Evaluation of Thyroid Function in Obese Dogs and in Dogs Undergoing a Weight Loss Protocol

Summary Obesity and weight loss have been shown to alter thyroid hormone homeostasis in humans. In dogs, obesity is the most common nutritional problem encountered and weight loss is the cornerstone of its treatment. Therefore, it is important to clarify how obesity and weight loss can affect thyroid function test results in that species. The objectives of this study were to compare thyroid function in obese dogs and in lean dogs and to explore the effects of caloric restriction and weight loss on thyroid hormone serum concentrations in obese dogs. In the first experiment, 12 healthy lean beagles and 12 obese beagles were compared. Thyroid function was evaluated by measuring serum concentrations of total thyroxine (TT4), free thyroxine (FT4), total triiodothyronine (TT3), thyrotropin (TSH), and reverse triiodothyronine (rT3) as well as a TSH stimulation test using 75 μg IV of recombinant human TSH. In the second experiment, eight obese beagles were fed an energy‐restricted diet [average 63% maintenance energy requirement (MER)] until optimal weight was obtained. Blood samples for determination of TT4, FT4, TT3, TSH and rT3, were taken at the start and then weekly during weight loss. Only TT3 and TT4 serum concentrations were significantly higher in obese dogs as compared to lean dogs. In the second experiment, weight loss resulted in a significant decrease in TT3 and TSH serum concentrations. Thus obesity and energy restriction significantly alter thyroid homeostasis in dogs, but the observed changes are unlikely to affect interpretation of thyroid function test results in clinics.     

Prevalence of Subclinical Hypothyroidism in a Morbidly Obese Population and Improvement after Weight Loss Induced by Roux-en-Y Gastric Bypass

Background:There are many studies concerning thyroid function in obesity, and some of them describe higher TSH levels in obese subjects. Few studies evaluated long-term changes in thyroid function caused by weight loss after bariatric surgery. Our aims were to evaluate the prevalence of subclinical hypothyroidism (SH) in a morbidly obese population and to analyze the effect of weight loss induced by Roux-en-Y gastric bypass (RYGBP) on TSH and thyroid hormone (TH) levels. Methods: TSH, free thyroxine (fT4) and total triiodothyronine (T3) levels were analyzed before and 12 months after RYGBP in patients with grade III or grade II obesity with co-morbidities. Subjects taking TH and/or with positive antithyroid antibodies and/or with overt hypothyroidism were excluded. Results: 72 subjects (62F/10M), with mean age 39.6±9.8 years and mean BMI 53.0±10.4 kg/m² were studied. The prevalence of SH before RYGBP was 25% (n=18). There was a significant post-surgical decrease in BMI in the whole population, as well as in SH patients. In the SH group and normal TSH group, there was a decrease in TSH and T3, but not in fT4. TSH was not correlated with initial BMI or percent change in BMI. TSH concentrations reached normal values in all SH patients after RYGBP. Conclusion: Our data confirm that severe obesity is associated with increased TSH. The decrease in TSH was independent of BMI, but occurred in all SH patients. A putative effect of weight reduction on the improvement of SH in all patients may be an additional benefit of bariatric surgery.     

Body Composition and Source of Weight Loss After Bariatric Surgery

Background: Little is known about the composition and source of weight loss after bariatric surgery for morbid obesity. Purpose: This study was undertaken to determine changes in weight, body mass index (BMI), lean body weight (LBW), fat weight (FW) and left ventricular cardiac mass (LVM) following vertical banded gastroplasty (VBG). Methods: After VBG for morbid obesity, 26 women and four men (mean age = 39.1 years) were weighed and had body composition analysis undertaken at intervals. Thirteen patients underwent echocardiography preoperatively and 1 year postoperatively to determine change in LVM and LVM index. Results: Over 12 months there was significant weight loss for all weight parameters examined (p < 0.05). Fat weight loss was most significant; total weight loss and reduction of BMI were significant but less so than fat loss (Wilcoxon's signed ranks test). LBW loss had the smallest contribution to weight loss (p < 0.0001). There was a significant loss of LVM and posterior cardiac wall thickness (p < 0.05). Conclusions: VBG can lead to loss of lean body weight and left ventricular mass, and more dramatically, fat weight, body weight, and BMI. Cardiac mass and lean body mass are preferentially conserved relative to body fat with weight loss after VBG.     

