Bone mineral density in patients with endogenous subclinical hyperthyroidism: Is this thyroid status a risk factor for osteoporosis?

Földes, J; Tarján, Gábor; Szathmári, Miklós; Varga, F; Krasznai, I; Horvath, C

doi:10.1111/j.1365-2265.1993.tb02403.x

Cited by 152 publications

(93 citation statements)

References 32 publications

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“…In line with this, the skeleton also seems to be in¯uenced in patients with endogenous subclinical hyperthyroidism in a way which suggests slight thyroid hormone excess at the tissue level: postmenopausal women with endogenous subclinical hyperthyroidism due to a multinodular goitre have reduced bone mass in comparison to women with normal TSH (27). Furthermore, we have shown that treatment of such patients with radioiodine with the aim of normalising serum TSH, results in increased bone mass as compared with those not treated (28).…”

Section: Discussionsupporting

confidence: 56%

Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

Faber¹,

Wiinberg

Schifter

et al. 2001

European Journal of Endocrinology

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Objective: Hyperthyroidism has profound effects on the cardiovascular system, including reduced systemic vascular resistance (SVR) due to relaxation of vascular smooth muscle cells, enhanced heart rate (HR) and cardiac output (CO) due to an increase in cardiac diastolic relaxation, contractility and heart rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T 4 ) and tri-iodothyronine (T 3 ) estimates within the reference range, in subjects with no obvious symptoms of hyperthyroidism. We measured haemodynamic changes (using impedance cardiography) in subjects with endogenous subclinical hyperthyroidism in order to elucidate whether these patients had signs of excess thyroid hormone at the tissue level. Design: The patients were otherwise healthy women with a multinodular goitre (n 6; age 47±81 years; serum TSH 0.006±0.090 mU/l and normal free T 4 and T 3 estimates), studied before and after normalisation of TSH (0.280±1.120 mU/l) by means of radioiodine treatment, and they were compared with 9 overt hyperthyroid patients (2 with multinodular goitre and 7 with Graves' disease) in the untreated state and after euthyroidism had been obtained. Results: Treatment of the subclinical hyperthyroid women resulted in 11% reduction in HR P , 0X02Y 19% reduction in CO from (means^S.D.) 6X93^2X15 lamin to 5X58^1X94 lamin P , 0X05Y and 30% increase in SVR P , 0X02X Similar but more pronounced changes were seen in the hyperthyroid group: 17% reduction in HR, 25% reduction in CO and 46% increase in SVR (all at least P , 0X05). Taking all 15 patients together, thyroid function (as measured by free T 3 index (FT3I) or TSH) correlated signi®cantly to the haemodynamic parameters as follows: the higher the thyroid function the lower the mean arterial pressure and SVR, and the higher the CO and central aortic compliance (stroke volume/pulse pressure) P , 0X05X Plasma norepinephrine increased signi®cantly after treatment of the overt hyperthyroid patients, whereas epinephrine did not change, and no changes were seen among subclinical hyperthyroid patients. Conclusion: Treatment of endogenous subclinical hyperthyroidism resulted in signi®cant changes in several haemodynamic parameters regarding the heart and the vascular system, compatible with some degree of excess tissue exposure to thyroid hormones in the untreated state. Our data favour more aggressive treatment of these patients, and endogenous subclinical hyperthyroidism might be regarded as a mild form of hyperthyroidism.

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Section: Discussionsupporting

confidence: 56%

Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

Faber¹,

Wiinberg

Schifter

et al. 2001

European Journal of Endocrinology

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“…Previous studies have been focused both on endogenous and drug-induced subclinical hyperthyroidism (Franklyn et al 1992, Kung et al 1993, Giannini et al 1994, Marcocci et al 1994, McDermott et al 1995, Muller et al 1995, Rosen et al 1998). In two studies, patients with nodular goitre and endogenous subclinical hyperthyroidism had lower BMD than comparable normal subjects (Mudde et al 1992, Foldes et al 1993, although in one trial significant reductions in BMD occurred only in postmenopausal and in sites rich in cortical bone (Foldes et al 1993). Some authors described decreased BMD in pre-and postmenopausal women with a significant negative correlation with T3 levels (Tauchmanova`et al 2004).…”

