Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
No where is weight loss more essential to health than in those with obesity related Type 2 diabetes and Metabolic Syndrome. Metabolic Syndrome can be thought of as Type 2 Diabetes before the blood sugar levels become elevated. Experts are now turning more often to surgery when convential treatment with diet, exercise and medication fails to control these diseases. Different forms of surgery are available to cause rapid weight loss which frequently results in a “cure” or at least substantial improvement in diabetes.
One type of surgery often done laparoscopically aims to reduce the size of the stomach. By reducing the stomach size less food is consumed and hunger reduced. In another type of surgery much of the small bowel is “by-passed” so less of the food is absorbed and more is passed out of the body through the large intestine.
In Brazil a new procedure is being pioneered by Dr. Aureo DePaula and colleagues which utilizes both techniques. This procedure involves making a “sleeve gastrectomy” as well as by-pass. Dr. DePaula removes a part of the stomach and sews the remaining piece to the end portion of the small intestine called the ileum.
According to Dr. DePaula the benefit of this procedure extends beyond the mere mechanical reduction of the size of the stomach and bowel. The piece of the stomach and bowel eliminated by the sleeve procedure are responsible for making hormones that stimulate appetite and interfering with the function of insulin and cause insulin resistance. So far the Brazilian team has demonstrated great success to reverse the metabolic problems of diabetics and those with metabolic syndrome. Almost 90% of men and women in their recent study were able to discontinue taking diabetic medication after undergoing the surgery.
The procedure is still considered experimental
Surgical teams around the world are now preparing to try to duplicate the success of Dr. DePaula. According to reports, in the United States one team is being established at Mt Sinai Hospital in New York.
Those interested in this procedure may learn more in November when there is a meeting of the International Congress of Endocrinology in Rio de Janeiro, Brazil. Here experts are expected to analyze available information on the sleeve procedure and make recommendations for its use.