The efficacy of intrathecal administration of a very low dose potirelin after acute spinal cord injury

Background and object

The objective of this study was to determine the effect of a very low dose protirelin in cerebrospinal fluid (CSF) glucose, magnesium and lactate levels after spinal cord trauma (SCT) in rabbits. We also aimed to evaluate whether this very low dose might induce analeptic effect.

Material and methods

Twenty rabbits were divided equally into two groups: group I (n = 10) was the control group, suffered from SCT but received only saline after SCT. Group II (n = 10) (treatment group), received a very low dose of 0.05 mg/kg thyrotropin releasing hormone (TRH), analogue protirelin intrathecally after SCT. The basal CSF glucose, magnesium and lactate levels were recorded in both groups. CSF lactate, glucose and magnesium contents were recorded at the same time (an hour before and after) SCT. Serum thyroid stimulating hormone (TSH), freetriiodothyronine (FT3) and freethyroxine (FT4) were measured in all rabbits before and after SCT.

Results

Before spinal cord trauma, there were not any significant differences in glucose, lactate and magnesium levels between group I and II whereas, after spinal cord trauma in group II, the significant suppression in elevation of lactate and glucose depletion (p < 0.05) were observed while no significant suppression was observed in magnesium level (p > 0.05) as compared with group I (Table 3). In respect of serum TSH levels, there were not any significant differences between two groups before and after SCT.

Conclusions

This study showed that intrathecal TRH has no analeptic effect on serum TSH, FT3 and FT4 levels but can attenuate the increase of lactate levels following spinal cord trauma. No significant decrease in magnesium level and also suppression of glucose decline in group II, may be related to the neuroprotective effects of TRH.     

基础甲状腺功能与IVF-ET妊娠结局的相关性研究

目的研究基础甲状腺功能三项(TSH、FT3、FT4水平)与体外受精-胚胎移植妊娠结局之间的关系。方法以2014年9月至2015年5月在南京大学医学院附属鼓楼医院生殖医学中心行长方案体外受精/卵胞浆内单精子注射-胚胎移植术(IVF/ICSI-ET)并行新鲜胚胎移植的不孕症患者作为研究对象。于IVF前月经第2~4天空腹留血,检测基础甲状腺功能三项:促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)。纳入甲状腺功能三项均正常的患者486例,分析基础甲状腺功能与IVF/ICSI妊娠结局的关系。结果 (1)486例患者中临床妊娠305例,活产249例,早期自然流产23例;(2)临床妊娠组与未妊娠组比较,TSH、FT3、FT4水平均无统计学差异(P0.05),临床妊娠组女方年龄小[(29.4±3.9)vs.(30.7±4.3)岁,P=0.001)]、子宫内膜厚[(11.0±2.2)mm vs.(9.9±1.9)mm,P0.001)];(3)活产组与早期自然流产组相比,基础TSH、FT3、FT4差异均无统计学意义(P0.05);(4)基础TSH≥2.5mIU/L的患者与TSH2.5mIU/L者的临床妊娠率、活产率、早期自然流产率和新生儿出生体重均无统计学差异(P0.05)。结论基础甲状腺功能三项如在正常范围不影响IVF结局,IVF前TSH≥2.5mIU/L但4.2mIU/L时不增加早期自然流产率,也不影响新生儿出生体重。     

Laparoscopic Gastric Bypass in Patients on Thyroid Replacement Therapy for Subnormal Thyroid Function – Prevalence and Short-Term Outcome

Background: Hypothyroidism is associated with increased body weight. Weight gain may occur despite normal levels of serum thyroid stimulating hormone (TSH) and thyroxine (T4) achieved by replacement therapy. We evaluated the prevalence of patients on thyroid replacement for subnormal thyroid function who were operated on for morbid obesity and monitored their postoperative weight loss pattern. Methods: Data was identified from a prospectively accrued database of patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) for morbid obesity from February 2000 to November 2001. All patients with subnormal thyroid function, diagnosed by past thyroid function tests and treated by an endocrinologist, who were on thyroid replacement therapy, were identified; 5 of these were matched for age, gender, preoperative body mass index (BMI) and surgical procedure (LRYGBP) to 5 non-hypothyroid patients. Weight loss at 3 and 9 months after surgery was compared between the 2 groups. Results: 192 patients underwent LRYGBP (n=155) or LAGB (n=37). Of the 21 patients (10.9%) on thyroid replacement identified, 14 were primary, 4 were postablative, and 3 were post-surgical; 17 underwent LRYGBP. All patients had normal preoperative serum levels of TSH and T4. Comparison of the 2 matched groups of patients revealed no difference in weight loss at 3 and 9 months after surgery (P=1.0). Conclusions: The prevalence of euthyroid patients on thyroid replacement for subnormal thyroid function who undergo surgical intervention for morbid obesity is high. Short-term weight loss in these patients is comparable to normal thyroid patients. Longer follow-up may be necessary to demonstrate the weight loss pattern in this group.     

