The relationship between thyroidectomy (surgical removal of the thyroid gland) and weight changes is complex and not fully understood. While the thyroid gland plays a crucial role in regulating metabolism and body weight, the impact of its removal on weight can vary significantly from person to person. Many patients report concerns about weight gain after thyroid surgery. This article examines the existing research and explores the factors that may contribute to weight changes following a thyroidectomy.
The Thyroid's Role in Weight Management
The thyroid gland produces hormones, primarily thyroxine (T4) and triiodothyronine (T3), that regulate the body's metabolism. These hormones influence how the body uses energy, affecting heart rate, body temperature, and weight. When the thyroid is overactive (hyperthyroidism), it can lead to weight loss, while an underactive thyroid (hypothyroidism) can cause weight gain.
Weight Changes After Thyroidectomy: What to Expect
Following a thyroidectomy, changes in thyroid function depend on whether the removal surgery was complete or partial, and the reason for removal. Many people gain weight after thyroid removal surgery. However, some people may lose weight or not experience any weight changes. If a portion of the thyroid gland remains, it may continue to function adequately, minimizing significant weight changes. However, if the entire thyroid is removed, the body can no longer produce thyroid hormone. In this case, thyroid hormone replacement medication becomes necessary to maintain normal metabolic function.
- Hyperthyroidism Correction: If the thyroidectomy was performed to treat hyperthyroidism, the surgery will likely result in hypothyroidism. This shift can slow down metabolism, potentially leading to weight gain. Surgical treatment of hyperthyroidism was associated with a weight gain of 6.3 kg over 1 year. Most weight gain occurred within 3 months of surgery and was not reversed with a return to euthyroidism.
- Hypothyroidism Development: Development of hypothyroidism and treatment of hyperthyroidism may be associated with weight gain. There is also an association between development of iatrogenic hypothyroidism and subsequent weight gain.
Research Findings on Weight Changes Post-Thyroidectomy
Research from 2023 did not identify specific factors that contributed to either weight gain or weight loss in people who had a thyroidectomy. Some factors that did not correlate with weight loss or gain among the participants included:
- age
- sex
- thyroid function before surgery
- thyroid status after surgery
- thyroid pathology (genetic testing of the removed thyroid gland)
One retrospective chart review documented weight and thyroid status after thyroidectomy and achievement of euthyroidism on thyroid hormone replacement, and one year later. The study also included matched patients with preexisting hypothyroidism, no thyroid disease, and thyroid cancer. The results indicated that patients who had undergone thyroidectomy in the previous year gained more weight than their matched counterparts with preexisting hypothyroidism. In addition, all patients with hypothyroidism, even though treated to achieve euthyroidism, experienced more weight gain than both subjects without hypothyroidism and subjects with iatrogenic hyperthyroidism. The greatest weight gain in the thyroidectomized group was in menopausal women. These data raise the question of an unidentified factor related to taking thyroid hormone replacement that is associated with weight gain, with an additional intriguing effect of thyroidectomy itself. Menopausal status confers additional risk.
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The Role of Thyroid Hormone Replacement Medication
After a complete thyroidectomy, thyroid replacement medication, typically levothyroxine (LT4), is prescribed to manage body functions like metabolism. Having your thyroid removed means that you will take thyroid replacement medication to help manage the functions that your thyroid gland used to perform. Finding the correct dosage is crucial, as an improper dosage can lead to weight changes and other symptoms.
- Hypothyroidism Symptoms: With hypothyroidism, this may look like fatigue, weight gain, and constipation.
- Hyperthyroidism Symptoms: With hyperthyroidism, this may include a rapid heartbeat, weight loss, and frequent bowel movements.
Factors Influencing Weight After Thyroidectomy
Several factors can influence weight changes after a thyroidectomy:
- Medication Dosage: Finding the right dose of thyroid medication is essential. Weight changes may occur until the appropriate dosage is established.
- Individual Metabolism: Each person's metabolism is unique, and how their body responds to thyroid hormone replacement can vary.
- Lifestyle Factors: Diet and exercise habits play a significant role in weight management, regardless of thyroid status.
- Menopausal Status: Weight gain in the thyroidectomized group was greater in menopausal women than in either premenopausal women or men.
Managing Weight Changes After Thyroidectomy
If you experience weight gain or weight loss after a thyroidectomy, consulting with your doctor is essential. They may need to adjust your medication.
For weight gain:
- Nutritious Diet: Eating a nutritious diet high in wholesome foods.
- Regular Physical Activity: Getting regular physical activity.
- Medication Adherence: Taking prescribed medications as directed.
For weight loss:
- Consult with a doctor to rule out other potential causes and ensure proper management.
