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Question for any one who had surgery and had hyperthyroidism (HYPER (the one where people who have it are usually skin just apparently not me) not HYPO). Did the surgery mess up your TSH levels? Before the surgery we got my levels to normal and was able to come off the meds. Was off them for 2 years and no issue. Then I had my bypass in March 2020. Levels were just checked and my TSH was 0.005..... so SUPER low

If its happening after eating it could be the reactive hypoglycemia, one lady who had it was put on a zero carb diet and that helped her. I recommend getting a referral to an endocrinologist from you primary doctor. Let them run the labs they are specialized in it and will know better than anyone here. 😬

I didn't think sleeve patients got it either, but who knows. Maybe some do but it's just not that common? Or it may not even have anything to do with your sleeve - I think even non-WLS people can get reactive hypoglycemia.

late dumping syndrome is reactive hypoglycemia (also known as postprandial hypoglycemia). It's not that uncommon in RNY patients - I don't know about sleeve patients. It seems to start when you're a couple years out.

Hi! Can you tell me what reactive hypoglycaemia is and how you deal with it?

"Gold standard" is a marketing term used in selling a procedure (cynically, it has been said that it applies to the surgeons themselves, as that is where they make the most "gold") and as such is basically meaningless. Here in the States, there are four mainstream procedures that are routinely performed, and approved by the ASMBS and the US insurance industry - lap bands, RNY, VSG and DS. The bands are falling out of favor owing to their high longterm complication rate and low effectiveness, but there is still a lot of marketing push for them by their manufacturers. The RNY has been around for forty years or so, based upon procedures that had been first developed 100 years before to treat gastric cancer and other gastric maladies (Billroth II). It was an improvement over the existing malabsorptive procedures such as the JIB (jejuno ileal bypass) but it still had the longstanding tradeoffs of its basic configuration - bile reflux, marginal ulcers (aka, the "NSAID problem"), dumping syndrome and moderate nutritional deficiencies. Bile reflux has largely been eliminated in the RNY WLS procedure via tailored limb lengths, but the others remain as common side effects and are largely controlled by diet or medication restrictions and supplements. It is overall a very good and mature procedure that works well with tolerable side effects, but it is far from perfect, which is why there is been an ongoing effort in the industry to find a replacement (this is how progress is made.) The duodenal switch (DS) was developed in the mid to late 1980's, which combined a moderate level of malabsorption with a moderate level of restriction (compared to the RNY which is more highly restrictive and minimally malabsorptive) that takes care of the RNY's problems with bile reflux, dumping/reactive hypoglycemia and marginal ulcers. In exchange, it is more technically challenging for the surgeon (which is why most don't offer it) and is a little more fussy on its' supplement regimen. On the plus side, it is more effective in treating diabetes, somewhat more effective on overall average weight loss, and much better at resisting regain. It should certainly be on the radar for anyone in the high BMI ranges and/or with a history of yoyo dieting. The main thing that has held the DS back from being more popular is its complexity, which often doesn't fit in with either surgeon's skill sets or business models (can't do as many procedures in a day.) The VSG came out of the DS as it is the first phase when the DS is done in two steps. Typically the VSG stomach is made smaller, about half the size, than the DS sleeve. It overall yields similar weight loss and regain characteristics to the RNY but without the dumping/reactive hypoglycemia or marginal ulcer predispositions and is also quicker and easier for the surgeon to perform, which is why it has been gaining popularity. The primary downside is the predisposition toward acid reflux owing to the stomach volume being reduced much more than the acid producing potential, to which the body doesn't always adapt. Nothing is perfect, and they all have a place for different circumstances. Getting beyond marketing fluff, hey are all the "gold standard" when used appropriately. The next new thing that is working its way through the industry is the SIPS/SADI (sometimes called the "loop" or simplified DS) that shows some good promise of having effectiveness somewhere between the RNY and the DS, with surgical complexity on the order of the RNY (it is being promoted as being "almost as good as the DS" while being more "accessible" - simpler so more surgeons can do it. It is still usually considered by most insurance to be investigational, and has yet to gain approval by the ASMBS, but there's a good chance that it may become that RNY replacement that the industry has been looking for.