Thyroid dysfunction in infertile women

Objective: To determine the frequency of thyroid dysfunction in infertile women referred for thyroid evaluation. Design: A retrospective case-control study. Place and Duration of Study: This study was carried out at Centre for Nuclear Medicine (CENUM), Mayo Hospital, Lahore, from July 2003 to December 2006. Patients and Methods: Age matched infertile (n=140 each) and fertile women (n=152 each) referred to CENUM for thyroid evaluation were investigated for incidence of hyperthyroidism (TSH < 0.03 mIU/L), hypothyroidism (TSH < 0.03 mIU/L) and thyroid autoimmunity (antithyroid peroxidase antibody titer>20 IU/L). Serum free T4 (FT4), free T3 (FT3) and antithyroid peroxidase antibody (TPO-Ab) was determined by radioimmunoassay (RIA) and TSH by immunoradiometric assay (IRMA). Results: Most of the infertile women (89.3%), like control women (93.4%), were euthyroid. The difference of overall thyroid dysfunction was not statistically significant in infertile and control women (10.7% vs. 7.9%; p=0.395). The same was true for incidence of hyperthyroidism (4.3% vs. 5.3%; p=0.701) as well as hypothyroidism (6.4% vs. 2.6%; p=0.104). In infertile women, the incidence of hypothyroidism (6.4%) was slightly higher as compared to hyperthyroidism (4.3%). In euthyroid women of both groups, mean FT4, FT3 and TSH levels were significantly higher (p < 0.05) in infertile women and double number of them had serum TSH>2.5 mIU/L compared to fertile women (31.2% vs. 15.6%; p<0.01). Similarly, more infertile women were TPO-Ab positive (titer>20 IU/L) than control women (7.2% vs. 1.4%; p < 0.05). Conclusion: Increased incidence of high normal TSH and raised TPO-Ab titer indicate relatively more frequent occurrence of compensated thyroid function in infertile women than normal women of reproductive age. This necessitates considering them a subgroup of women in which all aspects of pituitary-thyroid axis should be thoroughly investigated than merely TSH testing.     

Effect of Weight Loss after Bariatric Surgery on Thyroid-Stimulating Hormone Levels in Patients with Morbid Obesity and Normal Thyroid Function

Background

Several studies have reported that morbid obesity is associated with increased thyroid-stimulating hormone (TSH) levels. However, it is not clear what is the impact of bariatric surgery on postoperative thyroid function. The aim of this study was to evaluate the effect of weight loss after bariatric surgery on TSH levels in euthyroid patients with morbid obesity.

Methods

We performed a retrospective observational study of 949 euthyroid patients (86.1% female; age 42.0 ± 10.3 years, BMI 44.3 ± 5.7 kg/m²) with morbid obesity submitted to bariatric surgery (laparoscopic adjustable gastric band, Roux-en-Y gastric bypass, or sleeve gastrectomy). Patients were subdivided in two groups: normal TSH group (TSH <2.5 mU/L) and high-normal TSH group (TSH ≥2.5 mU/L). The impact of anthropometric parameters, comorbidities, TSH, free thyroxine (FT4), free triiodothyronine (FT3), type of surgery, and excessive body weight loss (EBWL) on TSH variation 12 months after surgery was evaluated.

Results

The high-normal TSH group (24.3% of patients) included more women, presented a higher BMI, higher systolic blood pressure, and higher FT3 levels. There was a significant decrease of TSH 12 months after surgery that was more marked in the high-normal TSH group (normal TSH group: 1.57 ± 0.49 to 1.53 ± 0.69 mIU/L, p = 0.063; high-normal TSH group: 3.23 ± 0.59 to 2.38 ± 0.86 mIU/L, p < 0.001). In a multivariate analysis, after adjusting for relevant covariates, EBWL, baseline BMI, and baseline FT3 were significantly associated with TSH decrease 12 months after bariatric surgery.

