Improved Levothyroxine Pharmacokinetics After Bariatric Surgery
Background: The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointesti...
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| Veröffentlicht in: | Thyroid (New York, N.Y.) N.Y.), 2013-04, Vol.23 (4), p.414-419 |
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| container_title | Thyroid (New York, N.Y.) |
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| creator | Gkotsina, Margarita Michalaki, Marina Mamali, Irene Markantes, Georgios Sakellaropoulos, George C. Kalfarentzos, Fotios Vagenakis, Apostolos G. Markou, Kostas B. |
| description | Background:
The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointestinal tract where LT4 is absorbed in patients with severe obesity before and after surgery.
Methods:
We studied 32 severely obese nonhypothyroid patients who underwent sleeve gastrectomy (SG;
n
=10), Roux-en-Y gastric bypass (RYGBP;
n
=7), or biliopancreatic diversion with long limbs (BPD-LL;
n
=15). Before surgery, from 8:00 a.m., blood samples were collected before and every 30 minutes after the oral administration of a solution of 600 μg of LT4. The same procedure was repeated 35 days after surgery. We estimated the pharmacokinetic parameters of LT4 before and after surgery, including the area under the curve (AUC), the peak thyroxine concentration (
C
max
), and the time to peak thyroxine concentration (
T
max
).
Results:
Following surgery, in the SG group, the mean AUC was higher than it was before surgery (18.97±6.01 vs. 25.048±6.47 [μg/dL]·h;
p |
| doi_str_mv | 10.1089/thy.2011.0526 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1321798226</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1321798226</sourcerecordid><originalsourceid>FETCH-LOGICAL-c337t-36d974a782ac1dbde47f2219386cdd65a33d864c4187e838c9835e83d245266e3</originalsourceid><addsrcrecordid>eNqFkEtPwzAQhC0EoqVw5Ipy5JLiR2I7J1QqXlIlkICz5dobGsij2E5F_z2OWrhy2tnVp9HOIHRO8JRgWVyF1XZKMSFTnFN-gMYkz0VaYCEOo8Y5TgXN-QideP-BMeFSsGM0oowQzGgxRtePzdp1G7DJAjZdNHPdd9VC8rzSrtGm-4xLqIxPZmUAl9xoV-ngKpO89O4d3PYUHZW69nC2nxP0dnf7On9IF0_3j_PZIjWMiZAybguRaSGpNsQuLWSipJQUTHJjLc81Y1byzGRECpBMmkKyPApLsxiLA5ugy51v_ParBx9UU3kDda1b6HqvCKNEFJJSHtF0hxrXee-gVGtXNdptFcFq6EzFmGroTA2dRf5ib90vG7B_9G9JEWA7YDjrtq0rWIIL_9j-AMVGeEQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1321798226</pqid></control><display><type>article</type><title>Improved Levothyroxine Pharmacokinetics After Bariatric Surgery</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Gkotsina, Margarita ; Michalaki, Marina ; Mamali, Irene ; Markantes, Georgios ; Sakellaropoulos, George C. ; Kalfarentzos, Fotios ; Vagenakis, Apostolos G. ; Markou, Kostas B.</creator><creatorcontrib>Gkotsina, Margarita ; Michalaki, Marina ; Mamali, Irene ; Markantes, Georgios ; Sakellaropoulos, George C. ; Kalfarentzos, Fotios ; Vagenakis, Apostolos G. ; Markou, Kostas B.</creatorcontrib><description>Background:
The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointestinal tract where LT4 is absorbed in patients with severe obesity before and after surgery.
Methods:
We studied 32 severely obese nonhypothyroid patients who underwent sleeve gastrectomy (SG;
n
=10), Roux-en-Y gastric bypass (RYGBP;
n
=7), or biliopancreatic diversion with long limbs (BPD-LL;
n
=15). Before surgery, from 8:00 a.m., blood samples were collected before and every 30 minutes after the oral administration of a solution of 600 μg of LT4. The same procedure was repeated 35 days after surgery. We estimated the pharmacokinetic parameters of LT4 before and after surgery, including the area under the curve (AUC), the peak thyroxine concentration (
C
max
), and the time to peak thyroxine concentration (
T
max
).
Results:
Following surgery, in the SG group, the mean AUC was higher than it was before surgery (18.97±6.01 vs. 25.048±6.47 [μg/dL]·h;
p
<0.01), whereas the values of
C
max
and
T
max
were similar to those before surgery. In the RYGBP group, mean AUC,
C
max
, and
T
max
were similar before and after surgery. In the BPD-LL group, mean AUC and
C
max
were higher after surgery than before (14.18±5.64 vs. 25.51±9.1 [μg/dL]·h,
p
<0.001; 5.62±1.34 vs. 8.16±2.57 μg/dL,
p
<0.001, respectively), whereas
T
max
was similar.
