RX--Y bypass & TSH levels

Question
Prior to my gastric bypass my thyroid panel was within normal limits. Five months after gastric bypass my TSH is elevated (8.2). My T4, free T4, T3, and free T3 are all still within normal limits. Do you know of any reason the gastric bypass and elevated TSH might be related? My primary physician said it could be related to the massive change in my protein intake, but the endocrinologist regarded me as though I were an idiot when I asked if the two could be related.
Thanks,
Kathryn

Answer
Kathryn,
You are quite reasonable to wonder if your gastric bypass is leading to variations in your TSH levels.  The changing effect of your thyroid medicine may come from three factors I can think of:
1) alteration in med absorption
2) altered body size leads to different requirements
3) elevated level of activity may lead to different leve of body demand for thyroid hormone

In any case, I can let you know that in my practice it is quite common for patients to require changes in their thyroid medication dose during the first 18 months following surgery.  I can reassure that there is not a long-term problem with medication absorption, so after adjustment your levels and dose should settle down.

Best wishes!
Dr JP

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