Abstract: Objective To investigate the changes in thyroid-stimulating hormone (TSH) in obese patients with subclinical hypothyroidism following symmetric three-port laparoscopic sleeve gastrectomy.Methods Clinical data of 60 cases of obese patients who underwent symmetric three-port laparoscopic sleeve gastrectomy between July 2019 and July 2022 were collected.Based on preoperative thyroid function,the patients were divided into an observation group(15 cases,with subclinical hypothyroidism) and a control group(45 cases,with normal thyroid function).Thyroid function was not intervened in the observation group either before or after surgery.Changes in body weight,body mass index (BMI),and thyroid function were compared between the two groups preoperatively and at 6 months postoperatively.Results Preoperative weight and BMI in the observation group were (107.53±10.27) kg and (37.53±3.44) kg/m2,respectively,which decreased to (90.85±10.23) kg and (31.33 ±2.48) kg/m2 at 6 months postoperatively.In the control group,preoperative weight and BMI were (106.77±10.49) kg and (37.89±3.35) kg/m2,respectively,decreasing to (86.79±9.49) kg and (31.02±2.53) kg/m2 at 6 months postoperatively.There were no statistically significant differences in weight or BMI between the two groups at the same time points (preoperatively or at 6 months postoperatively) (P>0.05).However,both groups showed significant reductions in weight and BMI at 6 months postoperatively compared to their preoperative levels (P<0.05).Preoperative TSH levels were (6.07±1.68)μIU/ml in the observation group and (2.22±1.02)μIU/ml in the control group,with a statistically significant difference between the groups (P<0.05).At 6 months postoperatively,TSH levels in the observation group decreased significantly compared to preoperative levels [(2.88±0.56)μIU/ml vs(6.07±1.68) μIU/ml,P<0.05].There were no statistically significant differences in free T4 (FT4) or free T3 (FT3) levels between the two groups either preoperatively or at 6 months postoperatively(P>0.05).Conclusion Laparoscopic sleeve gastrectomy has a beneficial therapeutic effect on obesity combined with subclinical hypothyroidism,which can significantly reduce TSH levels.

Key words: laparoscopic sleeve gastrectomy, obesity, subclinical hypothyroidism