Bone mineral density in patients receiving suppressive doses of thyroxine for differentiated thyroid carcinoma

Abstract

To determine bone mineral density in patients with differentiated thyroid carcinoma receiving thyroxine replacement therapy in suppressive doses, we studied 65 patients (47 women and 18 men; age 25-83 years, mean+/-SD 52.5+/-15.4 years). Patients were free of thyroid cancer in clinical and laboratory examinations at the time of the study. Bone mineral density of the lumbar spine and both hips was measured by dual-energy X-ray absorptiometry. There was no decrease in bone density in either 32 postmenopausal or 15 premenopausal women compared with an age- and sex-matched control group, nor was any decrease in bone density found in men. Our data suggest that thyroxine treatment in suppressive doses in patients with differentiated thyroid carcinoma is not a risk factor for the development of osteoporosis.

Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma

“…With respect to hyperthyroidism due to suppressive LT4 treatment, some trials included premenopausal women with little or no change in BMD between controls and long-term treated patients (Franklyn et al 1992, Giannini et al 1994, Marcocci et al 1994, Muller et al 1995. Studies performed in postmenopausal women showed decreased BMD in all measured sites in two trials (Diamon et al 1991, Kung & Yeung 1996 and no changes in another six (Franklyn et al 1992, Giannini , Hawkins et al 1994, Marcocci et al 1994, Muller et al 1995, Go¨rres et al 1996, Guo et al 1997.…”

Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma

“…Diamond et al demonstrated a negative effect on BMD in both pre-and postmenopausal women (n ¼ 24) (27) with a mean L-T4 dose of 2.8 mg/kg/day and found a significant correlation between the total cumulative dose of L-T4 and BMD, suggesting that overzealous L-T4 therapy may lead to bone loss. Studies in which doses lower than 2.5 mg/kg body weight per day were used, including the more recent study of Rosen et al (24,26,34) did not observe any negative effects on BMD. Before the introduction of second and third generation TSH assays in the late eighties, it was more difficult to monitor suppressive L-T4 therapy, because the detection limit was within the normal range.…”

Bone mineral density and bone fracture in male patients receiving long-term suppressive levothyroxine treatment for differentiated thyroid carcinoma

“…Similarly, most studies in postmenopausal women found no differences in BMD among patients with thyroid cancer treated with suppressive doses of levothyroxine and controls [7,8,10,11,[13][14][15][16][17], while other authors reported that they may constitute at least a risk group for decreased BMD, and that other factors for osteoporosis should be considered [6,18,19]. Despite several studies [7,[11][12][13][14][15][20][21][22][23] and meta-analyses [24] on this topic, the evidence that subclinical hyperthyroidism affects skeletal integrity and is, therefore, a risk factor for osteoporosis in men is inconclusive. Since androgens influence bone integrity and knowledge on osteoporosis in men is limited, study of the influence of suppressive therapy on the male skeleton is of interest.…”

“…However, the effect of subclinical hyperthyroidism (defined as a serum TSH concentration below the statistically defined lower limit of the reference range when serum FT 4 and T 3 concentrations are within their reference ranges [4]) on bone mineral density (BMD) has been a matter of debate [5]. Previous studies in premenopausal women revealed that subclinical thyrotoxicosis due to suppressive TSH treatment for DTC had no effect on bone mineral density [6][7][8][9][10][11][12][13][14][15]. Similarly, most studies in postmenopausal women found no differences in BMD among patients with thyroid cancer treated with suppressive doses of levothyroxine and controls [7,8,10,11,[13][14][15][16][17], while other authors reported that they may constitute at least a risk group for decreased BMD, and that other factors for osteoporosis should be considered [6,18,19].…”

“…Previous studies in premenopausal women revealed that subclinical thyrotoxicosis due to suppressive TSH treatment for DTC had no effect on bone mineral density [6][7][8][9][10][11][12][13][14][15]. Similarly, most studies in postmenopausal women found no differences in BMD among patients with thyroid cancer treated with suppressive doses of levothyroxine and controls [7,8,10,11,[13][14][15][16][17], while other authors reported that they may constitute at least a risk group for decreased BMD, and that other factors for osteoporosis should be considered [6,18,19]. Despite several studies [7,[11][12][13][14][15][20][21][22][23] and meta-analyses [24] on this topic, the evidence that subclinical hyperthyroidism affects skeletal integrity and is, therefore, a risk factor for osteoporosis in men is inconclusive.…”