切换至 "中华医学电子期刊资源库"

中华肥胖与代谢病电子杂志 ›› 2024, Vol. 10 ›› Issue (03) : 170 -176. doi: 10.3877/cma.j.issn.2095-9605.2024.03.003

青年专家论坛

减重手术对甲状腺功能影响的研究进展
张怡然, 刘宝胤, 聂云韬(), 孟化   
  1. 100069 北京,首都医科大学基础医学院
    100029 北京,中日友好医院普外科·代谢减重中心
  • 收稿日期:2024-03-05 出版日期:2024-08-30
  • 通信作者: 聂云韬
  • 基金资助:
    中日友好医院中央高水平医院临床科研业务费(2023-NHLHCRF-YYPP-TS-02,2023-NHLHCRF-YS-0103); 中央高水平医院临床科研业务费(NO.ZRJY2023-QM15); 中日友好医院"菁英计划"人才培育工程(NO.ZRJY2023-QM15); 北京市研究型病房建设临床研究项目(2022-YJXBF-03-02); 中日友好医院人才引进项目(NO.2018-RC-1); 青海省"昆仑英才·高端创新创业人才"项目(202308210043)

Research progress in the effect of bariatric surgery on thyroid function

Yiran Zhang, Baoyin Liu, Yuntao Nie(), Hua Meng   

  1. School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
    Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2024-03-05 Published:2024-08-30
  • Corresponding author: Yuntao Nie
引用本文:

张怡然, 刘宝胤, 聂云韬, 孟化. 减重手术对甲状腺功能影响的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 170-176.

Yiran Zhang, Baoyin Liu, Yuntao Nie, Hua Meng. Research progress in the effect of bariatric surgery on thyroid function[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2024, 10(03): 170-176.

肥胖患病率不断增加,可能导致不同程度的甲状腺功能异常。肥胖患者中临床型及亚临床型甲状腺功能减退症的发病率较正常人群显著增高。而体重减轻可通过改善机体炎症状态,恢复甲状腺功能。减重手术作为治疗肥胖及相关合并症的有效手段,对甲状腺激素及功能的影响尚不明确。本文围绕肥胖与甲状腺功能的关系、减重手术对促甲状腺激素、甲状腺激素、甲状腺自身抗体及甲状腺疾病的作用及相关机制等问题进行了总结分析,以期为临床实践提供帮助。

Obesity is a prevalent disease that may lead to thyroid dysfunction. The prevalence of overt and subclinical hypothyroidism is significantly higher in patients with obesity compared to the general population. Moreover, weight loss can restore thyroid function by improving the inflammatory state. Bariatric surgery has been demonstrated to be an effective treatment for obesity and related comorbidities. However, the effect of bariatric surgery on thyroid hormone and function remains uncertain. This article summarizes the effects and mechanisms of bariatric surgery on thyroid function and thyroid diseases to provide evidence for clinical practice.

