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‍Weight gain and difficulty losing weight are among the most common symptoms of hypothyroidism and Hashimoto’s, and are frequent patient complaints. As a result, most patients are looking for options that can finally help them “lose the thyroid weight.” Ahead, a look at the pros and cons of bariatric surgery for people with hypothyroidism.

Optimal thyroid hormone levels help regulate several body functions, including metabolic rate, brain development, digestive process, and bone maintenance.

When your thyroid hormone production drops (hypothyroidism), your body processes – including your metabolic rate – slow down and change. Too little thyroid hormone slows the body’s metabolism and can cause weight gain and difficulty losing weight.

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Bariatric surgery is a procedure that involves making changes to your digestive system as a treatment option for weight loss. Bariatric surgery is recommended only after careful diet and exercise regimens have been ineffective for obese patients.

While there are many benefits to having bariatric surgery, all forms of weight-loss surgery – while considered effective procedures – can pose severe risks and side effects. Throughout the preparation process, patients must make permanent, life-long health changes to their diet and implement regular exercise to ensure long-term success.

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There are five types of bariatric surgery. The most common types are sleeve gastrectomy, gastric bypass, and adjustable gastric banding.
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Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy, often called the “sleeve,” removes approximately 80% of the stomach, leaving the remaining stomach the size and shape of a banana. Sleeve gastrectomy is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen.

The procedure forces the patient’s new stomach to hold less food and liquid, reducing the intake (and calories) consumed. Since most of the stomach that produces the hunger hormone ghrelin is removed, hunger decreases, and feelings of fullness increase. These effects have helped patients achieve a healthy weight and better blood sugar balance.

Research has shown that sleeve gastrectomy is a successful and effective long-term treatment, resulting in 15.7%, 31.4%, and 41% weight loss at 1, 2, and 3 years.
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‍Gastric Bypass

The Roux-en-Y gastric bypass, known as a “gastric bypass,” is more complex than sleeve gastrectomy surgery and is more often recommended for patients who need to lose significant weight. It’s considered the most effective bariatric surgery, and the average weight loss after gastric bypass is about 70% of excess body weight. Gastric bypass is considered by many to be the gold standard bariatric operation and is the most commonly performed bariatric operation in the United States.

This procedure has also been shown as one of the best surgical interventions to improve or resolve diabetes.

There are downsides and risks, however. The surgery has a high 17% complication rate. After a gastric bypass, patients are also more likely to have problems with nutritional deficiencies, requiring supplementation with multivitamins, calcium, and vitamin B-12. It is also common for patients to develop ulcers at the bottom of the stomach due to smoking or an intake of regular use of non-steroidal anti-inflammatory medicines. It is also worth noting that patients who make poor food choices or over consume sugar and greasy, fatty foods may experience “dumping syndrome,” severe abdominal cramping, and diarrhea after eating.
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Adjustable Gastric Banding

Also known as lap banding, in adjustable gastric banding, a silicone device is placed around the top part of the stomach as a way to limit a patient’s food intake. Although it’s a simple surgery compared to gastric bypass or sleeve gastrectomy, patients getting the lap band can lose 40 to 50% of body weight, with a low risk of severe complications after surgery.

Although this procedure is reversible, there is a high risk of re-operation, bandage movement (slippage), or damage to the stomach over time. Patients should also be aware that this procedure can cause chronic heartburn or reflux, and patients may require frequent visits to a healthcare provider to get band adjustments.

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It is highly suggested that patients must meet the following requirements to be eligible for weight-loss surgery:

• Have a body  mass index (BMI) of 40+ or a BMI between 35 and 40
• Have an obesity-related condition, such as heart disease, diabetes, high blood pressure, severe sleep apnea, or morbid obesity.
• Weigh less than 450 pounds, the maximum weight that hospital radiology equipment can accommodate. Patients who need to lose weight before bariatric surgery can work with a bariatric nutritionist to achieve their goals and qualify for surgery.

Your physician can best judge if bariatric surgery is right for you.

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Optimal thyroid hormone levels help regulate several body functions, including metabolic rate, brain development, digestive process, and bone maintenance.

When your thyroid hormone production drops (hypothyroidism), your body processes – including your metabolic rate – slow down and change. Too little thyroid hormone slows the body’s metabolism, and can cause weight gain and difficulty losing weight.

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In a recent 2017 study, hypothyroid patients undergoing  bariatric surgery and taking hormone replacement therapy saw improvement in overall BMI and thyroid function.

With the help of bariatric surgery, a patient's metabolism can improve and empower them to make healthier lifestyle choices, resulting in continued weight loss and a higher quality of life.

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There is a complex interaction cycle between the thyroid, pituitary, adrenal glands, and the pancreas, insulin, and glucagon, which all play a role in obesity.

This feedback loop and many changes that occur during weight loss surgery can affect the entire body. One of the most common side effects of gastric bypass is poor absorption due to fluctuations in stomach acidity, slowed bowel movements, smaller stomach surfaces, and shorter intestines. This absorption problem is significant for hypothyroid patients who take thyroid medication after weight loss surgery. When absorption is impaired, hypothyroid patients may need slightly higher doses of thyroid medication or may benefit from the liquid form of levothyroxine (Tirosint) due to its enhanced absorption.

Another potential complication for people with hypothyroidism who undergo bariatric surgery is the impact on thyroid hormones. Rapid weight loss, typical after bariatric surgery, can alter thyroid hormone levels, potentially worsening existing hypothyroidism. Therefore, close monitoring of thyroid hormone levels is essential to prevent adverse complications.

Another factor to consider is that individuals with hypothyroidism may have a more challenging time losing weight than those without the condition, even after bariatric surgery. While surgery can help individuals with hypothyroidism lose weight and improve their overall health, it is not a cure for this endocrine disorder.

Moreover, adherence to diet and exercise post-surgery is crucial in maintaining long-term weight loss success. This means individuals with hypothyroidism may need to make an extra effort to adhere to their recommended post-surgery diet and exercise regimes to ensure success.

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In addition to helping achieve weight loss goals, bariatric surgery has another promising benefit for people with hypothyroidism. A 2019 study found that bariatric surgery – specifically sleeve gastrectomy – improved hypothyroidism in 44.5% of patients and wholly resolved it in 22.2% of patients. However, in this study, 33.3% of patients experienced no change in their hypothyroidism.

A new Saudi Arabian study published in 2023 supported the 2019 findings, reporting that bariatric surgery improves thyroid function in most patients. In the research discussed, the patients studied were all morbidly obese with overt hypothyroidism and underwent laparoscopic sleeve gastrectomy. The study found that after the surgery, the patients had significant improvements in their TSH levels, needed to reduce their thyroid hormone replacement medication dosage, and experienced improvements in their hypothyroidism symptoms. The study showed that bariatric surgery could significantly improve thyroid function and that morbidly obese patients frequently exhibit a return to normal TSH levels following surgery.

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Implementing a healthy lifestyle through a whole-food-based diet and regular exercise can help decrease inflammation, increase energy, and support your weight loss goals. It is important to seek medical advice about your risks with bariatric surgery and how it might affect your current treatment plan for conditions such as hypothyroidism and autoimmune diseases such as Hashimoto’s.

Schedule a visit with a Paloma doctor to monitor your thyroid levels and find if you have any nutritional deficiencies you may need to address.

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