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Dziedzic M, Bonczar M, Ostrowski P, Stachera B, Plutecki D, Buziak-Bereza M, Hubalewska-Dydejczyk A, Walocha J, Koziej M. Association between serum TSH concentration and bone mineral density: an umbrella review. Hormones (Athens) 2024:10.1007/s42000-024-00555-w. [PMID: 38581565 DOI: 10.1007/s42000-024-00555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The aim of this study was to summarize the results of previous studies, standardize the data, and present new statistical results in order to provide physicians with clinically significant outcomes regarding the association between serum TSH concentration and bone mineral density (BMD). METHODS To perform this umbrella review, a systematic search was conducted in which major online medical databases, such as PubMed, Web of Science, Embase, Scopus, Cochrane Library, and Google Scholar, were searched for meta-analyses and systematic reviews regarding the effect of TSH on BMD. Furthermore, all primary studies were screened for statistical analysis. RESULTS The statistical outcomes of the present study were based on the data of 75,898 patients. The pooled risk ratio of any kind of fracture in patients with subclinical hyperthyroidism was estimated to be 1.36 (95% CI: 1.18-1.56; p < 0.001). The SMD for BMD in the distal radius in male patients receiving L-thyroxine suppression therapy was estimated to be -0.61 (95% CI: -1.10-(-0.11); p = 0.02). Furthermore, the pooled risk ratio of any fracture in patients receiving L-thyroxine suppression therapy was estimated to be 1.98 (95% CI: 0.98 - 3.98; p = 0.06). In these patients, the BMD may significantly differ from that in non-treated patients. However, the difference depends on the type of bone. CONCLUSIONS Our data confirmed that subclinical hyperthyroidism has a detrimental effect on bones, causing decreased BMD. Based on the obtained results, the authors suggest that a reduced TSH serum level itself may be an individual factor associated with decreased BMD and, thus, with a greater risk of bone fracture. Nevertheless, it should be noted that the effects of TSH suppression therapy differ between areas of interest for assessing BMD. Furthermore, the results have shown that this issue may, in specific areas, concern not only postmenopausal women but also male patients. These conclusions should contribute to a careful consideration of the application of TSH suppressive therapy in all patients. Particular attention should be given to patients after DTC, while all the advantages and disadvantages of implementing L-thyroxine therapy should be individually considered.
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Affiliation(s)
- Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
- Youthoria. Youth Research Organization, Kraków, Poland.
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Bartłomiej Stachera
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Dawid Plutecki
- Youthoria. Youth Research Organization, Kraków, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Monika Buziak-Bereza
- Department of Endocrynology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
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Poudel P, Chalasani R, Goonathilake MR, Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, Inyang B, Koshy FS, George K, Mohammed L. Effect of Thyroxine and Thyrotropin on Bone Mineral Density in Postmenopausal Women: A Systematic Review. Cureus 2022; 14:e26353. [PMID: 35903569 PMCID: PMC9325683 DOI: 10.7759/cureus.26353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022] Open
Abstract
The effect of thyroid hormones on bone mineral density in postmenopausal women has been reported but is not completely established. To better understand this relationship, this systematic review of the reported association, differences, and effects of thyroxine and/or thyrotropin levels on bone mineral density was conducted. An electronic literature search was conducted on MEDLINE, PMC, Google Scholar, Cochrane Library, and Science Direct from inception to April 2022; 20 studies were identified which include five quasi-experimental studies, three community cohort studies, and 12 hospital-based cross-sectional studies. Following an extensive evaluation, it was difficult to conclusively determine the association or effect of thyroxine or thyrotropin levels on bone mineral density in postmenopausal women. It is therefore suggested to conduct additional non-randomized or randomized control studies on this topic for the benefit of postmenopausal women. Particular attention should be given to the adjustment of age, body mass index, smoking status, alcohol consumption, and dietary calcium in future research on this topic for rigorous analysis.
