Clinical Observations of Elevated ACTH Levels, Hyperinsulinemia, and Hypothyroidism Before and After Bariatric Surgery

Elevated ACTH levels have been observed in obese patient with hyperinsulinemia, potentially contributing to hypothyroid-like states through impaired T4-to-T3 conversion.We present the case of an 18-year-old female with a long-standing history of obesity (BMI: 47 kg/m²), hyperphagia, and symptoms consistent with hypothyroidism and hyperandrogenism.Laboratory tests revealed elevated ACTH (109.6 pg/mL), insulin (185.18μIU/mL), and TSH (5.857 μIU/mL), with decreased free T3 (2.4 pg/mL) levels, indicating subclinical hypothyroidism.The patient underwent bariatric surgery in April 2024.Three months postoperatively, significant clinical improvements were observed, including a 28.3% total weight loss and 60.6% excess weight loss.Follow-up hormonal analysis showed normalized insulin (17.9 μIU/mL), decreased ACTH and TSH levels, and increased free T3 (3.1 pg/mL).This case highlights the potential reversibility of ACTH-driven subclinical hypothyroidism and hyperphagia in the context of obesity-related insulin resistance following bariatric surgery.Weight loss can lead to substantial hormonal rebalancing and improved metabolic function.

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