Evaluation of Thyroid Hormone Replacement Dosing in Morbidly Obese Hypothyroid Patients after Bariatric Surgery-Induced Weight Loss

The most frequent endocrine disease in obese patients is hypothyroidism. To date, there are no clear data regarding what happens to the dose of levothyroxine (LT4) after bariatric surgery (BS). The objective of the present study was to evaluate thyroid hormone replacement dose in morbidly obese hypothyroid patients after BS-induced weight loss. We explore the best type of measured or estimated body weight for LT4 dosing. We performed an observational study evaluating patients with morbid obesity and hypothyroidism who underwent BS. We included 48 patients (three men). In morbidly obese hypothyroid patients 12 months after BS-induced weight loss, the total LT4 dose or the LT4 dose/kg ideal body weight did not change, while there was a significant increase in LT4 dose/body surface area, LT4 dose/kg weight, LT4 dose/kg adjusted body weight, LT4 dose/kg body fat, and LT4 dose/kg lean body weight. There were no differences in LT4 dose and its variation between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). The present study strongly suggests that LT4 dosing in obese hypothyroid patients can be individually adapted more precisely if it is based on ideal body weight.

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Sugammadex Ideal Body Weight Dose Adjusted by Level of Meeting Abstracts in Laparoscopic Bariatric Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182580409 ◽

2012 ◽

Vol 117 (1) ◽

pp. 93-98 ◽

Cited By ~ 31

Author(s):

Sandra Llauradó ◽

Antoni Sabaté ◽

Eva Ferreres ◽

Inmaculada Camprubí ◽

Anna Cabrera

Keyword(s):

Bariatric Surgery ◽

Body Weight ◽

Ideal Body Weight ◽

Tracheal Extubation ◽

Morbidly Obese ◽

Optimal Dosage ◽

Laparoscopic Bariatric Surgery ◽

Reversal Agent ◽

Ideal Body ◽

Time Required

Background Bariatric surgery patients are at risk of perioperative airway collapse. Neuromuscular blockade should be fully reversed before tracheal extubation. The optimal dosage of the reversal agent sugammadex in the morbidly obese is still unknown. This study explored the sugammadex dose adjusted according to train-of-four ratio (TOFR). Methods Prospective observational study of consecutive patients scheduled for laparoscopic bariatric surgery. To reverse a deep blockade (2 or fewer posttetanic twitches), a dose of sugammadex of 4 mg/kg ideal body weight (IBW) was followed by a second dose of 2 mg/kg IBW if the TOFR was less than 0.9 after 3 min. To reverse a moderate blockade (reappearance of the second twitch in the TOF), a 2 mg/kg IBW dose of sugammadex was followed by a second dose of 2 mg/kg IBW if the TOFR was less than 0.9 after 2 min. Sugammadex effectiveness was reflected by the time required to obtain a TOFr of 0.9 or more. Results A total of 120 patients were included. The blockade was deep at the end of surgery in 43 and moderate in 77. The median times (range) to TOFR of 0.9 or more were 167 (20-460) seconds and 113 (28-300) seconds in deep and moderate blockades, respectively (P < 0.05). The percentage of patients requiring a second dose of sugammadex were larger after deep blockades (39.5% [n = 17] vs. 23.4% [n = 18] after moderate blockades); the difference was not significant. Conclusion A sugammadex dose calculated according to IBW is insufficient for reversing both deep and moderate blockades in morbidly obese patients.

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Linear modulation of serum thyrotrophin by thyroid hormone treatment in hypothyroidism

Acta Endocrinologica ◽

10.1530/acta.0.0950472 ◽

1980 ◽

Vol 95 (4) ◽

pp. 472-478 ◽

Cited By ~ 6

Author(s):

A. Eugene Pekary ◽

Jerome M. Hershman ◽

Clark T. Sawin

Keyword(s):

Thyroid Hormone ◽

Hormone Replacement ◽

Hormone Treatment ◽

Significant Negative Correlation ◽

Thyroid Hormone Replacement ◽

Basal Serum ◽

Thyroid Hormone Levels ◽

Peak Versus ◽

Hypothyroid Patients ◽

Serum Tsh

Abstract. Basal serum TSH and the peak TSH response to a 500 μg TRH bolus were measured in 57 euthyroid and in 29 hypothyroid subjects either receiving graded thyroid hormone replacement or acutely removed from full replacement therapy. Serum TSH, total T4 and T3 were determined by sensitive radioimmunoassay methods. The peak versus basal TSH data for hypothyroid patients were linear within individuals. The regression slope of the peak versus basal TSH data for all hypothyroid subjects did not differ significantly from the corresponding slope for all euthyroid subjects. Basal and peak TSH versus T3 and T4 data for hypothyroid patients were also linear within each individual. Moreover, the regression of the basal TSH values averaged over the non-replacement to full replacement state against the TSH versus T3 slope had a significant negative correlation. This trend leads to an array of regression lines which average to the familiar hyperbolic relationship between thyrotrophin and thyroid hormone levels in man.