Long-Term Studies and Considerations
Studies of weight changes in euthyroid individuals undergoing thyroidectomy are difficult to locate in the literature. A small study employing eight patients and controls showed no weight change with thyroidectomy when euthyroidism was maintained. It is the authors' experience that euthyroid patients undergoing thyroidectomy, who are never permitted to develop hypothyroidism, report disturbing weight gain.
A population-based study examined weight and body mass index (BMI) changes at one, two, and three years of follow-up in (i) patients with thyroid cancer and benign thyroid nodules after thyroid surgery, and (ii) patients with thyroid nodules who did not have surgery. The study found that small changes in mean weight, BMI, and the number of patients whose weight increased between 5 and 10 kg were similar during each year of follow-up between patients in groups A and B. Furthermore, age >50 years, female sex, baseline BMI >25 kg/m2, and thyrotropin value at one to two years were not predictors of a 5% weight change.
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Conclusions from Meta-Analysis
In the meta-analysis, one to two years after surgery for thyroid cancer or thyroid nodules, patients gained on average 0.94 kg [confidence interval (CI) 0.58-1.33] and 1.07 kg [CI 0.26-1.87], respectively. On average, patients receiving care for thyroid nodules or cancer gain weight, but existing evidence suggests that surgery for these conditions does not contribute significantly to further weight gain. Therefore, the results suggest that any weight change in patients after thyroid surgery may be attributed to other factors, for instance age. The latter is further supported by findings of several large population-based studies of healthy individuals.
Thyroidectomy: Reasons and Procedure
Thyroidectomy is the surgical removal of all or part of your thyroid gland. Your thyroid is a butterfly-shaped gland located in the front of your neck. Health care providers perform thyroidectomy to treat thyroid disorders. How much of your thyroid gland is removed during thyroidectomy depends on the reason for the surgery.
Reasons for Thyroidectomy:
- Thyroid cancer: Cancer is the most common reason for thyroidectomy.
- Noncancerous enlargement of the thyroid (goiter): Removing all or part of your thyroid gland may be an option for a large goiter. A large goiter may be uncomfortable or make it hard to breathe or swallow.
- Overactive thyroid (hyperthyroidism): In hyperthyroidism, your thyroid gland produces too much of the hormone thyroxine. Thyroidectomy may be an option if you have problems with anti-thyroid drugs, or if you don't want radioactive iodine therapy.
- Suspicious thyroid nodules: Some thyroid nodules can't be identified as cancerous or noncancerous after testing a sample from a needle biopsy.
Procedure:
Surgeons typically perform thyroidectomy using general anesthesia, so you won't be awake during the procedure. The anesthesiologist or anesthetist gives you an anesthetic medication as a gas - to breathe through a mask - or injects a liquid medication into a vein. The surgical team places several monitors on your body to check your heart rate, blood pressure and blood oxygen level throughout the procedure.
Once you're unconscious, the surgeon makes a cut (incision) low in the center of your neck. It can often be placed in a skin crease where it will be hard to see after the incision heals. If you're having thyroidectomy because of thyroid cancer, the surgeon may also examine and remove lymph nodes around your thyroid. In some patients, the surgeon uses special equipment to monitor irritation of vocal cords during the procedure to prevent permanent damage.
Thyroidectomy usually takes 1 to 2 hours.
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Types of Thyroidectomy:
- Conventional thyroidectomy: This approach involves making an incision in the center of your neck to directly access your thyroid gland.
- Transoral thyroidectomy:
- Endoscopic thyroidectomy: This approach uses smaller incisions in the neck. Surgical instruments and a small video camera are inserted through the incisions.
Potential Risks After Thyroidectomy
Thyroidectomy is generally a safe procedure.
Risks:
- Bleeding.
- Low parathyroid hormone levels (hypoparathyroidism). Sometimes surgery damages the parathyroid glands, located behind your thyroid. The parathyroid glands regulate calcium levels in the blood.
Post-Operative Expectations
After thyroidectomy, some people may experience neck pain and a hoarse or weak voice. These symptoms typically last for only a short time. They may be due to irritation from the breathing tube inserted into the windpipe during surgery, or the result of nerve irritation caused by the procedure. You'll be able to eat and drink as usual after surgery. When you go home, you can usually return to your regular activities. It takes up to a year for the surgical scar to fade.
Partial thyroidectomy: If only part of your thyroid is removed, the remaining portion typically takes over the function of the entire thyroid gland.
Complete thyroidectomy: If your entire thyroid is removed, your body can no longer make thyroid hormone. Without medication, you'll develop symptoms of underactive thyroid (hypothyroidism). These symptoms may include dry skin, fatigue and weight gain. This hormone replacement is identical to the hormone normally made by your thyroid gland and performs all of the same functions.
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