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Kwak D, Ha J, Won Y, Kwon Y, Park S. Effects of thyroid-stimulating hormone suppression after thyroidectomy for thyroid cancer on bone mineral density in postmenopausal women: a systematic review and meta-analysis. BMJ Open 2021; 11:e043007. [PMID: 33986046 PMCID: PMC8126273 DOI: 10.1136/bmjopen-2020-043007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES We assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy. DATA SOURCES PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched from inception to 24 February 2021. STUDY SELECTION Case-control studies were included. DATA EXTRACTION AND SYNTHESIS Two authors independently reviewed the studies, extracted the data and performed meta-analysis of eligible studies. RESEARCH DESIGN AND METHODS Studies evaluating BMD in postmenopausal women with thyroid cancer who had thyroidectomy and levothyroxine therapy were included. Differences in BMD were presented as standardised mean differences (SMDs). Meta-analyses were conducted using a random-effects model. RESULTS Analysis of 16 case-control studies (426 patients and 701 controls without thyroid cancer) showed that stringent TSH suppression (TSH <0.10 mIU/L) after thyroidectomy had deleterious effects on the BMD of the lumbar spine in postmenopausal women compared with controls (SMD -0.55; 95% CI -0.99 to -0.10; I2=75.8%). There was no significant difference in patients with moderate TSH suppression (TSH 0.10-0.49 mIU/L). TSH suppression in postmenopausal women was not significantly associated with lower femoral neck BMD. Subgroup analysis of the lumbar spine showed that the association between stringent TSH suppression and lower BMD was consistent among studies with >10 years of follow-up (SMD -0.32; 95% CI -0.50 to -0.14). Subgroup analysis of the femoral neck showed that total thyroidectomy was related to detrimental effects on the BMD of the femoral neck (SMD -0.60; 95% CI -0.89 to -0.31; I2=90.4%), but near-total thyroidectomy was not (SMD 0.00; 95% CI -0.30 to 0.30; I2=55.6%). CONCLUSIONS Stringent TSH suppression had deleterious effects on the BMD of the lumbar spine after thyroidectomy in postmenopausal women. Further studies are needed to determine whether stringent TSH suppression after thyroidectomy increases the fracture risk.
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Affiliation(s)
- Donghee Kwak
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, The Republic of Korea
- Department of Orthopedic Surgery, 10th Fighter Wing Aeromedical Squadron, Suwon, The Republic of Korea
| | - Jane Ha
- Department of Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, The Republic of Korea
| | - Yousun Won
- Department of Radiology, Spine Love Hospital, Goyang, The Republic of Korea
| | - Yeongkeun Kwon
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, The Republic of Korea
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Sungsoo Park
- Center for Obesity and Metabolic Diseases, Korea University Anam Hospital, Seoul, The Republic of Korea
- Division of Foregut Surgery, Korea University College of Medicine, Seoul, The Republic of Korea
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Glynn N, Halsall DJ, Boran G, Cook P, McDermott JH, Smith D, Tormey W, Thompson CJ, O'Gorman D, McKenna MJ, Agha A. Growth hormone replacement may influence the biological action of thyroid hormone on liver and bone tissue. Growth Horm IGF Res 2021; 57-58:101393. [PMID: 33971491 DOI: 10.1016/j.ghir.2021.101393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/17/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Growth hormone (GH) replacement alters the peripheral interconversion of thyroxine (T4) and triiodothyronine (T3). However, little is known about the clinical impact of these alterations. We aimed to compare changes observed in the serum T3:T4 ratio with known biological markers of thyroid hormone action derived from different peripheral tissues. DESIGN We prospectively studied twenty GH deficient men before and after GH replacement in a tertiary referral endocrine center. Serum biochemical measurements included insulin like growth factor-1 (IGF-1), thyroid hormones (free & total T3, free & total T4 and reverse T3) and TSH. Changes in thyroid hormone concentration were compared to alterations in hepatic and bone biomarkers of thyroid hormone action. RESULTS GH replacement provoked a decline in serum free T4 concentration (-1.09 ± 1.99 pmol/L; p = 0.02) and an increase in free T3 (+0.34 ± 0.15 pmol/L; p = 0.03); therefore, the free T3:free T4 ratio increased from 0.40 ± 0.02 to 0.47 ± 0.02 (p = 0.002). Sex hormone binding globulin (SHBG) level was unchanged. However, a decline in serum ferritin (-26.6 ± 8.5 ng/mL; p = 0.005) correlated with a fall in freeT4. Alterations in lipid profile, including a rise in large HDL sub-fractions and Lp (a) (+2.1 ± 21.1 nmol/L; p = 0.002) did not correlate with thyroid hormone levels. Significant increases were recorded in serum bone turnover markers - procollagen type 1 amino-terminal propeptide +57.4%; p = 0.0009, osteocalcin +48.6%; p = 0.0007; c-terminal telopeptides of type 1 collagen +73.7%; p = 0.002. Changes in bone formation markers occurred in parallel with fluctuations in thyroid hormone. CONCLUSION GH-induced alterations in the thyroid axis are associated with complex, tissue specific effects on thyroid hormone action. Modulation of bone turnover markers suggests that GH may improve the biological action of thyroid hormone on bone.