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MON-LB101 5-Year Data of an Aggressive Pharmacological Approach to Moderate and Morbid Obesity: Is Prevention of Bariatric Surgery Feasible in the Long Run?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.2340 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Flavio Cadegiani

Keyword(s):

Bariatric Surgery ◽

Morbid Obesity ◽

Weight Loss ◽

Body Weight ◽

Weight Regain ◽

Morbidly Obese ◽

Biochemical Profile ◽

Initial Weight ◽

Initial Weight Loss

Abstract Background: Maintenance of weight loss in patients that undergo weight loss interventions is highly challenging, irrespective of the type of approach to obesity (whether surgical, pharmacological, or non-pharmacological). We proposed a protocol of an aggressive clinical treatment for obesity aiming to prevent the need of bariatric surgery, in patients unwilling to undergo this procedure, by proposing a protocol that included the combination of different anti-obesity medications and non-pharmacological modalities, for longer duration, and with an active approach to prevent weight regain. Our initial 2-year data showed that 93% (40 of 43 patients) with moderate and morbid obesity were able to avoid the need of bariatric surgery, with concomitant improvements of the biochemical profile. However, whether these patients would maintain their successful rates after five years was uncertain. Our objective is to describe the efficacy and safety of a long term (5-year data) pharmacological and multi-modal treatment for moderate and severe obesity. Methods: The 40 patients that were successful in the two-year approach in our obesity center (Corpometria Institute, Brasilia, DF, Brazil) were enrolled. A long-term anti-obesity protocol was employed, with continuous or intermittent use of anti-obesity drugs, trimestral body composition analysis, psychotherapy, visit to a nutritionist every four months, and both resistance and endurance exercises at least four times a week. Body weight (BW), total weight excess (TWE), body fat, markers of lipid and glucose metabolism, liver function, and inflammation were analyzed. Subjects that dropped out were considered as weight regain. Therapeutic success for the 5-year follow-up included as the maintenance of >20% loss of the initial BW loss, and no weight regain (or < 20% of the initial weight loss). Results: A total of 27 patients (67.5%) were able to maintain the body weight, seven dropped out, and six regained more than 20% of the initial weight loss. Of these, 21 (77.8%) had significant further increase of muscle mass and decrease of fat loss, while 17 (63.0%) had further weight loss (p < 0.05), compared to the 2-year data. Improvements on the biochemical profile persisted in all 27 patients, and had significant further improvements in 24 (88.9%) of these patients. Conclusion: The risk of weight regain five years after a weight loss treatment for obesity was significantly lower compared to previous literature, and comparable to the long-term outcomes of bariatric procedures. An aggressive, structured, and long-term clinical weight loss approach has been shown to be feasible, even for morbidly obese patients.

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Combination Treatment with T4 and T3: Toward Personalized Replacement Therapy in Hypothyroidism?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-3399 ◽

2012 ◽

Vol 97 (7) ◽

pp. 2256-2271 ◽

Cited By ~ 78

Author(s):

Bernadette Biondi ◽

Leonard Wartofsky

Keyword(s):

Quality Of Life ◽

Thyroid Hormone ◽

Replacement Therapy ◽

Hormone Replacement ◽

Hormone Action ◽

Thyroid Hormone Replacement ◽

Thyroid Hormone Action ◽

Thyroid Hormone Replacement Therapy ◽

Hypothyroid Patients

Abstract Context: Levothyroxine therapy is the traditional lifelong replacement therapy for hypothyroid patients. Over the last several years, new evidence has led clinicians to evaluate the option of combined T3 and T4 treatment to improve the quality of life, cognition, and peripheral parameters of thyroid hormone action in hypothyroidism. The aim of this review is to assess the physiological basis and the results of current studies on this topic. Evidence Acquisition: We searched Medline for reports published with the following search terms: hypothyroidism, levothyroxine, triiodothyronine, thyroid, guidelines, treatment, deiodinases, clinical symptoms, quality of life, cognition, mood, depression, body weight, heart rate, cholesterol, bone markers, SHBG, and patient preference for combined therapy. The search was restricted to reports published in English since 1970, but some reports published before 1970 were also incorporated. We supplemented the search with records from personal files and references of relevant articles and textbooks. Parameters analyzed included the rationale for combination treatment, the type of patients to be selected, the optimal T4/T3 ratio, and the potential benefits of this therapy on symptoms of hypothyroidism, quality of life, mood, cognition, and peripheral parameters of thyroid hormone action. Evidence Synthesis: The outcome of our analysis suggests that it may be time to consider a personalized regimen of thyroid hormone replacement therapy in hypothyroid patients. Conclusions: Further prospective randomized controlled studies are needed to clarify this important issue. Innovative formulations of the thyroid hormones will be required to mimic a more perfect thyroid hormone replacement therapy than is currently available.