hair loss is another thing that most (maybe all?) of us vets, in retrospect, wonder why we worried so much about. It's temporary - and for many of us, we're the only ones who notice the loss (I know some people lose a lot - a very noticeable amount - but most of us don't). It's a minor annoyance in the grand scheme of things. whether or not you need Spanx depends on where your loose skin is - and how much you have. I was apple-shaped, so I don't/didn't have much on my hips, butt, and thighs. Mine was almost all in my gut. And yes - I just tucked it into jeans or "tummy control" leggings, and always wore a slightly oversized, long-ish top. Ta da! Excess skin gone. I'm sure I was the only one who noticed it. Spanx would work, too, if you're not wearing something that it can be tucked into. as far as 500 calories, that's really just the first month or so. From about that point until maybe a year out, I was eating 600-800 calories a day, usually closer to 800. At around the year mark, I was at around 1000-1200. Now, in maintenance, I eat 1500-1700 a day. I did develop what we think was reactive hypoglycemia at about two years out, but I was told to eat something every 3-4 hours and, if I eat a carb, to be sure to pair it with a protein. That seemed to take care of it...

@AuthorLizzy thanks so much for your insight. I really feel motivated now ! thank you so much ! i will be " following you '' and your journey for sure. Can you give me some tips please ? do you know any others who have hypo and wls surgery that has lost slower also ? congrats and blessings on everything !! here is my personal email address also smaries_21@yahoo.com thank you!😍😍

I had my surgery in March and had hypothyroidism for 24 years and was on 100 mcg of synthroid. After losing 45 lbs in the first three months o went from hypo to hyperthyroid so doctor has taken me off synthroid completely. Just had blood work again last week and TSH and others thyroid levels are perfect. Just stay in contact with your doctor if you start feeling sluggish or have mental fog after losing some of your weight. I am thrilled that my metabolism has reset and I no longer need synthroid 🙂

I had issues with that at about two years out and they did a complete work-up. Everything normal. It was a head-scratcher for sure. But then it got really bad one afternoon about an hour or two after I had a piece of cake at some retirement party at work. My PCP suspects it may have been reactive hypoglycemia - and that my glucose level just happened to be normal at the time of the work-up. Although I'm sure you've been tested for that. I now eat something every three hours or so and always pair a carb (when I eat them) with a protein. It seems to have worked... But again, not sure what your issue is. I hope they can figure it out!

Had my RNY surgery March 9th and have lost 49 lbs but only lost two all last month. I was in hospital 3 days start of July with liver enzyme issues and my TSH (thyroid) numbers had went from hypo to hyperthyroid. Dr took me off synthroid for 3 days and then went back on 1/2 dose (50 mcg). Did that for a week and a half and the mental fog and sluggishness came back. Dr took me off synthroid completely. I go back Aug 20th to have TSH checked again. Could my going on and off and on and off synthroid be causing this drastic slow down in weight loss? I am still 30 lbs from my goal of 160 and was losing 2 lbs a week before this all happened. I have really enjoyed reading everyone's posts and getting some great advice on here!

Had my RNY surgery March 9th and have lost 49 lbs but only lost two all last month. I was in hospital 3 days start of July with liver enzyme issues and my TSH (thyroid) numbers had went from hypo to hyperthyroid. Dr took me off synthroid for 3 days and then went back on 1/2 dose (50 mcg). Did that for a week and a half and the mental fog and sluggishness came back. Dr took me off synthroid completely. I go back Aug 20th to have TSH checked again. Could my going on and off and on and off synthroid be causing this drastic slow down in weight loss? I am still 30 lbs from my goal of 160 and was losing 2 lbs a week before this all happened. I have really enjoyed reading everyone's posts and getting some great advice on here!

