Bone mass disorders in patients treated with a replacement dose of levothyroxine.

Authors

  • María Antonia López Rubio Médico de Atención Primaria.Gerencia de Atención Integrada de Albacete. Albacete. Médico Interno Residente de Obstetricia y Ginecología. Gerencia de Atención Integrada de Albacete. Albacete.
  • Pedro Juan Tárraga López Médico de Atención Primaria.Gerencia de Atención Integrada de Albacete. Albacete. Profesor de Ciencias Médicas Universidad de Castilla La Mancha.
  • Francisco Naharro De Mora Médico de Atención Primaria.Gerencia de Atención Integrada de Albacete. Albacete.
  • José Antonio Rodríguez Montes Catedrático de Cirugía. Universidad Autónoma de Madrid. Hospital Universitario La Paz. Madrid.
  • Mª Loreto Tárraga Marcos Enfermera Residencia Geriátrica Los Alamos de Albacete,
  • Ibrahim M. Sarek Médico Residente Centro Salud Zona 5A: Albacete,
  • Mª Carmen Frias López Jefe Estudios Unidad Docente de Medicina familiar y Comunitaria de Albacete.

DOI:

https://doi.org/10.19230/jonnpr.2016.1.5.1050

Keywords:

Thyroid, levothyroxine, osteoporosis, subclinical hypothyroidism, risk factors.

Abstract

Some thyroid diseases have been associated with osteoporosis due to the effect of thyroid hormones on bone resorption. On this basis, chronic treatment with thyroid hormones, especially suppressive doses, could lead to osteoporosis.

Objective: To estimate the prevalence of osteoporosis in patients treated with thyroid hormone in a health center in the city of Albacete.

Methods: Cross-sectional study, conducted in patients diagnosed with subclinical hypothyroidism in treatment with levothyroxine in the city of Albacete. Patients were selected by reviewing medical records and laboratory parameters. Physical examination and medical history data were collected. Subsequently they underwent a bone density test and completed a questionnaire.

Results: 112 patients were included in the study, with female predominance (88.5%), mean age of 42.5 years and a tendency to be overweight (mean BMI of 25.67 kg/m2, 95% CI: 18,02-35,49) . The average TSH was 6.67 mU / ml (95% CI: 4.31 - 11.15) with normal free T4. Osteoporosis was only found in 14%, with osteopenia prevailing among those where some kind of bone loss was found. Paradoxically, there is a greater bone mass loss in patients with a higher BMI. Although the bone mass deficit has been significantly associated with sex and years of treatment with levothyroxine, it is not related to dose nor to hormone levels detected in blood.

Conclusions: The characteristics of our population do not make it particularly susceptible to developing osteoporosis (premenopausal women, overweight, non-smokers) and cases that were found are not doses dependent, but rather time dependent, therefore there must be other factors contributing to this pathology.

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References

Mundy GR, Ibbotson KJ, D'Souza SM. The hypercalcemia of cancer. Clinical implications and pathogenic

mechanisms. N Engl J Med 310:1718-1727. 1984.

Ineck BA, Tien MH. Effects of subclinical hypothyroidism and its treatment on serum lipids. Ann

Pharmacother, 2003; 37: 725-730.

Bauer DC, Nevitt MC, Ettinger B, Stone K. Low thyrotropin levels are not associated with bone loss in older

women: a prospective study. J Clin Endocrinol Metab 1997; 82: 2931-2936.

López Rubio MA, Tárraga López PJ, Rodríguez Montes JA, Frías López MC, Solera Albero J, Bermejo López

P. Alteración del perfil lipídico y del riesgo cardiovascular en pacientes con Hipotiroidismo subclínico.

JONNPR. 2016;1(2):45-49. DOI: DOI: 10.19230/jonnpr.2016.1.2.970

Ross DS. Bone disease in hyperthyroidism. En: Avioli LV. Krane SM. Eds. Metabolic Bone Disease. San

Diego: Academic Press 1998: 531-544.

Hanna FW, Pettit RJ, Ammari F, Evans WD, Sanderman D, Lazarus JH. Effect of replacement doses of

thyroxine on bone mineral density. Clin Endocrinol 1998; 48: 229-234.

Mestre Reoyo G.I. Hipotiroidismo. Siete días médicos 2006; 673: 56-60.

Garton M, Reid I, Loveridge N, Robins S, Murchison L, Beckett G, Reid D. Bone mineral density and

metabolism in premenopausal women taking L-thyroxine replacement therapy.Clin Endocrinol. 1994;41:747.

Ribot C, Tremollieres F, Pouilles JM, Louvet JP. Bone mineral density and thyroid hormone therapy. Clin

Endocrinol 1990;33:143.

TI Flynn RW, Bonellie SR, Jung RT, MacDonald TM, Morris AD, Leese GP. Serum thyroid-stimulating

hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term

thyroxine therapy. J Clin Endocrinol Metab. 2010;95:186.

Leese GP, Jung RT, Guthrie C, Waugh N, Browning MC. Morbidity in patients on L-thyroxine: a comparison of

those with a normal TSH to those with a suppressed TSH. Clin Endocrinol. 1992;37:500.

Garin MC, Arnold AM, Lee JS, Robbins J, Cappola AR.Subclinical thyroid dysfunction and hip fracture and

bone mineral density in older adults: the cardiovascular health study.J Clin Endocrinol Metab. 2014:2657-64.

Vestergaard P, Weeke J, Hoeck HC, Nielsen HK, Rungby J, Rejnmark L, Laurberg P, Mosekilde L. Fractures

in patients with primary idiopathic hypothyroidism.Thyroid. 2000;10:335.

Schneider DL, Barrett-Connor EL, Morton DJ. Thyroid hormone use and bone mineral density in elderly men.

Arch Intern Med. 1995;155:2005.

Kung AW, Pun KK. Bone mineral density in premenopausal women receiving long-term physiological doses of

levothyroxine. JAMA. 1991;265:2688.

Meier C, Beat M, Guglielmetti M, Christ-Crain M, Staub JJ, Kraenzlin M. Restoration of euthyroidism

accelerates bone turnover in patients with subclinical hypothyroidism: a randomized controlled trial.

Osteoporos Int. 2004;15:209.

Ross DS. Bone disease in hyperthyroidism. En: Avioli LV. Krane SM. Eds. Metabolic Bone Disease. San

Diego: Academic Press 1998: 531-544.

Mosekilde I, Eriksen EF, Charles P. Effects of thyroid hormones on bone and mineral metabolism. Endocrinol

Metab Clin N Am 1990; 19: 35-63.

Faber J, Jensen IW, Petersen I, Nygaar B, Hegedus I, Siersbaek Nielsen K. Normalization of serum

thyrotropin by means of radioiodine treatment in subclinical hyperthyroidism: effect on bone loss in postmenopausal women. Clin Endocrinol 1998; 48: 285-290.

Franklin JA, Maisonneuve P, Sheppard MC, Betteridge J, Boyle P. Mortality after the treatment of

hypertyroidism with radioactive iodine. N Eng J Med 1998; 338: 712-718.

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Published

2016-08-14

Issue

Vol. 1 No. 5: (OCTOBER 2016) JONNPR.2016;1(5):159-198

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