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. 2025 Sep 16:dgaf519.
doi: 10.1210/clinem/dgaf519. Online ahead of print.

Adverse outcomes in patients with hypothyroidism undergoing bariatric surgery: A retrospective study using TriNetX

Vandrize Meneghini  1   2 , Fabyan Esberard de Lima Beltrão  1   3   4 , George Golovko  5 , Riley K Watson  6 , Sarah Samreen  7 , Matthew D Ettleson  8 , Isabela M Benseñor  2 , Antonio C Bianco  1
Affiliations

Adverse outcomes in patients with hypothyroidism undergoing bariatric surgery: A retrospective study using TriNetX

Vandrize Meneghini et al. J Clin Endocrinol Metab. .

Abstract

Context: Bariatric surgery (BS) effectively reduces obesity-related risks, but its outcomes in patients with preexisting hypothyroidism are unclear.

Objective: To evaluate the impact of preexisting hypothyroidism on adverse health outcomes following BS.

Design: A retrospective cohort study utilizing the TriNetX Global Collaborative Network database.

Setting: Healthcare organizations.

Patients: Patients with obesity who underwent BS or not, with and without hypothyroidism were propensity score-matched.

Exposure: Treated hypothyroidism versus healthy thyroid.

Main outcome measures: The short-term outcomes comprised mortality, readmission, ICU admission, and surgical and systemic complications. The long-term outcomes included mortality, major adverse events, bone health, and metabolic, renal, and neurological outcomes.

Results: There were 5,700 patients in each cohort (46.7±12 years, 88% female). In the short term, patients with hypothyroidism exhibited higher risks of readmission (RR:1.25;CI:1.14-1.36), incisional hernia (RR:1.56;CI:1.12-2.18), and biliary diseases (RR:1.39;CI:1.05-1.86). In the long term, patients with hypothyroidism had higher risks of incident cerebrovascular events (HR:1.25;CI:1.00-1.55), diabetes (HR:1.39;CI:1.12-1.74), and dyslipidemia (HR:1.20;CI:1.02-1.42). There were also higher risks of fall (HR:1.20;CI:1.02-1.40), osteoporosis (HR:1.30;CI:1.07-1.58), polyneuropathy (HR:1.34;CI:1.08-1.66), hypoglycemia (HR:1.51;CI:1.23-1.87), as well as iron (HR:1.17;CI:1.04-1.31) and vitamin B (HR:1.34;CI:1.20-1.49) deficiencies. Hypothyroidism-associated risks of poor outcomes were higher in patients who underwent gastric bypass. Compared to the nonsurgical care, patients with hypothyroidism who underwent BS showed a lower risk of obesity-related outcomes but a higher risk of iron and vitamin B deficiencies, osteoporosis, and hypoglycemia.

Conclusion: Preexisting hypothyroidism in bariatric patients increases the risks of adverse outcomes. However, the risk of obesity-related outcomes is decreased in this population when compared to nonsurgical care.

Keywords: Bariatric Surgery; Gastric Bypass; Hypothyroidism Thyroid Diseases; Obesity; Postoperative Complications.

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