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Affiliation(s)
- Nigel Glynn
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - David J Halsall
- Department of Clinical Biochemistry, Addenbrooke's Hospital, Cambridge, UK
| | - Gerard Boran
- Department of Clinical Biochemistry, Tallaght University Hospital, Dublin, Ireland
| | - Paul Cook
- Department of Chemical Pathology, University Hospital Southampton, UK
| | - John H McDermott
- Department of Endocrinology, Connolly Memorial Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - William Tormey
- Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland
| | | | - Donal O'Gorman
- 3U Diabetes Consortium, National Institute for Cellular Biotechnology, School of Health and Human Performance, Dublin City University, Ireland
| | - Malachi J McKenna
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Amar Agha
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland.
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Cellini M, Rotondi M, Tanda ML, Piantanida E, Chiovato L, Beck-Peccoz P, Lania A, Mazziotti G. Skeletal health in patients with differentiated thyroid carcinoma. J Endocrinol Invest 2021; 44:431-442. [PMID: 32696339 DOI: 10.1007/s40618-020-01359-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Osteoporosis and fractures are important comorbidities in patients with differentiated thyroid cancer (DTC), with potential negative impact on quality of life and survival. The main determinant of skeletal fragility in DTC is the thyrotropin (TSH)-suppressive therapy, which is commonly recommended to prevent disease's recurrence, especially in patients with structural incomplete response after thyroid surgery and radio-iodine therapy. TSH-suppressive therapy can stimulate bone resorption with consequent bone loss, deterioration of bone microstructure and high risk of fragility fractures. The skeletal effects of TSH-suppressive therapy may be amplified when thyroid cancer cells localize to the skeleton inducing alterations in bone remodelling, impairment of bone structure and further increase in risk of fractures. The management of skeletal fragility in DTC may be challenging, since prediction of fractures is a matter of uncertainty and data on effectiveness and safety of bone-active agents in this clinical setting are still scanty. This review deals with pathophysiological, clinical and therapeutic aspects of skeletal fragility of patients with DTC.
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Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - M L Tanda
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - E Piantanida
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - P Beck-Peccoz
- University of Milan, Via Pietro Custodi 16, 20136, Milan, Italy
| | - Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090, Milan, Italy
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Szulc P. Biochemical bone turnover markers in hormonal disorders in adults: a narrative review. J Endocrinol Invest 2020; 43:1409-1427. [PMID: 32335857 DOI: 10.1007/s40618-020-01269-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hormonal disorders are often associated with abnormal levels of bone turnover markers (BTMs). N-terminal propeptide of type I procollagen (PINP) and serum C-terminal cross-linking telopeptide of type I collagen (CTX-I) are the reference markers of bone formation and bone resorption, respectively. METHODS A comprehensive literature search within the MEDLINE and Web of Science databases was performed. RESULTS Acromegaly is associated with higher BTM levels, which decrease during the remission after treatment. Adult-onset growth hormone deficiency is often associated with decreased BTM levels. Growth hormone replacement therapy stimulates bone turnover and increases BTM levels. Hypothyroidism is characterized by general slowing of bone metabolism which is reflected by lower BTM levels. The replacement thyroid hormone therapy increases the bone turnover rate and BTM levels increase. Patients with thyroid cancer receive a suppressive dose of thyroid hormones and may have slightly elevated BTM levels. Patients with overt hyperthyroidism had higher BTM levels and anti-thyroid therapy induces a rapid decrease in the BTM levels. Patients with overt primary hyperparathyroidism have higher BTM levels, whereas those with asymptomatic and normocalcemic hyperparathyroidism usually have normal BTM levels. Hypoparathyroidism is characterized by slightly decreased BTM levels. Cushing's syndrome is characterized consistently by markedly decreased osteocalcin concentration, whereas data on other BTMs are discordant. CONCLUSIONS BTMs help us to better understand mechanisms of the impact of hormonal disorders and their treatment on bone metabolism. However, it is unknown whether BTMs may be used to monitor the effect of their treatments on bone in the clinical practice.