Conclusions:
The pharmacokinetic parameters of LT4 absorption are improved following SG and BPD-LL types of bariatric procedures. We conclude that the stomach, the duodenum, and the upper part of the jejunum are not sites for LT4 absorption, because in the above-mentioned bariatric procedures these are bypassed or removed.</description><identifier>ISSN: 1050-7256</identifier><identifier>EISSN: 1557-9077</identifier><identifier>DOI: 10.1089/thy.2011.0526</identifier><identifier>PMID: 23110329</identifier><language>eng</language><publisher>United States: Mary Ann Liebert, Inc</publisher><subject>Adolescent ; Adult ; Bariatric Surgery ; Female ; Humans ; Male ; Middle Aged ; Obesity - metabolism ; Obesity - surgery ; Original Studies ; Thyroid Dysfunction: Hypothyroidism, Thyrotoxicosis, and Thyroid Function Tests ; Thyroid Hormones - blood ; Thyroxine - pharmacokinetics ; Treatment Outcome</subject><ispartof>Thyroid (New York, N.Y.), 2013-04, Vol.23 (4), p.414-419</ispartof><rights>2013, Mary Ann Liebert, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-36d974a782ac1dbde47f2219386cdd65a33d864c4187e838c9835e83d245266e3</citedby><cites>FETCH-LOGICAL-c337t-36d974a782ac1dbde47f2219386cdd65a33d864c4187e838c9835e83d245266e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23110329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gkotsina, Margarita</creatorcontrib><creatorcontrib>Michalaki, Marina</creatorcontrib><creatorcontrib>Mamali, Irene</creatorcontrib><creatorcontrib>Markantes, Georgios</creatorcontrib><creatorcontrib>Sakellaropoulos, George C.</creatorcontrib><creatorcontrib>Kalfarentzos, Fotios</creatorcontrib><creatorcontrib>Vagenakis, Apostolos G.</creatorcontrib><creatorcontrib>Markou, Kostas B.</creatorcontrib><title>Improved Levothyroxine Pharmacokinetics After Bariatric Surgery</title><title>Thyroid (New York, N.Y.)</title><addtitle>Thyroid</addtitle><description>Background:
The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointestinal tract where LT4 is absorbed in patients with severe obesity before and after surgery.
Methods:
We studied 32 severely obese nonhypothyroid patients who underwent sleeve gastrectomy (SG;
n
=10), Roux-en-Y gastric bypass (RYGBP;
n
=7), or biliopancreatic diversion with long limbs (BPD-LL;
n
=15). Before surgery, from 8:00 a.m., blood samples were collected before and every 30 minutes after the oral administration of a solution of 600 μg of LT4. The same procedure was repeated 35 days after surgery. We estimated the pharmacokinetic parameters of LT4 before and after surgery, including the area under the curve (AUC), the peak thyroxine concentration (
C
max
), and the time to peak thyroxine concentration (
T
max
).
Results:
Following surgery, in the SG group, the mean AUC was higher than it was before surgery (18.97±6.01 vs. 25.048±6.47 [μg/dL]·h;
p
<0.01), whereas the values of
C
max
and
T
max
were similar to those before surgery. In the RYGBP group, mean AUC,
C
max
, and
T
max
were similar before and after surgery. In the BPD-LL group, mean AUC and
C
max
were higher after surgery than before (14.18±5.64 vs. 25.51±9.1 [μg/dL]·h,
p
<0.001; 5.62±1.34 vs. 8.16±2.57 μg/dL,
p
<0.001, respectively), whereas
T
max
was similar.
Conclusions:
The pharmacokinetic parameters of LT4 absorption are improved following SG and BPD-LL types of bariatric procedures. We conclude that the stomach, the duodenum, and the upper part of the jejunum are not sites for LT4 absorption, because in the above-mentioned bariatric procedures these are bypassed or removed.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Bariatric Surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Obesity - metabolism</subject><subject>Obesity - surgery</subject><subject>Original Studies</subject><subject>Thyroid Dysfunction: Hypothyroidism, Thyrotoxicosis, and Thyroid Function Tests</subject><subject>Thyroid Hormones - blood</subject><subject>Thyroxine - pharmacokinetics</subject><subject>Treatment Outcome</subject><issn>1050-7256</issn><issn>1557-9077</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEtPwzAQhC0EoqVw5Ipy5JLiR2I7J1QqXlIlkICz5dobGsij2E5F_z2OWrhy2tnVp9HOIHRO8JRgWVyF1XZKMSFTnFN-gMYkz0VaYCEOo8Y5TgXN-QideP-BMeFSsGM0oowQzGgxRtePzdp1G7DJAjZdNHPdd9VC8rzSrtGm-4xLqIxPZmUAl9xoV-ngKpO89O4d3PYUHZW69nC2nxP0dnf7On9IF0_3j_PZIjWMiZAybguRaSGpNsQuLWSipJQUTHJjLc81Y1byzGRECpBMmkKyPApLsxiLA5ugy51v_ParBx9UU3kDda1b6HqvCKNEFJJSHtF0hxrXee-gVGtXNdptFcFq6EzFmGroTA2dRf5ib90vG7B_9G9JEWA7YDjrtq0rWIIL_9j-AMVGeEQ</recordid><startdate>20130401</startdate><enddate>20130401</enddate><creator>Gkotsina, Margarita</creator><creator>Michalaki, Marina</creator><creator>Mamali, Irene</creator><creator>Markantes, Georgios</creator><creator>Sakellaropoulos, George C.