表1 不同文献中减重手术后患者甲状腺功能指标的变化
[1]
Chen K, Shen Z, Gu W, et al. Prevalence of obesity and associated complications in China: A cross-sectional, real-world study in 15.8 million adults [J]. Diabetes Obes Metab, 2023, 25(11): 3390-3399.
[2]
Federation WO. World Obesity Atlas 2023 [R]. 2023.
[3]
Babić Leko M, Gunjača I, Pleić N, et al. Environmental factors affecting thyroid-stimulating hormone and thyroid hormone levels [J]. Int J Mol Sci, 2021, 22(12): 6521.
[4]
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 肥胖代谢外科个案管理术前临床路径中国专家共识(2023版) [J/CD]. 中华肥胖与代谢病电子杂志, 2023, 9(2): 73-82.
[5]
Reinehr T, De Sousa G, Andler W. Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids [J]. J Clin Endocrinol Metab, 2006, 91(8): 3088-3091.
[6]
Nannipieri M, Cecchetti F, Anselmino M, et al. Expression of thyrotropin and thyroid hormone receptors in adipose tissue of patients with morbid obesity and/or type 2 diabetes: effects of weight loss [J]. Int J Obes (Lond), 2009, 33(9): 1001-1006.
[7]
De Pergola G, Ciampolillo A, Paolotti S, et al. Free triiodothyronine and thyroid stimulating hormone are directly associated with waist circumference, independently of insulin resistance, metabolic parameters and blood pressure in overweight and obese women [J]. Clin Endocrinol (Oxf), 2007, 67(2): 265-269.
[8]
Michalaki MA, Vagenakis AG, Leonardou AS, et al. Thyroid function in humans with morbid obesity [J]. Thyroid, 2006, 16(1): 73-78.
[9]
Marzullo P, Mele C, Mai S, et al. The impact of the metabolic phenotype on thyroid function in obesity [J]. Diabetol Metab Syndr, 2016, 8(1): 59.
[10]
Reinehr T. Obesity and thyroid function [J]. Mol Cell Endocrinol, 2010, 316(2): 165-171.
[11]
Abiri B, Ahmadi AR, Mahdavi M, et al. Association between thyroid function and obesity phenotypes in healthy euthyroid individuals: an investigation based on Tehran Thyroid Study [J]. Eur J Med Res, 2023, 28(1): 179.
[12]
Reinehr T, Isa A, De Sousa G, et al. Thyroid hormones and their relation to weight status [J]. Hormone Research in Paediatrics, 2008, 70(1): 51-57.
[13]
Bian N, Sun X, Zhou B, et al. Obese patients with higher TSH levels had an obvious metabolic improvement after bariatric surgery [J]. Endocr Connect, 2021, 10(10): 1326-1336.
[14]
Walczak K, Sieminska L. Obesity and Thyroid Axis [J]. Int J Environ Res Public Health, 2021, 18(18): 9434.
[15]
Rotondi M, Leporati P, La Manna A, et al. Raised serum TSH levels in patients with morbid obesity: is it enough to diagnose subclinical hypothyroidism? [J]. Eur J Endocrinol, 2009, 160(3): 403-408.
[16]
Juiz-Valiña P, Outeiriño-Blanco E, Pértega S, et al. Effect of weight loss after bariatric surgery on thyroid-stimulating hormone levels in euthyroid patients with morbid obesity [J]. Nutrients, 2019, 11(5): 1121.
[17]
Lai Y, Wang J, Jiang F, et al. The relationship between serum thyrotropin and components of metabolic syndrome [J]. Endocr J, 2011, 58(1): 23-30.
[18]
Wang X, Gao X, Han Y, et al. Causal association between serum thyrotropin and obesity: a bidirectional, mendelian randomization study [J]. J Clin Endocrinol Metab, 2021, 106(10): e4251-e4259.
[19]
Van Hulsteijn LT, Pasquali R, Casanueva F, et al. Prevalence of endocrine disorders in obese patients: systematic review and meta-analysis [J]. Eur J Endocrinol, 2020, 182(1): 11-21.
[20]
Abu-Ghanem Y, Inbar R, Tyomkin V, et al. Effect of sleeve gastrectomy on thyroid hormone levels [J]. Obes Surg, 2015, 25(3): 452-456.
[21]
Aykota MR, Atabey M. Effect of sleeve gastrectomy on thyroid-stimulating hormone levels in morbidly obese patients with normal thyroid function [J]. Eur Rev Med Pharmacol Sci, 2021, 25(1): 233-240.
[22]
Granzotto PCD, Mesa Junior CO, Strobel R, et al. Thyroid function before and after Roux-en-Y gastric bypass: an observational study [J]. Surg Obes Relat Dis, 2020, 16(2): 261-269.
[23]