developing reactive hypoglycemia (RH) isn't that uncommon, but I haven't heard of people developing diabetes after surgery. In any case, I'm not sure it would be result of the surgery or not, since these surgeries tend to improve diabetes (or put it in remission). in the case of RH, the things you mentioned happen to people after ingesting a lot of sugar, but the symptoms usually kick in an hour or two later. RH can be controlled by limiting (or avoiding) sugar and eating something every three or four hours. And if you eat a carb, you're supposed to eat a protein with it. I'd check with my PCP - not sure what's going on. But I'd sure want to get that under control...

Yeah I thought it would be okay for the steamed vegetables because I love them but then the nutritionist is like no absolutely nothing so I feel like they don’t really understand the reactive hypoglycemia and the terrible nausea.

Yeah I see a lot of people say they only had to do a few days before and my doc nutritionists is scary the daylights out if us saying if we have anything at all then there will be stomach residue which makes me think then how do other people only do a few days. Doesn't make sense to me. I Have lost 5 pounds in 4 days. But I have reactive hypoglycemia and the nausea and headaches are killing me.

I am a type 1.5. Can any type 1’s comment on what WLS you are getting? I’m afraid if I get the bypass that I’ll get dumping syndrome if I go hypo and need to ingest sugar to get my bg back to normal again. I’m using the tandem x2 / dexcom g6 / controlIQ closed loop system and it is da bomb! But I do still have occasional very low lows.

Food and liquid timing, pyloric sphincter function, and how it pertains to VSG function and GERD: The pyloric sphincter (PS) is located at the bottom of your stomach/sleeve, and connects the sleeve and duodenum. When open, this valve is roughly the diameter of a dime. When closed, it’s roughly the diameter of the tip of a ballpoint pen. In terms of VSG function, dense proteins and foods that take longer to digest (i.e. fibrous foods) cause the PS to close and hold food in the stomach for pre-digestion, allowing acids begin to break down these foods. This is why we’re instructed to eat protein first: to close the PS so that food stays in the sleeve longer, providing a sense of satiety. It takes ca. 30-60 minutes for food to clear the PS. This is also why we’re instructed not to drink liquids for 30-60 minutes after eating. Incidentally, "slider" foods do not close the PS: instead, these foods "slide" directly through the open PS into the duodenum. In terms of GERD, after you consume a protein-dense meal, the PS closes, holding the contents of the meal in the sleeve for pre-digestion. If you drink liquids within 30-60 minutes after a meal, the liquid has nowhere to go but up, where it hits the lower esophageal sphincter (LES), and above that, a flapper valve. The function of both of these valves is to prevent food, bile, and acids in the stomach from backing up into the esophagus. This is an exceptionally high pressure system, and is the reason why it hurts when you eat to much or too fast, or drink too soon, after eating when the PS is still closed. Vomiting and/or foamies is the only available pressure release. Even in a full-size stomach, the addition of liquids to food speeds gastric emptying by roughly 15%-20%, and some studies indicate that the transit time is anywhere between 25%-35% after VSG. *It’s also interesting to note that after VSG, simple carbs passing through the PS are less liquified due to fewer digestive enzymes being available than with a complete stomach, which is also what causes dumping and reactive hypoglycemia. These unhealthy simple sugars pass directly through the pylorus, causing pancreatic enzymes to flood the bowels in order to be able to digest them. The pancreas then reacts by “dumping” large amounts of insulin into the common bile duct, causing a massive reduction in sugar absorption and feelings of weakness and other diabetic symptoms. It’s very similar to dumping syndrome in RNY patients.