Conclusion

Bariatric surgery promotes a decrease of TSH that is significantly greater in patients with high-normal TSH and is independently associated with EBWL after surgery.

     

微波消融术与甲状腺腺叶切除术对BRAF V600E基因野生型cN0甲状腺微小乳头状癌临床效果对比研究

目的探讨微波消融术与甲状腺腺叶切除术对BRAF^V600E基因野生型cN0甲状腺微小乳头状癌（PTMC）的临床效果。 方法选取2017年1月至2019年7月湖北省黄冈市中心医院收治的BRAF^V600E基因野生型cN0-PTMC患者108例,采用随机数字表法分为切除组和消融组,每组54例;切除组行甲状腺腺叶切除术,消融组行微波消融术。比较两组围手术期相关指标、甲状腺功能、术后并发症发生情况及随访情况等。 结果与切除组比较,消融组手术时间、术中出血量、VAS评分、术后住院时间及住院费用显著降低,美观满意度更高（t=27.825、29.693、10.145、15.495、8.152、12.662,均P<0.01）。术后消融组TSH水平较术前显著降低（t=32.457,P<0.001）,FT3及FT4水平较术前无显著差异;术后切除组TSH水平较术前显著升高（t=130.517,P<0.001）,FT3及FT4水平较术前显著降低（t=28.104、25.641,均P<0.001）;术后两组TSH、FT3及FT4水平比较,差异有统计学意义（t=21.022、6.586、4.659,均P<0.001）。消融组术后总并发症发生率为7.4%,显著低于切除组的22.2%,差异有统计学意义（χ2=4.688,P=0.030）。消融组术前与术后各时间点病灶体积比较差异有统计学意义（W=21.052,P<0.001）。随访期间,两组均未发现病灶复发或远处转移病例。 结论与甲状腺腺叶切除术相比,微波消融术治疗BRAF^V600E基因野生型cN0-PTMC不仅具有微创、恢复快、美观满意度高、并发症少等优势,而且能够更好地保留甲状腺功能,且预后良好,具有较高的临床应用价值。     

Long-Term Results of Gastroplasty for Morbid Obesity: Binge-Eating as a Predictor of Poor Outcome

We investigated the long-term results after vertical banded gastroplasty (VBG) for morbid obesity and evaluated some predictors of poor outcome. Twenty-seven morbidly obese patients (mean BMI 50 kg/m²) who underwent VBG a mean of 5.4 years earlier were studied. The mean weight loss was 31 kg or 40.5% of excess weight. Ten patients (37%) were within 50% of their ideal weight. The patients were classified as bingers (n = 10) and non-bingers (n = 17) according to the modified Binge Eating Scale. One-year postoperative weight losses were 55% and 57% respectively of excess weight, but at the time of the study weight losses were 24% and 50% of excess weight (p = 0.04) in the bingers and non-bingers, respectively. The mean weight regain was 23 kg in the bingers vs 8 kg in the non-bingers, p = 0.01. Two bingers had excellent weight loss results, but otherwise an unsuccessful outcome. Weight reduction did not correlate with age, sex or age of onset of obesity. These results show that binge-eating strongly predicts poor weight loss maintenance after gastroplasty in the long-term, though initial weight reduction is good. We suggest that binge-eating should be evaluated before gastroplasty and taken into consideration in the design of treatment.     

Effects of Thyroid Hormone Therapy on Cut-Surface Healing of the Remnant Stomach with Short-Term Weight Loss Alterations after Sleeve Gastrectomy

Background: The hypothalamic–pituitary–tyhroid axis is directly affected by drastic changes in energy stores. The aim of the present study was to determine the effects of triiodothyronine (T3) treatment on cut-surface healing of remnant stomach with weight loss alterations after sleeve gastrectomy (SG). Methods: Thirty male Wistar Albino rats were divided into three groups: sham (n = 6), control (n = 12), and experimental (n = 12). Control and experimental group rats underwent sleeve gastrectomy. Experimental group rats received a single dose of T3 (400 mg/100 g) on the first postoperative day whereas control group rats received 0.9% NaCl. All rats were sacrificed on the seventh postoperative day. Results: In the group of rats receiving T3, levels of FT3 were significantly higher and that of FT4 were significantly lower compared with both the control and sham group rats (p <.05). No significant difference was found between control and T3 group rats in terms of weight loss (p >.05). Microscopic examination of the cut surface of remnant stomach in the control group rats revealed significantly more severe tissue necrosis, edema, and disruption of mucosal epithelium than in the T3 group rats (p <.05). On the other hand, bridging of the submucosal and muscular layers, tissue granulation, fibroblast accumulation, neoangiogenesis, and collagen deposition in the T3 group rats were significantly higher than in the control group rats (p <.05). Conclusions: Sleeve gastrectomy did not significantly alter thyroid hormone levels in short term. T3 hormone therapy seems to deliver constructive therapeutic effects for wound healing while causing no adverse effect on weight reduction.     

