ArticleDiabetes/metabolism research and reviews2026
Low Preoperative Free Triiodothyronine, Particularly in Females, Is Associated With Reduced Weight Loss and Diabetes Remission After Bariatric Surgery in Euthyroid Adults.
Shaobo Li, Yinfang Tu, Hongwei Zhang, Yunfeng Xiao, Yuqian Bao, Jun Yin, Yujin Ma, Haoyong Yu, Fengjing Liu
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Shaobo LiDepartment of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.ORCID https://orcid.org/0000-0001-7313-6054 Yinfang TuDepartment of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Hongwei ZhangDepartment of General Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Yunfeng XiaoDepartment of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Yuqian BaoDepartment of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.ORCID https://orcid.org/0000-0002-4754-3470 Jun YinDepartment of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.ORCID https://orcid.org/0000-0002-9826-3583 Yujin MaHenan Key Laboratory of Rare Diseases, Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.ORCID https://orcid.org/0000-0003-2054-3398 Haoyong YuDepartment of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.ORCID https://orcid.org/0000-0002-8621-4960 Fengjing LiuDepartment of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.ORCID https://orcid.org/0000-0002-8956-7489 Funding
National Natural Science Foundation of China 82470881National Natural Science Foundation of China 82601612the Noncommunicable Chronic Diseases-National Science and Technology Major Project 2023ZD0509205the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support 20172025the Shanghai Municipal Health Commission of General Program 202440117
6 · The paper itselfAbstract
aimsWith the rising prominence of GLP-1 receptor agonists, identifying predictors of optimal bariatric surgery candidates has become increasingly important. We investigated cross-sectional relationships between thyroid hormones and obesity-related parameters, and evaluated the predictive value of baseline thyroid hormones for weight loss (WL) and diabetes remission (DR) after bariatric surgery.
methodsThis study included a cross-sectional cohort of 1567 euthyroid patients with overweight or obesity, of whom 1034 with complete 1 year postoperative data were included in the longitudinal analysis. Body composition was assessed using validated predictive equations and abdominal MRI. The primary outcomes were successful WL (total WL ≥ 25%) and DR (fasting glucose < 5.6 mmol/L and HbA1c < 6.0% without antidiabetic medications) during the 3 year follow-up.
resultsBreakpoint analysis indicated that free triiodothyronine (FT3) plateaued beyond an age threshold while showing a linear correlation with fat-free mass index. Higher baseline FT3 tertiles were significantly linked to increased likelihood of achieving successful WL and DR at 1 year follow-up, with stronger associations in females. Optimal FT3 thresholds were identified as 4.75 (females) and 5.05 (males) for WL, and 4.57 (females) and 5.00 (males) for DR. Preoperative FT3 levels below these thresholds were significantly associated with reduced WL and DR over 3 years.
conclusionsSerum FT3 exhibits an age-related breakpoint effect, and low preoperative FT3, particularly in females, is a critical predictor of suboptimal short- and long-term WL and DR success post-bariatric surgery. Sex-specific FT3 thresholds may aid in preoperative risk stratification and inform personalised treatment decisions in the era of expanding obesity therapeutics.
Indexed as
Bariatric SurgeryBiomarkersDiabetes Mellitus, Type 2ObesityTriiodothyronineWeight LossAdultCross-Sectional StudiesFemaleFollow-Up StudiesHumansMaleMiddle AgedPreoperative PeriodPrognosisRemission InductionBiomarkersTriiodothyroninebariatric surgerydiabetes remissionobesitythyroid functionweight loss
Identifiers
PMID42733963
PMCPMC13572958
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