Section: Discussionmentioning

confidence: 99%

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

Reverter

Holgado²,

Alonso³

et al. 2005

Endocr Relat Cancer

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The effect of subclinical hyperthyroidism on bone mineral density is controversial and could be significant in patients with differentiated thyroid carcinoma who receive suppressive doses of levothyroxine (LT4). To ascertain whether prolonged treatment with LT4 to suppress thyrotropin had a deleterious effect on bone mineral density and/or calcium metabolism in patients thyroidectomized for differentiated thyroid cancer we have performed a cross-sectional study in a group of 88 women (meantSD age: 51t12 years) treated with LT4 after near-total thyroidectomy and in a control group of 88 healthy women (51t11 years) matched for body mass index and menopausal status. We determined calcium metabolism parameters, bone turnover marker N-telopeptide and bone mass density by dual-energy X-ray absorptiometry. No differences were found between patients and controls in calcium metabolism parameters or N-telopeptide except for PTH, which was significantly increased in controls. No differences were found between groups in bone mineral density in femoral neck (0.971t0.148 gr/cm 2 vs 0.956t0.130 gr/cm 2 in patients and controls respectively, P = 0.5). In lumbar spine, bone mineral density values were lower in controls than in patients (1.058t0.329 gr/cm 2 vs 1.155t0.224 gr/cm 2 respectively, P<0.05). When premenopausal (n = 44) and postmenopausal (n = 44) patients were compared with their respective controls, bone mineral density was similar both in femoral neck and lumbar spine. The proportion of women with normal bone mass density, osteopenia and osteoporosis in patient and control groups was similar in pre-and postmenopausal women. In conclusion, long-term suppressive LT4 treatment does not appear to affect skeletal integrity in women with differentiated thyroid carcinoma.

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“…Even low-normal TSH levels can already be associated with low BMD and increased risk of osteoporosis in healthy postmenopausal women (4,5,26).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, thyrotropin (TSH) is a negative regulator of bone remodeling, inhibiting the formation and survival of osteoclasts and the differentiation of osteoblasts (3). Also, it has been proposed that low TSH levels, per se, can predispose to osteoporosis and fragility fractures (4,5,6). However, the studies investigating the effects of endogenous subclinical hyperthyroidism on the skeleton are scarce, with most of them reflecting the effect of supraphysiologic doses of thyroid hormone to suppress TSH secretion in the treatment of differentiated thyroid carcinoma or nontoxic goiter and providing conflicting results (7).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of silent vertebral fractures detected by vertebral fracture assessment in young Portuguese men with hyperthyroidism

Barbosa¹,

Mascarenhas²,

Silva³

et al. 2015

European Journal of Endocrinology

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Background: Hyperthyroidism is a risk factor for reduced bone mineral density (BMD) and osteoporotic fractures. Vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) is a radiological method of visualization of the spine, which enables patient comfort and reduced radiation exposure. Objectives: This study was carried out to evaluate BMD and the prevalence of silent vertebral fractures in young men with hyperthyroidism. Design: We conducted a cross-sectional study in a group of Portuguese men aged up to 50 years and matched in hyperthyroidism (nZ24) and control (nZ24) groups. Materials and methods: A group of 48 Portuguese men aged up to 50 years was divided and matched in hyperthyroidism (nZ24) and control (nZ24) groups. BMD (g/cm 2 ) at L 1 -L 4 , hip, radius 33%, and whole body as well as the total body

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Bone mineral density in patients with endogenous subclinical hyperthyroidism: Is this thyroid status a risk factor for osteoporosis?

Cited by 152 publications

References 32 publications

Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

Haemodynamic changes following treatment of subclinical and overt hyperthyroidism

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

Prevalence of silent vertebral fractures detected by vertebral fracture assessment in young Portuguese men with hyperthyroidism

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