</creator><creator>Kalfarentzos, Fotios</creator><creator>Vagenakis, Apostolos G.</creator><creator>Markou, Kostas B.</creator><general>Mary Ann Liebert, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130401</creationdate><title>Improved Levothyroxine Pharmacokinetics After Bariatric Surgery</title><author>Gkotsina, Margarita ; Michalaki, Marina ; Mamali, Irene ; Markantes, Georgios ; Sakellaropoulos, George C. ; Kalfarentzos, Fotios ; Vagenakis, Apostolos G. ; Markou, Kostas B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-36d974a782ac1dbde47f2219386cdd65a33d864c4187e838c9835e83d245266e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Bariatric Surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Obesity - metabolism</topic><topic>Obesity - surgery</topic><topic>Original Studies</topic><topic>Thyroid Dysfunction: Hypothyroidism, Thyrotoxicosis, and Thyroid Function Tests</topic><topic>Thyroid Hormones - blood</topic><topic>Thyroxine - pharmacokinetics</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gkotsina, Margarita</creatorcontrib><creatorcontrib>Michalaki, Marina</creatorcontrib><creatorcontrib>Mamali, Irene</creatorcontrib><creatorcontrib>Markantes, Georgios</creatorcontrib><creatorcontrib>Sakellaropoulos, George C.</creatorcontrib><creatorcontrib>Kalfarentzos, Fotios</creatorcontrib><creatorcontrib>Vagenakis, Apostolos G.</creatorcontrib><creatorcontrib>Markou, Kostas B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Thyroid (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gkotsina, Margarita</au><au>Michalaki, Marina</au><au>Mamali, Irene</au><au>Markantes, Georgios</au><au>Sakellaropoulos, George C.</au><au>Kalfarentzos, Fotios</au><au>Vagenakis, Apostolos G.</au><au>Markou, Kostas B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved Levothyroxine Pharmacokinetics After Bariatric Surgery</atitle><jtitle>Thyroid (New York, N.Y.)</jtitle><addtitle>Thyroid</addtitle><date>2013-04-01</date><risdate>2013</risdate><volume>23</volume><issue>4</issue><spage>414</spage><epage>419</epage><pages>414-419</pages><issn>1050-7256</issn><eissn>1557-9077</eissn><abstract>Background:
The absorption of levothyroxine (LT4) is affected by many factors. Bariatric surgery is recommended in severely obese patients. The aim of this study was to determine the consequences of bariatric surgery on LT4 pharmacokinetic parameters, and to identify the regions of the gastrointestinal tract where LT4 is absorbed in patients with severe obesity before and after surgery.
Methods:
We studied 32 severely obese nonhypothyroid patients who underwent sleeve gastrectomy (SG;
n
=10), Roux-en-Y gastric bypass (RYGBP;
n
=7), or biliopancreatic diversion with long limbs (BPD-LL;
n
=15). Before surgery, from 8:00 a.m., blood samples were collected before and every 30 minutes after the oral administration of a solution of 600 μg of LT4. The same procedure was repeated 35 days after surgery. We estimated the pharmacokinetic parameters of LT4 before and after surgery, including the area under the curve (AUC), the peak thyroxine concentration (
C
max
), and the time to peak thyroxine concentration (
T
max
).
Results:
Following surgery, in the SG group, the mean AUC was higher than it was before surgery (18.97±6.01 vs. 25.048±6.47 [μg/dL]·h;
p
<0.01), whereas the values of
C
max
and
T
max
were similar to those before surgery. In the RYGBP group, mean AUC,
C
max
, and
T
max
were similar before and after surgery. In the BPD-LL group, mean AUC and
C
max
were higher after surgery than before (14.18±5.64 vs. 25.51±9.1 [μg/dL]·h,
p
<0.001; 5.62±1.34 vs. 8.16±2.57 μg/dL,
p
<0.001, respectively), whereas
T
max
was similar.
Conclusions:
The pharmacokinetic parameters of LT4 absorption are improved following SG and BPD-LL types of bariatric procedures. We conclude that the stomach, the duodenum, and the upper part of the jejunum are not sites for LT4 absorption, because in the above-mentioned bariatric procedures these are bypassed or removed.</abstract><cop>United States</cop><pub>Mary Ann Liebert, Inc</pub><pmid>23110329</pmid><doi>10.1089/thy.2011.0526</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1050-7256 |
| ispartof | Thyroid (New York, N.Y.), 2013-04, Vol.23 (4), p.414-419 |
| issn | 1050-7256 1557-9077 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1321798226 |
| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Adolescent Adult Bariatric Surgery Female Humans Male Middle Aged Obesity - metabolism Obesity - surgery Original Studies Thyroid Dysfunction: Hypothyroidism, Thyrotoxicosis, and Thyroid Function Tests Thyroid Hormones - blood Thyroxine - pharmacokinetics Treatment Outcome |
| title | Improved Levothyroxine Pharmacokinetics After Bariatric Surgery |
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