Lips MA, Pijl H, Van Klinken JB, et al. Roux-en-Y gastric bypass and calorie restriction induce comparable time-dependent effects on thyroid hormone function tests in obese female subjects [J]. Eur J Endocrinol, 2013, 169(3): 339-347.
[24]
Chikunguwo S, Brethauer S, Nirujogi V, et al. Influence of obesity and surgical weight loss on thyroid hormone levels [J]. Surg Obes Relat Dis, 2007, 3(6): 631-635.
[25]
Neves JS, Souteiro P, Oliveira SC, et al. Preoperative thyroid function and weight loss after bariatric surgery [J]. Int J Obes (Lond), 2019, 43(2): 432-436.
[26]
Ruiz-Tovar J, Boix E, Galindo I, et al. Evolution of subclinical hypothyroidism and its relation with glucose and triglycerides levels in morbidly obese patients after undergoing sleeve gastrectomy as bariatric procedure [J]. Obes Surg, 2014, 24(5): 791-795.
[27]
Yu H, Li Q, Zhang M, et al. Decreased leptin is associated with alterations in thyroid-stimulating hormone levels after Roux-en-Y gastric bypass surgery in obese euthyroid patients with type 2 diabetes [J]. Obes Facts, 2019, 12(3): 272-280.
[28]
Teke E, Güneş Y, Çoruhlu B, et al. Effects of laparoscopic sleeve gastrectomy on thyroid hormones and relationship between metabolic parameters and long-term total weight loss [J]. Surg Endosc, 2024, 38(4): 1807-1812.
[29]
Kamal M, Aisha HaA, Fahmy MH, et al. The impact of laparoscopic sleeve gastrectomy on thyroid functions in egyptian patients with obesity [J]. J Gastrointest Surg, 2023, 27(7): 1345-1352.
[30]
Abdelbaki TN, Elkeleny MR, Sharaan MA, et al. Impact of laparoscopic sleeve gastrectomy on obese patients with subclinical hypothyroidism [J]. J Laparoendosc Adv Surg Tech A, 2020, 30(3): 236-240.
[31]
Lautenbach A, Wernecke M, Mann O, et al. Thyroid-stimulating hormone levels in euthyroid patients 8 years following bariatric surgery [J]. Int J Obes (Lond), 2022, 46(4): 825-830.
[32]
Gokosmanoglu F, Aksoy E, Onmez A, et al. Thyroid homeostasis after bariatric surgery in obese cases [J]. Obes Surg, 2020, 30(1): 274-278.
[33]
Ma B, Yang P, Gao J, et al. Relationship of vitamin a and thyroid function in individuals with obesity and after laparoscopic sleeve gastrectomy [J]. Front Nutr, 2022, 9: 824193.
[34]
Tian Z, Nie Y, Li Z, et al. Total weight loss induces the alteration in thyroid function after bariatric surgery [J]. Front Endocrinol (Lausanne), 2024, 15: 1333033.
[35]
Chen Y, Zhang W, Pan Y, et al. Thyroid function before and after laparoscopic sleeve gastrectomy in patients with obesity [J]. Obes Surg, 2022, 32(6): 1954-1961.
[36]
Duran ID, Gülçelik NE, Bulut B, et al. Differences in calcium metabolism and thyroid physiology after sleeve gastrectomy and Roux-en-Y gastric bypass [J]. Obes Surg, 2019, 29(2): 705-712.
[37]
Karaman K, Mansıroglu K, Subasi O, et al. Thyroid hormone changes after sleeve gastrectomy with and without antral preservation [J]. Obes Surg, 2021, 31(1): 224-231.
[38]
Maccuish A, Razvi S, Syed AA. Effect of weight loss after gastric bypass surgery on thyroid function in euthyroid people with morbid obesity [J]. Clin Obes, 2012, 2(1-2): 25-28.
[39]
Salman MA, Rabiee A, Salman A, et al. Laparoscopic sleeve gastrectomy has a positive impact on subclinical hypothyroidism among obese patients: a prospective study [J]. World J Surg, 2021, 45(10): 3130-3137.
[40]
Xia MF, Chang XX, Zhu XP, et al. Preoperative thyroid autoimmune status and changes in thyroid function and body weight after bariatric surgery [J]. Obes Surg, 2019, 29(9): 2904-2911.
[41]
Liu F, Di J, Yu H, et al. Effect of Roux-en-Y gastric bypass on thyroid function in euthyroid patients with obesity and type 2 diabetes [J]. Surg Obes Relat Dis, 2017, 13(10): 1701-1707.
[42]
Zhang H, Liu W, Han X, et al. Effect of laparoscopic Roux-en-Y gastric bypass surgery on thyroid hormone levels in chinese patients, could it be a risk for thyroid nodules? [J]. Obes Surg, 2017, 27(10): 2619-2627.
[43]