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Randomized crossover study of 40% vs. 55% carbohydrate weight loss strategies in women with previous gestational diabetes mellitus and non-diabetic women of 130-200% ideal body weight.

Journal of the American College of Nutrition ◽

10.1080/07315724.1995.10718523 ◽

1995 ◽

Vol 14 (4) ◽

pp. 369-375 ◽

Cited By ~ 12

Author(s):

C M Peterson ◽

L Jovanovic-Peterson

Keyword(s):

Diabetes Mellitus ◽

Weight Loss ◽

Body Weight ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Ideal Body Weight ◽

Ideal Body ◽

Previous Gestational Diabetes Mellitus ◽

Randomized Crossover Study ◽

Previous Gestational Diabetes

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Clinical-epidemiological evaluation in overweight and obese patients after “DCD method” application

Clinical Management Issues ◽

10.7175/cmi.v3i1.559 ◽

2009 ◽

Vol 3 (1) ◽

pp. 33-41

Author(s):

Marina Conese ◽

Grace Massiah ◽

Piero Oberto De Cavi

Keyword(s):

Weight Loss ◽

Body Weight ◽

Quality Improvement ◽

Who Classification ◽

Life Quality ◽

Ideal Body Weight ◽

Obese Patients ◽

Ideal Body ◽

Epidemiological Evaluation ◽

Dietary Education

The article describes an experimental observation performed for 2 years on 200 patients: 150 female and 50 male between 25 and 65 years old, overweight with class I, II and III obesity (WHO classification). Patients with overt diabetic pathology and with “borderline” hyperglycemia, hypertriglyceridemia and hypercholesterolemia are subjected to “DCD method” (appropriate dietary education associated to New-Electrosculpture) in Bari (DCD office). The aim of the study is weight loss, with patients’ life quality improvement. What we have obtained is an ideal body weight recover without anti-obesity drug use, with maintenance of the results obtained for 18 months.

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Abstract P385: My Unlimited Health Potential: Short term Effect of Participation in a Worksite Lifestyle Intervention Program on Significant Weight Loss and Eligibility Criteria for Bariatric Surgery Among High Risk Individuals

Circulation ◽

10.1161/circ.129.suppl_1.p385 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Lara L Roberson ◽

Ehimen Aneni ◽

Sameer Shaharyar ◽

Ebenezer Oni ◽

Maribeth Rouseff ◽

...

Keyword(s):

Cardiovascular Disease ◽

Bariatric Surgery ◽

Weight Loss ◽

Body Weight ◽

High Risk ◽

Disease Risk ◽

Morbidly Obese ◽

Metabolic Risk ◽

Short Term

Background: Current recommendations support bariatric surgery among the morbidly obese as an option to mitigate future risk of cardiovascular disease, diabetes and hypertension. To date, there is little evidence on the effect of extensive lifestyle interventions among those high-risk individuals in reducing the need for such procedures. Methods: The purpose of the present study was to examine the efficacy of an intensive lifestyle workplace intervention on significant body weight and cardiovascular disease risk factors across the spectrum of obesity. Changes in BMI were measured from baseline to 12 week follow up, along with corresponding improvements in cardio-metabolic risk. In addition, the decrease in participants meeting criteria for bariatric surgery over the study period was examined. Bariatric surgery criteria were defined as BMI≥40 or BMI between 35 and 40 and at least one of the following co-morbidities: diabetes, hypertension, or high cholesterol. Results: The study population consisted of 169 individuals (49±10 years, 77% female) with BMI≥27 at baseline and complete data at follow-up. A total of 65 (39%) participants lost at least 5% of both their initial BMI and body weight. Additionally, 32% dropped an entire BMI category. Of note, 38%(18 of 48) who were classified as BMI>40 were in BMI 35-39 at follow-up, respectively 37%(13 of 55) of individuals in the BMI category 35-39 successfully moved to the BMI category 30-34 at 3 months follow-up. Sixty-three participants (37% of total) initially met criteria for bariatric surgery. At 12 weeks follow-up 35% (22 of 63) of these candidates no longer qualified. Conclusions: Worksites can be effective for achieving clinically important reductions in body weight and diminish the potential need for procedures among a small proportion of morbidly obese individuals. Further follow-up is needed to ascertain whether weight loss can be sustained long-term, and if the short term gains will translate to significant improvements in cardio-metabolic risk profile.

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