Renal artery resistance index, thyroid hormones, and thyroid volume in the early kidney transplants recipients

BACKGROUND: Thyroid hormones could affect renal function, and, on the other hand, renal dysfunction may affect thyroid function. Disturbances of concentrations of thyroid hormones are often associated with thyroid gland enlargement. The aim of the study was to assess the function and morphology of the thyroid (volume and hormones concentration) and kidney function after transplantation (creatinine concentration and resistance index [RI] of transplant artery). MATERIAL AND METHODS: The group included 13 females, 19 males; aged 19-69 years, mean 44.75 +/- 14.8 years after transplantation with stable graft function. Thyroid volume, renal artery RI, creatinine concentration, and concentrations of T3, rT3, FT3, FT4, and TSH were estimated the day before surgery, and at 1, 3, 6, and 10 days after transplantation. RESULTS: The statistical analysis revealed a negative correlation between delta RI (difference between RI at 3 and 6 days after transplantation) and serum creatinine concentration, 10 days after transplantation (r = -0.63; P < 0.01). We also observed a negative correlation between creatinine serum concentration at 10 days after transplantation and delta thyroid volume (Delta Vol; r = - 0.48; p < .05), a positive correlation between delta FT4 (Delta FT4) serum concentration, and delta creatinine (Delta Crea; r = 0.73; P < .001). CONCLUSIONS: The dynamics of RI changes in the transplant kidney artery between 3 and 6 days after transplantation may predict graft function. Together with improved kidney function at 10 days after transplantation, we observed a regression of goiter.     

Is there any relation between thyroid gland function and kidney transplant function?

INTRODUCTION: Patients with chronic renal failure exhibit abnormalities of thyroid function. Reports regarding thyroid function in kidney transplant recipients (TX) are rare, particularly those individuals on long-term immunosuppression. The aim of this study was to investigate correlations between FT3, FT4, TSH concentrations, thyroid volume, and graft function. MATERIAL AND METHODS: The study enrolled 46 kidney allograft recipients (aged 27-67 years,) engrafted between years 1994 and 2000 and clinically stable. The mean time after TX was 45.3 +/- 37.4 months. Transplanted patients received prednisone, cyclosporine, and azathioprine. The control group included 22 patients with normal renal function. In addition to serum creatinine, TSH, FT3, and FT4 concentrations, thyroid examinations were performed with a 7.5-MHz linear probe to calculated the thyroid volume. RESULTS: Thyroid volume in TX patients was 25.3 +/- 13.3 mL. A positive correlation existed between thyroid volume and serum creatinine (P <.05), and a negative one between thyroid volume and TSH (P <.05). No correlation was observed between TSH, FT4, and serum creatinine. The time after TX was negatively related to TSH (P <.05). A negative correlation existed also between FT3 and creatinine in TX patients (P <.05). In the control group the concentrations of TSH and FT3 were within normal ranges. CONCLUSION: The FT3 concentration correlates with function of the renal graft. In TX patients the supplementary thyroid hormone therapy should be considered.     