Guan B, Chen Y, Yang J, et al. Effect of bariatric surgery on thyroid function in obese patients: a systematic review and Meta-analysis [J]. Obes Surg, 2017, 27(12): 3292-3305.
[44]
Bianco AC, Salvatore D, Gereben B, et al. Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases [J]. Endocr Rev, 2002, 23(1): 38-89.
[45]
Janssen IM, Homan J, Schijns W, et al. Subclinical hypothyroidism and its relation to obesity in patients before and after Roux-en-Y gastric bypass [J]. Surg Obes Relat Dis, 2015, 11(6): 1257-63.
[46]
Almunif DS, Bamehriz F, Althuwaini S, et al. The effect of laparoscopic sleeve gastrectomy on serum thyroid-stimulating hormone levels in obese patients with overt and subclinical hypothyroidism: a 7-year retrospective study [J]. Obes Surg, 2020, 30(4): 1491-1497.
[47]
Aggarwal S, Modi S, Jose T. Laparoscopic sleeve gastrectomy leads to reduction in thyroxine requirement in morbidly obese patients with hypothyroidism [J]. World J Surg, 2014, 38(10): 2628-2631.
[48]
Fazylov R, Soto E, Cohen S, et al. Laparoscopic Roux-en-Y gastric bypass surgery on morbidly obese patients with hypothyroidism [J]. Obes Surg, 2008, 18(6): 644-647.
[49]
Garg H, Aggarwal S, Misra MC, et al. Mid to long term outcomes of Laparoscopic Sleeve Gastrectomy in Indian population: 3-7 year results—A retrospective cohort study [J]. Int J Surg, 2017, 48: 201-209.
[50]
Khan WF, Singla V, Aggarwal S, et al. Outcome of bariatric surgery on hypothyroidism: experience from a tertiary care center in India [J]. Surg Obes Relat Dis, 2020, 16(9): 1297-1301.
[51]
Rudnicki Y, Slavin M, Keidar A, et al. The effect of bariatric surgery on hypothyroidism: Sleeve gastrectomy versus gastric bypass [J]. Surg Obes Relat Dis, 2018, 14(9): 1297-1303.
[52]
Almukainzi M, Alqahtani R, Alanazi R, et al. Insight of the biopharmaceutical implication of sleeve gastrectomy on levothyroxine absorption in hypothyroidism patients [J]. Obes Surg, 2024, 34(1): 192-197.
[53]
Gadiraju S, Lee CJ, Cooper DS. Levothyroxine dosing following bariatric surgery [J]. Obes Surg, 2016, 26(10): 2538-2542.
[54]
Yska JP, Arfman IJ, Van Oijen MA, et al. Long-term effect of bariatric surgery on the use of levothyroxine and thyroid levels [J]. Obes Surg, 2022, 32(3): 742-748.
[55]
Papoian V, Ylli D, Felger EA, et al. Evaluation of thyroid hormone replacement dosing in overweight and obese patients after a thyroidectomy [J]. Thyroid, 2019, 29(11): 1558-1562.
[56]
Gale SM, Castracane VD, Mantzoros CS. Energy homeostasis, obesity and eating disorders: recent advances in endocrinology [J]. J Nutr, 2004, 134(2): 295-298.
[57]
Flier JS, Harris M, Hollenberg AN. Leptin, nutrition, and the thyroid: the why, the wherefore, and the wiring [J]. J Clin Invest, 2000, 105(7): 859-861.
[58]
Huang J, Chen Y, Wang X, et al. Change in adipokines and gastrointestinal hormones after bariatric surgery: a Meta-analysis [J]. Obes Surg, 2023, 33(3): 789-806.
[59]
Ajjan RA, Watson PF, Findlay C, et al. The sodium iodide symporter gene and its regulation by cytokines found in autoimmunity [J]. J Endocrinol, 1998, 158(3): 351-358.
[60]
Netto BD, Bettini SC, Clemente AP, et al. Roux-en-Y gastric bypass decreases pro-inflammatory and thrombotic biomarkers in individuals with extreme obesity [J]. Obes Surg, 2015, 25(6): 1010-1018.
[61]
De Sousa PaM, Pereira JRD, Carneiro JRI, et al. Impact of bariatric surgery on thyroid morphology and thyroid function [J]. Obes Surg, 2023, 33(10): 3193-3197.
[62]
Zhu C, Gao J, Mei F, et al. Reduction in thyroid-stimulating hormone correlated with improved inflammation markers in chinese patients with morbid obesity undergoing laparoscopic sleeve gastrectomy [J]. Obes Surg, 2019, 29(12): 3954-3965.
[63]
Refetoff S, Dewind LT, Degroot LJ. Familial syndrome combining deaf-mutism, stuppled epiphyses, goiter and abnormally high PBI: possible target organ refractoriness to thyroid hormone [J]. J Clin Endocrinol Metab, 1967, 27(2): 279-294.
[64]
