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Levothyroxine Absorption in Morbidly Obese Patients Before and After Roux-En-Y Gastric Bypass (RYGB) Surgery

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Abstract

Background

Roux-en-Y gastric bypass (RYGB) modifies the anatomical structure of the upper intestine tract, reduces gastric acid secretion, and may impair LT4 absorption. The aim of this study was to evaluate the LT4 absorption in morbidly obese patients before and after RYGB.

Methods

Thirty morbidly obese patients were divided in two groups: The NS group included 15 patients before RYGB surgery (BMI = 43.1 ± 4 kg/m2), and the S group included 15 patients after surgery (BMI = 37.3 ± 4 kg/m2). Two baseline samples were collected, and 600 μg of oral LT4 tablets were administered. Blood samples were collected at 30, 60, 120, 180, 240, 300, and 1440 min. Serum-free T4 (FT4), total T4 (TT4), and TSH were measured at each time point. The increase in TT4, FT4, and TSH (ΔTT4, ΔFT4, and ΔTSH) was calculated, subtracting from the baseline mean value.

Results

The pharmacokinetics parameters regarding LT4 absorption, maximum ΔTT4, and area under the curve(AUC) of both ΔTT4 and ΔFT4 were significantly higher in the S group compared with the NS group (p < 0.05). It was observed, however, that there was a significant delay in the absorption of LT4 in the S group. Basal serum TSH and leptin levels were higher in the NS group (p = 0.016 and 0.026, respectively), whereas basal serum TT4, FT4, ΔTSH, and the AUC of ΔTSH were similar between groups.

Conclusions

In this study, we have demonstrated that Roux-en-Y bypass surgery does not diminish LT4 absorption. A small but significant delayed absorption of LT4, however, was observed in patients after surgery.

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Acknowledgments

We are grateful to the patients who have consented to undergo LT4 absorption tests. We also want to express our gratitude to Suzimara A. de Oliveira from The Central Laboratory, Valeria Samuel Lando from the Endocrine Laboratory (LIM 42) for conducting the thyroid function tests and leptin measurements, and to Aché Laboratórios Farmacêuticos S.A. for the supply of LT4 tablets (Levoid®).

Disclosure Summary

This work was partially funded by a research grant from Aché Laboratórios Farmacéuticos S.A. to Fundação Faculdade de Medicina São Paulo, Brazil, a non-profit organization. A partial grant was also received from Instituto da Tiróide (São Paulo), also a non-profit organization. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Authors and Affiliations

  1. Department of Biological Sciences, Federal University of São Paulo, Rua Prof. Artur Riedel 275, Eldorado, Diadema, São Paulo, 09972-270, Brazil

    Ileana Gabriela Sanchez Rubio

  2. Department of Medicine, Division of Endocrinology, University of São Paulo Medical School, Av Dr Arnaldo 455, 4A, São Paulo, São Paulo, 01246903, Brazil

    Ana Luiza Galrão

  3. Division of Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil

    Marco Aurelio Santo

  4. Department of Medicine, University of São Paulo Medical School, Av Dr Arnaldo 455, São Paulo, São Paulo, 01246-903, Brazil

    Antonio Carlos Zanini

  5. Department of Medicine, University of São Paulo Medical School, Artur Ramos 96, 01454-903, São Paulo, Brazil

    Geraldo Medeiros-Neto

Authors
  1. Ileana Gabriela Sanchez Rubio
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  2. Ana Luiza Galrão
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  3. Marco Aurelio Santo
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Correspondence to Geraldo Medeiros-Neto.

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Rubio, I.G.S., Galrão, A.L., Santo, M.A. et al. Levothyroxine Absorption in Morbidly Obese Patients Before and After Roux-En-Y Gastric Bypass (RYGB) Surgery. OBES SURG 22, 253–258 (2012). https://doi.org/10.1007/s11695-011-0452-8

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  • DOI: https://doi.org/10.1007/s11695-011-0452-8

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