Abstract Introduction: The aim was to evaluate metabolic parameters in a group of patients older than 65 years old compared to younger adults at three and six months after bariatric surgery (BS). Material and Methods: Prospective analytic study of a cohort of 40 patients under BS since June, 2015 to March, 2018. Participants were divided into two groups (Group A: ≥65; B: <65 years old). Anthropometrics and metabolic parameters were assessed before and 3 and 6 months after BS. The excess weight loss percentage (EWLP) and the Triglycerides/HDLc (TAG/HDLc) ratio, as a marker of insulin resistance, were also evaluated. A p <0.05 was statistically significant. Results: Forty patients were under BS, we included thirty six: 21 patients were at group A (median age: 59, RIQ: 48-61 years old) and 15 at group B (median age 67, RIQ: 66-69 years old), the prevalence of patients with type 2 diabetes was 53% (n=8) in group B vs. 43% (n=9) at group A. After 3 and 6 months of BS, we found no statistical difference between groups in weight loss and the EWLP and the decrease in fasting blood glucose (FBG), HbAc1% levels but a significant rise in the levels of HDLc in group B. We observed a statistically decrease in the TAG/HDLc ratio and a positive correlation between HbA1c% and levels of FBG, HDLc and the TAG/HDLc ratio in group B. Moreover, we found a reduction in the use of antidiabetics and lipid lowering drugs in this age group. Conclusions: The metabolic effects of BS achieved significant benefits in the ≥65 y/o cohort, especially by decreasing insulin resistance, even in those patients without diagnosis of type 2 diabetes.

Resumen Introducción: El objetivo fue evaluar los parámetros metabólicos en pacientes adultos ≥65 años en comparación con adultos <65 años a los 3 y 6 meses de ser sometidos a cirugía bariátrica (CB). Material y Métodos: Estudio analítico de cohorte prospectiva en 40 pacientes sometidos a CB durante el periodo julio de 2015 y marzo de 2018. Los pacientes fueron divididos en dos grupos (A: ≥65 años; B: <65 años) y se evaluaron parámetros antropométricos y parámetros bioquímicos antes de la CB y a los 3 y 6 meses posteriores. Se calculó el porcentaje de peso perdido (PEPP) y se evaluó el índice triglicéridos/HDLc (TAG/HDLc) como marcador de insulinorresistencia. Una p<0.05 se consideró estadísticamente significativa. Resultados: De los 40 pacientes sometidos a la CB, se incluyeron 36: 21 pacientes eran del grupo A (mediana de edad: 59, RIQ: 48-61 años) y 15 pacientes del grupo B (mediana de edad: 67, RIQ: 66-69 años), el porcentaje de pacientes con diabetes mellitus tipo 2 era de 53% (n=8) en B vs. 43% (n=9) en A. Luego de 3 y 6 meses post- CB se observó en el grupo B un descenso en el peso, índice de masa corporal y porcentaje de exceso de peso perdido (PEPP) no significativo, disminución en los niveles de glucemia y HbA1c sumado a un aumento significativo en los niveles de HDLc, además de un descenso significativo del índice TAG/HDLc en el grupo B. Se encontró una correlación positiva entre los niveles de HbA1c y PEPP, HDLc y el índice TAG/HDLc así como el descenso del uso de antidiabéticos e hipolipemiantes en el grupo B. Conclusiones: Los efectos metabólicos de la CB alcanzaron beneficios significativos en la cohorte de AM, especialmente al reducir la insulinoresistencia, incluso en aquellos pacientes sin diagnóstico de diabetes tipo 2.

Although hypothyroidism is associated with an increased prevalence of psychiatric manifestations, myxedema madness is rarely observed. We report the case of a 62-year-old woman with no prior history of psychiatric disorders, who presented to the emergency department with psychomotor agitation 6 weeks after total thyroidectomy for papillary thyroid cancer. Serum thyroid stimulating hormone (TSH) on admission was 62.9 mIU/L and free T4 was < 0.35 ng/dL, indicating severe hypothyroidism. After ruling out other possible causes, the diagnosis of myxedema madness was considered; hence, antipsychotic drug treatment and intravenous levothyroxine were prescribed. Behavioral symptoms returned to normal within 4 days of presentation, while levels of thyroid hormones attained normal values 1 week after admission. Recombinant TSH (Thyrogen®) was used successfully to prevent new episodes of mania due to thyroid hormone withdrawal in further controls for her thyroid cancer. This case illustrates that myxedema madness can occur in the setting of acute hypothyroidism, completely reverting with levothyroxine and antipsychotic treatment. Recombinant TSH may be a useful tool to prevent myxedema madness or any severe manifestation of levothyroxine withdrawal for the follow-up of thyroid cancer.