BMI was 44.82 ± 9.46 kg/m2. Percentage total weight loss (%TWL) during 6 months and 1 year was 25.46 ± 4.59 and 36.61 ± 5.13 (p < 0.001), respectively. The baseline value of TSH, FT3, and FT4 was 7.78 ± 11.11, 3.07 ± 0.46, and 1.29 ± 0.27, respectively. Serum TSH significantly reduced at 6 months (3.82 ± 2.15) (p- 0.040) and 1 year (2.61 ± 1.62) (p-0.018), while changes in FT3 and FT4 were not significant. There was a negative correlation of TSH (r - 0.395*, p 0.031) and FT3(r - 0.357*, p = 0.049) with %TWL at 1 year. Thyroid replacement therapy (TRT) dosage significantly reduced 1 year following surgery (p < 0.001). TSH and FT3 are directly associated with TRT improvement.

Bariatric surgery promotes significant improvement in thyroid function and a decrease in TRT dosage. A negative correlation was observed between %TWL, FT3, and TSH reduction. A reduction in FT3 and TSH directly correlates with decreased TRT dosage.