Şenay DURMAZ CEYLAN, Şuuri Ahsen CEYLAN, Fatih EKER, Aşkın GÜNGÜNEŞ

Morbid obez hastalarda kilo kaybının insulin direnci, bazal metabolizma hızı, antropometrik ölçümler ve tiroid fonksiyonlarına etkisi

Giriş ve Amaç: Obez kişilerde tiroid fonksiyonlarında değişiklik olduğu gösterilmesine rağmen kilo kaybının tiroid fonksiyonlarına olan etkisi açık değildir. Bu çalışmanın amacı morbid obeziteli kişilerde kilo kaybının tiroid fonksiyonlarına, antropometik ölçümlere, bazal metabolizma hızına ve metabolik sendrom parametrelerine olan etkilerini araştırmaktır. Gereç ve Yöntem: Çalışmamızda morbid obezite (BMI≥40 kg/m2) nedeni ile başvuran kilo verme programına uygun olarak ilk 6 ay içinde kilo kaybı sağlanan 107 kişinin hastane sisteminde kayıtlı verileri retropektif olarak değerlendirildi. İlk başvuru sırasında ve ilk 6 ay içinde kilo kaybı sağlandıktan sonra biyoelektriksel impedans ile antropometrik ölçümleri, bel çevresi, kan basınçları, serbest T3 (FT3), serbest T4 (FT4), TSH, Tiroid ultrasonu, total kolesterol, LDL-kolesterol, HDL-kolesterol, trigliserid, HOMAIR, glukoz ve insulin düzeyleri obesite polikliniğindeki hasta verilerinden kaydedildi. Bulgular: Morbid obezli kişilerde kilo kaybı sonrası yağ kitlesinde (p=0.001), yağ yüzdesinde p=0.001, bazal metabolizma hızında (p=0,01), bel çevresinde (p=0.001) ve BMI (p=0.001) değerlerinde belirgin azalma sağlandı;kas kitlesi, yağsız vücut kitlesi ve kemik kitlesinde ise değişiklik saptanmadı; FT4 düzeyinde istatistiksel olarak artma saptanırken (1.23± 0.18 vs. 1.29±0.21 ng/dL, p=0.01), TSH ve FT3 düzeyinde ise anlamlı bir farklılık bulunmamıştır. Morbid obezitesi olan hastaların kilo kaybı sonrası açlık plazma glukozunda anlamlı bir farklılık olmazken, açlık plazma insulin düzeyleri (p=0,001) ve HOMA-IR (p=0,004) değeri anlamlı olarak azaldı. Total kolesterol (p=0,014) ve HDL kolesterolde (p=0,003) azalma meydana geldi, sistolik kan basıncı (p=0.0001) ve diastolik kan basıncı da anlamlı olarak azaldı (p=0.001). Sonuçlar: Bizim verilerimize göre morbid obeziteli kişilerde kilo kaybı tiroid fonksiyonlarında yanlızca FT4 düzeyinde artışa neden olmuştur ancak bu minimal artışın klinik bir önemi bulunmamaktadır. Hastalarımızda kan basıncı azalması, total kolesterolde azalma, bel çevresinde ve insulin direncinde azalma sağlanmış olup, kilo kaybı sonrası morbid obeziteleri devam etse bile metabolik sendrom parametrelerinde ilk 6 ay içinde düzelme olmuştur.

Anahtar Kelimeler:

Morbid obezite, tiroid fonksiyon testleri, kilo kaybı, metabolik sendrom

The effect of weight loss on insulin resistance, basal metabolic rate, anthropometric measurements and thyroid functions in patients with morbid obesity

Introduction and Aim: Although the changes in thyroid functions have been demonstrated in obese subjects, the effect of weight loss on thyroid functions is not clear in morbid obesity. The aim of this study is to investigate the effects of weight loss on thyroid functions, anthropometric measurements, basal metabolic rate and metabolic syndrome parameters in patients with morbid obesity.Material and Method: In our study, 107 patients who had lost weight in the first 6 months in accordance with the weight loss program applied for morbid obesity (BMI≥40 kg/m2) were evaluated retrospectively. Anthropometric measurements with bioelectrical impedance, waist circumference, blood pressures, free T3 (FT3), free T4 (FT4), TSH, thyroid ultrasound, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, Homeostatic Model Assessment Insulin Resistance (HOMA-IR), glucose and insulin levels were recorded from patient records in obesity department.Results: After weight loss, there were significant decrease in fat mass (p=0.001), fat percentage (p=001, basal metabolic rate (p=0.01), waist circumference (p=0.001), and BMI (p=0.001). however, there were no change in muscle mass, lean body mass and bone mass; there were a statistically significant increase in mean FT4 level (1.23±0.18 vs. 1.29±0.21 ng / dL, p=0.01), but no significant differences were found in mean TSH and FT3 levels. There was no significant difference in fasting plasma glucose after weight loss in patients with morbid obesity, whereas fasting plasma insulin levels (p=0.001) and HOMA-IR (p=0.004) decreased significantly. Total cholesterol (p=0.014) and HDL cholesterol (p=0.003) decreased, systolic blood pressure (p=0.0001) and diastolic blood pressure decreased significantly (p=0.001) Conclusions: According to our data, weight loss in patients with morbid obesity caused an increase in thyroid function only in FT4 levels, but this minimal increase of FT4 levels does not have clinical significance. Our patients have decreased blood pressure, total cholesterol, waist circumference, and insulin resistance, and improved metabolic syndrome parameters within the first 6 months, even if morbid obesity persisted after weight loss.

Keywords:

Morbid obesity, thyroid function tests, weight loss, metabolic syndrome,

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