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Affiliation(s)
- P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Yoon BH, Lee Y, Oh HJ, Kim SH, Lee YK. Influence of Thyroid-stimulating Hormone Suppression Therapy on Bone Mineral Density in Patients with Differentiated Thyroid Cancer: A Meta-analysis. J Bone Metab 2019; 26:51-60. [PMID: 30899725 PMCID: PMC6416150 DOI: 10.11005/jbm.2019.26.1.51] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The effects of subclinical hyperthyroidism on bone mineral density (BMD) induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with differentiated thyroid cancer (DTC) remains unclear. We conducted a meta-analysis to determine the influence of TSH suppression therapy on BMD. Methods We performed a systematic search to identify studies which included BMD measurement of femoral neck, total hip or lumbar spine in patients on TSH suppression therapy for DTC. Main outcome measures were difference of BMD of femoral neck, total hip or lumbar spine measured by dual energy X-ray absorptiometry between patients and controls. Results A systematic search yielded a total of 11 published controlled cross-sectional studies (including about 571 patients and 836 controls). TSH suppression therapy was associated with the lower BMD of total hip (weighted mean difference [WMD], -0.023; 95% confidence interval [CI], -0.047 to 0.000; P=0.050) and spine (WMD, -0.041; 95% CI, -0.057 to -0.026; P<0.001) in postmenopausal women with DTC, while it was not associated with that in premenopausal women and men with DTC. Conclusions Although the included studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the lower BMD of spine and total hip in postmenopausal women (but not in premenopausal women and men) with DTC. A large, well-designed study with long-term follow-up would provide further insight into the influence of TSH suppression therapy and loss of BMD.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Youjin Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Jin Oh
- Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department of Urology, Urological Cancer Center, National Cancer Center, Goyang, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Petkus DL, Murray-Kolb LE, De Souza MJ. The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Med 2018; 47:1721-1737. [PMID: 28290159 DOI: 10.1007/s40279-017-0706-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite the severity and prevalence of iron deficiency in exercising women, few published reports have explored how iron deficiency interacts with another prevalent and severe condition in exercising women: the 'female athlete triad.' This review aims to describe how iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health. The effects of iron deficiency on energy status are discussed in regards to thyroid function, metabolic fuel availability, eating behaviors, and energy expenditure. The interactions between iron deficiency and reproductive function are explored by discussing the potentially impaired fertility and hyperprolactinemia due to iron deficiency and the alterations in iron metabolism due to menstrual blood loss and estrogen exposure. The interaction of iron deficiency with bone health may occur via dysregulation of the growth hormone/insulin-like growth factor-1 axis, hypoxia, and hypothyroidism. Based on these discussions, several future directions for research are presented.
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Affiliation(s)
- Dylan L Petkus
- Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Mary Jane De Souza
- Department of Kinesiology, The Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA.
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Zhao J, Wang H, Zhang Z, Zhou X, Yao J, Zhang R, Liao L, Dong J. Vitamin D deficiency as a risk factor for thyroid cancer: A meta-analysis of case-control studies. Nutrition 2018; 57:5-11. [PMID: 30086436 DOI: 10.1016/j.nut.2018.04.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/26/2018] [Accepted: 04/21/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The association between vitamin D deficiency and thyroid cancer is controversial. Some studies have demonstrated that higher serum vitamin D levels might protect against thyroid cancer, whereas others have not, or have even indicated the opposite to be the case. The aim of this meta-analysis was to investigate the association between vitamin D deficicency and thyroid cancer and propose that vitamin D deficiency is a risk factor for thyroid cancer. METHODS This was a meta-analysis of 14 articles of the association between vitamin D deficiency and thyroid cancer. Databases including PubMed, Cochrane library, Sinomed, CNKI, Wanfang, and clinical trial register centers, were searched for case-control studies of vitamin D in thyroid cancer. RESULTS Fourteen studies were included in this meta-analysis. A fixed-effect model was used to merge the standardized mean difference value of serum 25-hydroxyvitamin D levels. The pooled effect showed that the levels of serum 25-hydroxyvitamin D were lower in patients with thyroid cancer preoperatively than in the controls (-0.22; 95% confidence interval [CI], -0.36 to -0.09; P = 0.001). There was no difference after thyroid cancer patients underwent thyroidectomy (-0.19; 95% CI, -0.47 to 0.10; P = 0.21). A fixed-effect model was used to pool the odds ratio of thyroid cancer and vitamin D deficiency. It showed that the pooled odds ratio from six studies was 1.30 (95% CI, 1.00-1.69; P = 0.05). Subgroup analysis of 25-hydroxyvitamin D levels between different pathologic characteristics in patients with thyroid cancer was summarized, but no statistical differences were determined. CONCLUSIONS Lower serum 25-hydroxyvitamin D levels were associated with increased risk for thyroid cancer. On the other hand, vitamin D deficiency may act as a risk factor for thyroid cancer.