So I'm 3 years post-op. I got the sleeve and I'm looking into getting the bypass. I have been busting my butt working out, eating right up until the last few months because I started to give up hope. Anyhow, I have Thyroid issues that were finally diagnosed as hypo after a year and I'm struggling to lose more. I lost a total of 80lbs and it's slowly going up and down. I had acid reflux here and there but didn't think it was due to the sleeve the longest time. smh. Well, now I'm in the process of getting approved by my insurance. I should know my requirements this week. Has anyone got a sleeve to bypass revision done? If so can you share your stories, whether it was a success or fail, wins, and complications. What to expect. Anything you can share. HW - 283 LW - 208 CW - 230 GW - 160 Sleeve did on 05/26/2017

I am an employee benefits professional and if you elect COBRA you should be fine. The employer is required by law to treat COBRA participants exactly as they do actively employed participants. You might have some hiccups from it going from active to COBRA coverage, just in terms of one ending and one starting, depending on how quickly you elect the coverage and make your payment. That is easily sorted out once they receive your COBRA Payment and reactivate your coverage. I am SO SORRY that your husband lost his job. That just makes it all so much more stressful.

I have reactive hypoglycemia, so I can relate! I'm so sorry you're going through this - my heart goes out to you..

The only time I don't have the whole 'body kicking it out' type thing, is when I eat grilled chicken. My surgeons nurse took blood multiple times and nothing came up unusual and said my symptoms were dumping syndrome. Although, in self research, I found I had the same symptoms as reactive hypoglycemia. I've had either extremely rare difficulties, even since I had surgery in the hospital, or I've had unheard of symptoms that no one can pinpoint with a sleever. It's awful and I feel lost to be honest. Sent from my moto g(7) supra using BariatricPal mobile app

if it's RH (reactive hypoglycemia), it wouldn't be that you drank it too fast - it's most likely the sugar in the whipped cream. Or some other sugar you ate within an hour or two before you had the symptoms. I'd run it by your surgeon or your PCP. It could be something else - but it does sound a lot like RH.

sounds like it might be reactive hypoglycemia (RH), which some people refer to as "late dumping". I used to get it about an hour or so after I ate too much sugar. It's not all that uncommon in RNY patients - and it usually starts a year or two after surgery. You can control it by limiting (or avoiding) sugar - and my PCP also suggested I try to eat something every 3-4 hours. It's helped a lot - I rarely get those episodes anymore. P.S. admittedly I'm not a healthcare worker, so I don't know for sure - but it does sound a lot like what I had/have. And again, it's not uncommon in bypass patients.

Have you had any medical evaluation of your GERD other than just what you are feeling - an upper GI or endoscopy to see whats going on in there to cause it? Self diagnosis is not a good start toward a revision. The VSG has a predisposition toward GERD owing to the stomach volume being cut down much more than the acid production potential along with its high pressure character (much like the RNY is predisposed toward marginal ulcers, dumping and reactive hypoglycemia owing to its specific quirks.) If your GERD is a simple result of the above VSG factors, then revising to a DS won't help the situation; an RNY is the more typical solution. However, if your GERD is caused by a hiatal hernia or a malformed sleeve (strictures and the like) then it is not unreasonable for surgery to correct that particular problem will do the trick; a DS in itself will not do anything for GERD as it will use your existing VSG as a starting point - a re-sleeve may be done at the same time depending upon need. Revising to the DS will help some with losing some regain but mostly will help avoid future regain, but revisions in general are typically only marginally successful in treating regain. I can't speak for your specific insurance, but generally insurance will cover any medically necessary revisions for treating complications.

Good luck to everyone having surgery this week! I saw my GP to check in last week and had her take me off my one extended release heart med. Pulse went from super low to more normal levels, but my BP is also more reactive so that could be fun. I have my endoscopy tomorrow... woohoo. Not. Fortunately my best friend is taking me, so I at least get some time with her to get me through the process while the rest of the family is at work/school. I've been doing protein shakes for breakfast and lunch with veggie snacks after school around 3 and protein/veggies for dinner for the last 2 weeks, and I can really tell how the hunger is diminishing if I stick to that and not "cheat". Helps me not feel as worried about the milk only diet starting on the 11th.