Influence of obesity and surgical weight loss on thyroid hormone levels

BACKGROUND: The pathophysiologic relationship between morbid obesity and thyroid hormones is not well understood. The goal of this study was to evaluate the influence of obesity and weight reduction after bariatric surgery on thyroid hormone levels. METHODS: Patients who underwent gastric bypass or adjustable gastric banding at our institution, had no previous diagnosis of thyroid disorder, were not taking medication that could affect the thyroid function evaluation, and who were nonsmokers were included in this retrospective evaluation. The association between the thyroid-stimulating hormone (TSH) and free thyroxine (T(4)) levels and body mass index (BMI), and the influence of weight loss after bariatric surgery on these hormones were investigated at different points (preoperatively and 6 and 12 months after bariatric surgery). RESULTS: A total of 86 patients met the study criteria. The TSH levels correlated positively with BMI (P <.001, r = .91) within the BMI range of 30-67 kg/m(2). The mean BMI change from 49 to 32 kg/m(2) after bariatric surgery was associated with a mean reduction in the TSH level from 4.5 to 1.9 microU/mL. Free T(4) showed no association with BMI and was not significantly influenced by weight loss. Before bariatric surgery, 10.5% of the subjects had laboratory values consistent with subclinical hypothyroidism. After bariatric surgery, 100% of these patients experienced significant weight reduction with simultaneous resolution of their subclinical hypothyroidism. CONCLUSION: The results of our study have demonstrated a statistically significant positive association between serum TSH within the normal range and BMI. No association was found between BMI and free T(4) serum levels. The prevalence of subclinical hypothyroidism in study group was 10.5%. Weight loss after bariatric surgery improved or normalized thyroid hormone levels.     

Some Hormonal Changes Before and After Vertical Banded Gastroplasty for Severe Obesity

Background: Hormonal disturbances play a role in the development of obesity, but may be a consequence of obesity itself. In this study we assessed the influence of the surgically-induced weight loss on some important hormonal abnormalities in the morbidly obese patients. Material and Methods: Fasting serum prolactin, insulin, cortisol and thyroid hormones: free thyroxin (FT4),free triiodothyronine (FT3) and thyrotropin (TTH), have been studied by radioimmune methods before vertical banded gastroplasty (VBG) and after operation in the early (10-14 days) and late period when excess weight loss (EWL) 51.7-57.1% had been achieved. Results: On the 10-14 day after VBG, prolactin increased significantly in women (p<0.05), but decreased after weight loss (p<0.01). Fasting insulin was lowered significantly (p<0.05) soon after VBG in the hyperinsulinemic (51.7 % of the total group) and diabetic (n-9) patients. After weight loss, insulin decreased significantly (p< 0.0001) vs. preoperative. Concentration of cortisol was unchanged both in the early and in the late postoperative period. On the days 10-14, significant elevation of TTH and decrease of FT3 (p<0.05) have been noted. After essential weight loss TTH dropped significantly vs. preoperative (p< 0.05) with no changes in FT3 and FT4 concentration. Conclusions: VBG and consequent weight loss favorably influence the hormonal abnormalities in the morbidly obese. Further studies are needed to make clear a relationship between this and other parameters of metabolic syndrome. The hormonal abnormalities may influence the indications for surgery in less than morbidly obese patients with metabolic syndrome.     

A prospective study of thyroid function,bone loss,and fractures in older men: The MrOS study

Excess thyroid hormone is associated with increased bone loss and fracture risk in older women, but few data exist for men. We sought to determine if thyroid function is independently associated with bone loss and fracture risk in older men. Data were analyzed from the Osteoporotic Fractures in Men (MrOS) study, a cohort of community‐dwelling U.S. men aged 65 years and older. Using a case‐cohort design, fasting baseline serum archived at ?80°C was assayed for thyroid‐stimulating hormone (thyrotropin) (TSH) and free thyroxine (FT4) in 397 men with confirmed nonspine fracture, including 157 hip fractures, and 1420 randomly selected men without fracture. TSH and FT4 were analyzed as continuous variables and as thyroid function categories (subclinical hyperthyroid, euthyroid, and subclinical hypothyroid). Hip dual‐energy X‐ray absorptiometry (DXA) (Hologic QDR4500) was measured at baseline and after a mean follow‐up of 4.6 years. Incident nonspine fractures were centrally adjudicated. Bone loss was evaluated with multivariate regression methods and fractures risk was evaluated using hazard models that accounted for the case‐cohort sampling, adjusted for age, clinic‐site, body mass index (BMI), race, physical activity, corticosteroid use, smoking, alcohol intake, and thyroid medication use. In fully adjusted analyses, TSH was not associated with risk of nonspine fracture (relative hazard [RH] 0.92 per SD decrease in TSH; 95% confidence interval [CI], 0.74–1.14), but was significantly associated with risk of hip fracture (RH 1.31; 95% CI, 1.01–1.71), which persisted among normal range TSH values (RH 1.21; 95% CI, 1.00–1.47). There was no association between TSH or FT4 and bone loss, and fracture risk did not differ significantly by thyroid function category. We conclude that although neither TSH nor FT4 are associated with bone loss, lower serum TSH may be associated with an increased risk of hip fractures in older men. © 2013 American Society for Bone and Mineral Research.     

