Bone mass disorders in patients treated with a replacement dose of levothyroxine.
DOI:
https://doi.org/10.19230/jonnpr.2016.1.5.1050Keywords:
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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