Jostel A, Ryder WD, Shalet SM. The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH Index [J]. Clin Endocrinol (Oxf), 2009, 71(4): 529-534.
[65]
Laclaustra M, Moreno-Franco B, Lou-Bonafonte JM, et al. Impaired sensitivity to thyroid hormones is associated with diabetes and metabolic syndrome [J]. Diabetes Care, 2019, 42(2): 303-310.
[66]
Krause C, Grohs M, El Gammal AT, et al. Reduced expression of thyroid hormone receptor β in human nonalcoholic steatohepatitis [J]. Endocr Connect, 2018, 7(12): 1448-1456.
[67]
Dickson SL, Egecioglu E, Landgren S, et al. The role of the central ghrelin system in reward from food and chemical drugs [J]. Mol Cell Endocrinol, 2011, 340(1): 80-87.
[68]
Benaiges D, Más-Lorenzo A, Goday A, et al. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure? [J]. World J Gastroenterol, 2015, 21(41): 11804-11814.
[69]
Currie PJ, Mirza A, Fuld R, et al. Ghrelin is an orexigenic and metabolic signaling peptide in the arcuate and paraventricular nuclei [J]. Am J Physiol Regul Integr Comp Physiol, 2005, 289(2): R353-r358.
[70]
Gurgul E, Ruchała M, Kosowicz J, et al. Ghrelin and obestatin in thyroid dysfunction [J]. Endokrynol Pol, 2012, 63(6): 456-462.
[71]
Junnila RK, List EO, Berryman DE, et al. The GH/IGF-1 axis in ageing and longevity [J]. Nat Rev Endocrinol, 2013, 9(6): 366-376.
[72]
Giavoli C, Profka E, Rodari G, et al. Focus on GH deficiency and thyroid function [J]. Best Pract Res Clin Endocrinol Metab, 2017, 31(1): 71-78.
[73]
Rodriguez-Arnao J, Miell JP, Ross RJ. Influence of thyroid hormones on the GH-IGF-I axis [J]. Trends Endocrinol Metab, 1993, 4(5): 169-173.
[74]
Yamauchi I, Sakane Y, Yamashita T, et al. Effects of growth hormone on thyroid function are mediated by type 2 iodothyronine deiodinase in humans [J]. Endocrine, 2018, 59(2): 353-363.
[75]
Ock S, Ahn J, Lee SH, et al. IGF-1 receptor deficiency in thyrocytes impairs thyroid hormone secretion and completely inhibits TSH-stimulated goiter [J]. Faseb j, 2013, 27(12): 4899-4908.
[76]
Gancheva S, Kahl S, Herder C, et al. Metabolic surgery-induced changes of the growth hormone system relate to improved adipose tissue function [J]. Int J Obes (Lond), 2023, 47(6): 505-511.
[77]
Edén Engström B, Burman P, Holdstock C, et al. Effects of gastric bypass on the GH/IGF-I axis in severe obesity--and a comparison with GH deficiency [J]. Eur J Endocrinol, 2006, 154(1): 53-59.
[1] 陈嘉婷, 杜美君, 石冰, 黄汉尧. 母体系统性疾病对新生儿唇腭裂发生的影响[J]. 中华口腔医学研究杂志(电子版), 2024, 18(04): 262-268.
[2] 孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[3] 李猛, 姜腊, 董磊, 吴情, 贾犇黎. 腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 554-557.
[4] 吉顺富, 汤晓燕, 徐进. 腹腔镜近端胃癌根治术中拓展胃后间隙在肥胖患者中的应用研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 393-396.
[5] 杨波, 胡旭, 何金艳, 谢铭. 腹腔镜袖状胃切除术管胃固定研究现状[J]. 中华普外科手术学杂志(电子版), 2024, 18(04): 452-455.
[6] 唐小久, 胡曼, 许必君, 肖亚. 肥胖合并胃食管反流病患者严重程度与其焦虑抑郁及营养状态的相关性研究[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 360-364.
[7] 王星, 陈园, 热孜万古丽·乌斯曼, 郭艳英. T2DM、Obesity、NASH、PCOS共同致病因素相关的分子机制[J]. 中华临床医师杂志(电子版), 2024, 18(05): 481-490.
[8] 许琳. 甲状腺激素及相关疾病与性激素关系的研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(03): 315-318.
[9] 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会胃食管反流疾病诊疗外科专家工作组, 日本肥胖治疗学会, 韩国减重与代谢外科学会. 袖状胃切除术患者胃食管反流病诊治专家共识(2024版)[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 145-162.
[10] 刘纪元, 周新秀, 商洲, 陈悦之. 肥胖与妊娠期并发症研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 163-169.
[11] 王思奇, 张念荣, 周彪, 刘宝胤, 孟化. 肥胖与胆囊疾病研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 177-183.
[12] 郭明杰, 周春起, 余佳慧, 李世红, 朱红梅, 刘雁军, 杨华武. 肥胖与胃食管反流病的关系及减重术后反流治疗研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 184-192.
[13] 罗斯敏, 周苗苗, 石绮屏. 肥胖脂肪代谢及肠道微生物群异常与骨关节炎关系的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 200-205.
[14] 高昊雯, 王桂琦, 庞利云, 张新昕, 谷敬锋. 减重手术治疗肥胖症相关认知障碍的研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 206-212.
[15] 吴子龙, 吴冰, 袁开盛, 胡瑞翔, 杨华, 王存川. 肥胖与胰腺疾病研究进展[J]. 中华肥胖与代谢病电子杂志, 2024, 10(03): 213-219.
阅读次数
全文


摘要