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Affiliation(s)
- Junyu Zhao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Haipeng Wang
- Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Zhongwen Zhang
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Xiaojun Zhou
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Jinming Yao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Rui Zhang
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Lin Liao
- Department of Endocrinology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China.
| | - Jianjun Dong
- Department of Medicine, Division of Endocrinology, Qilu Hospital of Shandong University, Shandong University, Jinan, Shandong, China
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Lin SY, Lin CL, Chen HT, Kao CH. Risk of osteoporosis in thyroid cancer patients using levothyroxine: a population-based study. Curr Med Res Opin 2018; 34:805-812. [PMID: 28884595 DOI: 10.1080/03007995.2017.1378174] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The outcomes of thyroid cancer patients using levothyroxine are largely undetermined. METHODS The study population consisted of 9398 patients newly diagnosed with thyroid cancer; their data was retrieved from a subset of the National Health Insurance Research Database of Taiwan during the period of 1999-2011. In this nationwide retrospective cohort study, we compared the risk of osteoporosis among thyroid cancer patients with levothyroxine use, those without levothyroxine use, and propensity-score-matched non-thyroid controls. We also investigated the duration-response and dose-response relationships between levothyroxine use and the risk of osteoporosis. The competing risk was also analyzed. RESULTS The mean duration of follow-up was 6.63 years for patients without thyroid cancer, 5.45 years for thyroid cancer patients without levothyroxine use, and 6.46 years for thyroid cancer patients with levothyroxine use. The incidence of osteoporosis was higher in the thyroid cancer cohort than in the non-thyroid-cancer cohort (8.69 vs. 6.60 per 1000 person-years, respectively), with an adjusted hazard ratio of 1.39 (95% confidence interval [CI] = 1.22-1.58). Thyroid cancer patients with levothyroxine use exhibited a significantly higher risk of osteoporosis than non-thyroid-cancer patients, while thyroid cancer patients not using levothyroxine did not have significant higher risks than non-thyroid-cancer patients. Compared with patients without thyroid cancer, the risk of osteoporosis increased from 1.53 (95% CI = 0.91-2.57) in patients receiving a cumulative dose of ≤265 mg levothyroxine, to 3.62 in those receiving a cumulative dose of >395 mg levothyroxine (95% CI = 2.16-6.06). CONCLUSION Our population-based cohort study showed that thyroid cancer patients receiving levothyroxine have a higher risk of osteoporosis.
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Affiliation(s)
- Shih-Yi Lin
- a Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University , Taichung , Taiwan
- b Division of Nephrology and Kidney Institute , China Medical University Hospital , Taichung , Taiwan
| | - Cheng-Li Lin
- c Management Office for Health Data, China Medical University Hospital , Taichung , Taiwan
- d College of Medicine , China Medical University , Taichung , Taiwan
| | - Hsien-Te Chen
- e Department of Orthopedics , China Medical University Hospital , Taichung , Taiwan
| | - Chia-Hung Kao
- a Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University , Taichung , Taiwan
- f Department of Nuclear Medicine and PET Center , China Medical University Hospital , Taichung , Taiwan
- g Department of Bioinformatics and Medical Engineering , Asia University , Taichung , Taiwan
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Thyroid Hormone Signaling in the Development of the Endochondral Skeleton. VITAMINS AND HORMONES 2018; 106:351-381. [PMID: 29407442 PMCID: PMC9830754 DOI: 10.1016/bs.vh.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Thyroid hormone (TH) is an established regulator of skeletal growth and maintenance both in clinical studies and in laboratory models. The clinical consequences of altered thyroid status on the skeleton during development and in adulthood are well known, and genetic mouse models in which elements of the TH signaling axis have been manipulated illuminate the mechanisms which underlie TH regulation of the skeleton. TH is involved in the regulation of the balance between proliferation and differentiation in several skeletal cell types including chondrocytes, osteoblasts, and osteoclasts. The effects of TH are mediated primarily via the thyroid hormone receptors (TRs) α and β, ligand-inducible nuclear receptors which act as transcription factors to regulate target gene expression. Both TRα and TRβ signaling are important for different stages of skeletal development. The molecular mechanisms of TH action in bone are complex and include interaction with a number of growth factor signaling pathways. This review provides an overview of the regulation and mechanisms of TH action in bone, focusing particularly on the role of TH in endochondral bone formation during postnatal growth.