Mineral Metabolism in Obese Patients Following Vertical Banded Gastroplasty

Background Bone disease has been described in patients after surgical treatment for obesity, but few studies have dealt with the impact of vertical banded gastroplasty on mineral metabolism. We have examined bone mineral metabolism in morbidly obese patients before and after 3 months after vertical banded gastroplasty without vitamin D supplementation. Methods Sixteen morbidly obese patients (14 women, 2 men) with a mean (±SD) age of 38 ± 9 years and a body mass index (BMI) of 47.1 ± 8.1 kg/m² were studied. No vitamin D supplementation was given. Body weight, fat mass, calcium, 25OHD, iPTH, bone remodeling markers, and leptin levels were measured at baseline and after weight loss. Results Mean weight loss was 28 ± 11 kg; BMI and body fat mass decreased by 20 and 35%, respectively. Bone resorption markers and albumin-corrected serum calcium increased after operation, whereas iPTH fell. Serum 25OHD levels rose. Leptin levels decreased. Serum iPTH was positively correlated with weight, BMI, and fat mass before operation (p < 0.05), and its decline after weight reduction was negatively associated with the increase in bone resorption markers (p < 0.01). Leptin concentration was correlated with BMI and body fat mass (p < 0.05) both before and after surgery. Conclusions Weight reduction obtained in morbidly obese subjects 3 months after vertical banded gastroplasty increases bone turnover markers and decreases PTH secretion. Serum 25OHD levels rose. Therefore, no reasons for a metabolic bone disease related to hypovitaminosis D were readily apparent. However, an increase in bone turnover, which is generally regarded as a potential risk factor for osteoporosis, was observed. Further work is needed to clarify the importance of this turnover increase in the long run.     

Pre- and Postoperative Esophageal and Gastric pH Levels in Morbidly Obese Patients Undergoing Vertical Gastroplasty

Background: The aim of this study was to determine whether the anatomicofunctional changes induced by vertical gastroplasty lead to pH alterations in the esophagus and body and antrum of the stomach. Materials and Methods: 23 non-smoking volunteers (3 men, 20 women) mean age 35.29 ± SD 6.85 years, mean weight 163.17 ± 52.11 kg and mean BMI 56.06 ± 14.01 kg/m2 were studied. The pH of the esophagus, body and antrum of the stomach were measured preoperatively and 18 months postoperatively (after excess weight loss). Data was analyzed statistically using paired student t-test. Results: The pH values before (pH₁) and after (pH₂) the operation were: for the esophagus pH_1e ± SD = 6.12 ± 0.31 and pH_2e ± SD = 5.92 ± 0.37 (P =0.38), for the body of the stomach pH_1b ± SD = 2.2 ± 0.30 and pH_2b ± SD = 2.56 ± 0.34 (P =0.30), and for the antrum pH_1a ± SD = 1.78 ± 0.28, and pH_2a ± SD = 1.65 ± 0.36 (P =0.011). Conclusions: Vertical gastroplasty does not affect the pH levels in the esophagus and in the body of the stomach. However, there is acidification in the antrum, which could lead to pH-related diseases.     

Effects of Weight Loss on QT Interval in Morbidly Obese Patients

Background: Obesity causes structural changes to the heart that may influence its function. Furthermore, morbid obesity is associated with an acquired prolongation of the QTc interval that may lead to potentially hazardous arrhythmias. The present study investigated the effect of body weight loss following vertical banded gastroplasty (VBG) on the QTc interval. Methods: 17 morbidly obese patients, scheduled for elective VBG, were studied before the operation and 8-10 months postoperatively, when each patient had achieved a weight loss of ≥ 25% of the preoperative body weight. Results: 15 patients achieved significant body weight loss of ≥ 25% within the first 8-10 postoperative months (P <0.001).This weight loss, corresponding to an excess weight loss of 48.7% and a mean body mass index (BMI) reduction from 49.7 kg/m² to 36.6 kg/m², was followed by significant shortening of the QTc interval from 428 msec to 393 msec (P <0.001). Conclusions: The significant postoperative weight loss following VBG was accompanied by shortening of the QTc interval. This effect is expected to reduce the incidence of fatal conditions associated with the long QT syndrome, such as malignant ventricular arrhythmias and sudden death, and therefore improve morbidity and mortality.