Abstract
The most common endocrine disease in obesity is hypothyroidism and secondary endocrine alterations, including abnormal thyroid function, are frequent in obesity. It is unclear whether impaired thyroid function is the cause or the consequence of increased adiposity; furthermore, there are no clear data regarding the best way to dose levothyroxine for patients with both hypothyroidism and obesity, and the effect of bariatric surgery (BS). The aim of the present article is to review some controversial aspects of the relation between obesity and the thyroid: (1) Thyroid function in obesity and the effect of BS (2) Thyroid hormone treatment (THT) in obese patients with hypothyroidism and the effect of BS. In summary: In morbidly obese patients, TSH is moderately increased. Morbid obesity has a mild central resistance to the thyroid hormone, reversible with weight loss. In morbidly obese hypothyroid patients, following weight loss, the levothyroxine dose/kg of ideal weight did not change, albeit there was an increment in the levothyroxine dose/kg of actual weight. From a clinical practice perspective, in morbid obesity, diagnosing mild hypothyroidism is difficult, BS improves the altered thyroid function and THT can be adapted better if it is based on ideal weight.
Highlights
Published: 28 February 2022The thyroid hormone (TH) controls dietary intake as well as energy expenditure, both resting and total, and obesity and different metabolic diseases can appear in patients with altered thyroid function
It is common to find slightly increased values of thyrotropin (TSH) in obesity [3,4]. It is unclear whether the altered thyroid function present in obesity is due to the excess adiposity or, alternatively, the decreased thyroid function is the cause of the excess adiposity
A diminution in circulating thyrotropin levels has been found in obesity following lifestyle induced weight loss [51] and the decline in thyrotropin levels has been found associated with excessive weight loss after bariatric surgery [32,34]
Summary
The thyroid hormone (TH) controls dietary intake as well as energy expenditure, both resting and total, and obesity and different metabolic diseases can appear in patients with altered thyroid function. It is common to find slightly increased values of thyrotropin (TSH) in obesity [3,4] It is unclear whether the altered thyroid function present in obesity is due to the excess adiposity or, alternatively, the decreased thyroid function is the cause of the excess adiposity. A clear amelioration in obesity-related diseases has been found following BS These benefits in patients occur early, before the presence of any significant weight loss, so that benefits may be probably due to the gastrointestinal hormonal secretion modifications due to bariatric surgery [17]. The most prevalent endocrine disease in obesity is decreased thyroid function and it is recommended to measure circulating thyroid hormones in all obese patients [2]. The objective of the present article is to review some controversial aspects of the relation between obesity and thyroid function: (1) thyroid function in obesity and the influence of bariatric surgery; (2) thyroid hormone replacement in obese patients with hypothyroidism and the influence of bariatric surgery
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