Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism

Abstract

Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to nonvoluminous nodular goiter and its effect on bone metabolism I therapy in elderly patients with subclinical hyperthyroidism (SCH) due to nodular disease and who did not receive antithyroid drugs (ATDs), and the effect of the treatment on bone metabolism. Subjects and methods: Thirty-six patients with TSH ≤ 0.1 mIU/L and non-voluminous goiter (< 60 cm 3 ) were studied. Bone mineral density (BMD) was assessed in 17 women with osteopenia. Results: Mean 24-h 131 I uptake was 17.5%. Symptoms of thyrotoxicosis were reported by two (5.5%) patients in the first week after therapy. One year after radioiodine treatment, SCH was resolved in 30 (83.3%) patients, and hypothyroidism was detected in one (2.7%). In the patients in whom TSH returned to normal, femoral and lumbar spine BMD increased by 1.9% and 1.6%, respectively, in average. I em 24 h foi 17,5%. Sintomas de tireotoxicose foram reportados por dois pacientes (5,5%) na primeira semana após a terapia. Um ano após o radioiodo, HSC foi resolvido em 30 pacientes (83,3%) e hipotireoidismo ocorreu em 1 (2,7%). Nas pacientes que normalizaram o TSH, DMO em fêmur e coluna lombar incrementou em média 1,9% e 1,6%, respectivamente. Conclusões: Em idosos com HSC e bócio não volumoso, radioiodo, não precedido de DATs, é uma alternativa terapêutica segura e eficaz. Resolução do HSC tem benefício na DMO em mulheres menopausadas com osteopenia. Arq Bras Endocrinol Metab. 2013;57(2):144-7 Descritores Hipertireoidismo subclínico; radioiodo; doença nodular

Symptoms of thyrotoxicosis, bone metabolism and occult atrial fibrillation in older women with mild endogenous subclinical hyperthyroidism

“…In contrast to our series, in other studies showing a reduction of BMD in postmenopausal women with endogenous SCH, almost all patients had TSH ≤0·1 mIU/l . Furthermore, studies showing improvement of BMD after treatment of SCH with methimazole or radioiodine included patients with TSH ≤0·1 mIU/l or <0·2 mIU/l …”

Impact of subclinical hyperthyroidism on bone

“…By contrast, in untreated controls BMD declined by about 2% per year at the hip and the spine 77 . Similar results emerged from a recent prospective study where BMD at 1 year after achievement of euthyroidism had increased by 1.9% at the FN and by 1.6% at the LS 78 . Conversely, in the four patients with persistent SH, the average BMD had declined by 2% at the FN and by 1.8% at the LS 78 .…”

The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism

“…However, no long-term prospective controlled trials have assessed whether treatment reduces the risk of AF and other cardiovascular events. Prospective studies conducted in postmenopausal women with SHyper showed an improvement in BMD after ATDs or RAI therapy [99,100,110,111,112,113], while BMD progressively declined in untreated patients [99,100]. Femoral and lumbar spine BMDs were increased by 1.9 and 1.6%, respectively, 1 year after RAI treatment [99,110].…”