Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy

Dominguez, M.L.; Iglesias, Sonsoles Guadalix; Arroba, Cristina Martín-Arriscado; Álvarez, Begoña; Díaz-Guerra, Guillermo Martínez; Martínez-Pueyo, José Ignacio; Herrero, Eduardo Ferrero; Carranza, Federico Hawkins

doi:10.1007/s12020-018-1671-8

Cited by 28 publications

(27 citation statements)

References 22 publications

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“…The comparative study concerning pre-and postmenopausal patients with differentiated thyroid carcinoma (DTC) receiving long-term TSH suppressive therapy (TST) revealed that postmenopausal women with DTC receiving TST had lover TBS, compared to premenopausal patients. These TBS changes did not co-occur with BMD loss [53]. Similar results concerning TST in group of postmenopausal DTC patients were confirmed by other authors, also indicating that more than five years of TST resulted in lower lumbar spine TBS values compared to patients with therapy of less than three years (1.335 ± 0.092 vs. 1.296 ± 0.078, p = 0.015) [54].…”

Section: Thyroid Diseasessupporting

confidence: 84%

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Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders

Halupczok-Żyła

Bolanowski

2019

Endokrynologia Polska

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Trabecular bone score (TBS) index has recently been obtained as a result of textural greyscale analysis of DXA images. Because it enables the assessment of bone microarchitectural texture, TBS may be useful in evaluating bone quality. This study explores the current knowledge of the use of TBS in patients with endocrine disorders with co-occurring bone structure changes. Currently, the clinical importance TBS was verified in terms of disorders of the growth hormone/insulin-like growth factor 1 (GH/IGF-I) axis, glucocorticoid excess, thyroid and parathyroid disease, as well as in diabetes mellitus type 1 and 2. It has been clarified that patients suffering from various endocrinopathies are a group in which TBS should be used routinely because it correlates with clinical factors and may improve patient management in various endocrine disorders. (Endokrynol Pol 2019; 70 (4): 350-356)

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Section: Thyroid Diseasessupporting

confidence: 84%

“…Trabecular bone score cut-off points classifying normal and abnormal TBS values have not yet been defined. The only available TBS range is one that has been proposed for postmenopausal women [21][22][23].…”

Section: Tbs Evaluation Resultsmentioning

confidence: 99%

Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders

Halupczok-Żyła

Bolanowski

2019

Endokrynologia Polska

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“…De Mingo Dominguez et al analyzed BMD, TBS, and bone turnover markers in 61 premenopausal and 84 postmenopausal Caucasian women at baseline (within 3 months after total thyroidectomy) and after 10 years of TSH suppressive therapy. Postmenopausal women showed a lower TBS compared to premenopausal women and there was no correlation between changes in TBS and BMD (46). In another retrospective cohort study involving 273 postmenopausal women with DTC treated with TSH suppressive therapy, Moon et al showed that TSH suppressive therapy was associated with lower TBS and this association was independent of age, BMI, and BMD (47).…”

Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

TSH suppressive therapy and bone

Brancatella

Marcocci

2020

Endocrine Connections

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Thyroid hormones stimulate bone turnover in adults by increasing osteoclastic bone resorption. TSH suppressive therapy is usually applied in patients with differentiated thyroid cancer (DTC) to improve the disease outcome. Over the last decades several authors have closely monitored the potential harm suffered by the skeletal system. Several studies and meta-analyses have shown that chronic TSH suppressive therapy is safe in premenopausal women and men. Conversely, in postmenopausal women TSH suppressive therapy is associated with a decrease of bone mineral density, deterioration of bone architecture (quantitative computed tomography, QCT; trabecular bone score, TBS), and, possibly, an increased risk of fractures. The TSH receptor is expressed in bone cells and the results of experimental studies in TSH receptor knockout mice and humans on whether low TSH levels, as opposed to solely high thyroid hormone levels, might contribute to bone loss in endogenous or exogenous thyrotoxicosis remain controversial. Recent guidelines on the use of TSH suppressive therapy in patients with DTC give value not only to its benefit on the outcome of the disease, but also to the risks associated with exogenous thyrotoxicosis, namely menopause, osteopenia or osteoporosis, age > 60 years, and history of atrial fibrillation. Bone health (BMD and/or preferably TBS) should be evaluated in postmenopausal women under chronic TSH suppressive therapy or in those patients planning to be treated for several years. Antiresorptive therapy could also be considered in selected cases (increased risk of fracture or significant decline of BMD/TBS during therapy) to prevent bone loss.

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“…Only three studies analyzed the effect of thyroid function on TBS. In two prospective cohorts of participants with thyroid cancer undergoing TSH suppressive therapy for 5 to 10 years [26,27], excess LT4 treatment had a deleterious effect on TBS only in women transitioning from pre-to post-menopause [26], and no effect in post-menopausal women at treatment initiation [26,27]. But in a euthyroid cohort [28] high-normal free T4 levels, but not TSH values, were associated with low TBS only in post-menopausal women.…”

Section: Discussionmentioning

confidence: 99%

Skeletal Effects of Levothyroxine for Subclinical Hypothyroidism in Older Adults: A TRUST Randomized Trial Nested Study

Rodríguez

Stuber

Giovane

et al. 2019

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Both thyroid dysfunction and levothyroxine (LT4) therapy have been associated with bone loss, but studies on the effect of LT4 for subclinical hypothyroidism (SHypo) on bone yielded conflicting results. Objective To assess the effect of LT4 treatment on bone mineral density (BMD), Trabecular Bone Score (TBS), and bone turnover markers (BTMs) in older adults with SHypo. Design and Intervention Planned nested substudy of the double-blind placebo-controlled TRUST trial. Participants with SHypo were randomized to LT4 with dose titration versus placebo with computerized mock titration. Setting and Participants 196 community-dwelling adults over 65 years enrolled at the Swiss TRUST sites had baseline and 1-year follow-up bone examinations; 4 participants withdrew due to adverse events not related to treatment. Main Outcome Measures One-year percentage changes of BMD, TBS, and 2 serum BTMs (serum CTX-1 [sCTX] and procollagen type 1 N-terminal polypeptide [P1NP]). Student’s t-test for unadjusted analyses and linear regression adjusted for clinical center and sex were performed. Results Mean age was 74.3 years ± 5.7, 45.4% were women, and 19.6% were osteoporotic. The unadjusted 1-year change in lumbar spine BMD was similar between LT4 (+0.8%) and placebo-treated groups (–0.6%; between-groups difference +1.4%: 95% confidence interval [CI] –0.1 to 2.9, P = .059). Likewise, there were no between-group differences in 1-year change in TBS (–1.3%: 95% CI –3.1 to 0.6, P = .19), total hip BMD (–0.2%: 95% CI –1.1 to 0.1, P = .61), or BTMs levels (sCTX +24.1%: 95% CI –7.9 to 56.2, P = .14), or after adjustment for clinical centers and sex. Conclusions Over 1-year levothyroxine had no effect on bone health in older adults with SHypo. Registration ClinicalTrial.gov NCT01660126 and NCT02491008

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Low trabecular bone score in postmenopausal women with differentiated thyroid carcinoma after long-term TSH suppressive therapy

Cited by 28 publications

References 22 publications

Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders

Trabecular bone score (TBS) as a noninvasive and complementary tool for clinical diagnosis of bone structure in endocrine disorders

TSH suppressive therapy and bone

Skeletal Effects of Levothyroxine for Subclinical Hypothyroidism in Older Adults: A TRUST Randomized Trial Nested Study

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