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Parker WA, Edafe O, Balasubramanian SP. Long-term treatment-related morbidity in differentiated thyroid cancer: a systematic review of the literature. Pragmat Obs Res 2017; 8:57-67. [PMID: 28553154 PMCID: PMC5440065 DOI: 10.2147/por.s130510] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Differentiated thyroid cancer (DTC) occurs in relatively young patients and is associated with a good prognosis and long survival. The management of this disease involves thyroidectomy, radioiodine therapy, and long-term thyroid-stimulating hormone suppression therapy (THST). The long-term effects of the treatment and the interaction between subclinical hyperthyroidism and long-term hypoparathyroidism are poorly understood. This review sought to examine the available evidence. Methods A PubMed search was carried out using the search terms “Thyroid Neoplasms” AND (“Thyroxine” OR “Hypocalcemia” OR “Thyrotropin”). Original English language articles published in the last 30 years studying the morbidity from thyroid-stimulating hormone (TSH) suppression and hypoparathyroidism following a surgery for DTC were retrieved and reviewed by 2 authors. Results Of the 3,000 results, 66 papers including 4,517 patients were selected for the present study. Studies reported on a range of skeletal (included in 34 studies, 1,647 patients), cardiovascular (17 studies, 957 patients), psychological (10 studies, 663 patients), and other outcomes (10 studies, 1,348 patients). Nine of 26 studies on patients who underwent THST showed a reduction in bone density, and 13 of 23 studies showed an increase in bone turnover markers. Skeletal effects were more marked in postmenopausal women. There was no evidence of increased fracture risk, and only little data were available on hypoparathyroidism. Four of five studies showed an increased left ventricular mass index on echocardiography, and one study showed a higher prevalence of atrial fibrillation (AF). There was little difference in basic physiological parameters and limited literature regarding symptoms or significant events. Six studies showed associations between long-term TSH suppression and impaired quality of life. Impaired glucose metabolism and prothrombotic states were also found in DTC patients. Conclusion There is limited literature regarding long-term DTC treatment-related morbidity, particularly regarding the effects of long-term hypocalcemia. Most studies have focused on surrogate markers and not on clinical outcomes. A large prospective study on defined clinical outcomes would help characterize the morbidity of treatment and stimulate research on tailoring treatment strategies.
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Affiliation(s)
- William Ae Parker
- Department of Oncology and Metabolism.,Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield
| | - Ovie Edafe
- Endocrine Surgery Unit, Directorate of General Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sabapathy P Balasubramanian
- Department of Oncology and Metabolism.,Endocrine Surgery Unit, Directorate of General Surgery, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Boruah P, Baruah AJ, Hajong R, Nath CK, Barman B, Chutia H, Sarma K. A Study to Assess the Validity of Estimation of Serum Ostase Level in Hyperthyroid and Hypothyroid Cases. J Clin Diagn Res 2016; 10:BC08-BC11. [PMID: 27790421 PMCID: PMC5071921 DOI: 10.7860/jcdr/2016/19750.8441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/15/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION One of the more specific assessments of the metabolic status of bone in normal and in disease conditions is the measurement of bone specific alkaline phosphatase or ostase. The measurement of serum ostase has several advantages over the measurements of other bone parameter. Because of its relatively long half-life, in-vivo (1 to 3days), it is relatively unaffected by diurnal variation. AIM To find the correlation of serum ostase level in hyper and hypothyroid cases and also to study the validity of routine estimation of serum ostase in hyper and hypothyroid cases so as to monitor the base level bone health on presentation. MATERIALS AND METHODS Serum ostase level was studied in 74 patients with disorder of thyroid function. Serum ostase level, Thyroid Stimulating Hormone (TSH), FT3, FT4 levels were estimated by chemiluminescent technique. The instrument used was Beckman- coulter Access 2. A total of 39 patients were hypothyroid, 31 were hyperthyroid and 4 patients had subclinical hyperthyroidism. RESULTS The serum ostase level was found to be elevated above 40 μg/L in 26 of the cases and above 16 μg/L but below 40μg/L in 5 cases of hyperthyroidism along with decrease in Bone Mineral Density (BMD). Serum ostase level was found to be directly proportional to the serum FT3 level (Normal range of serum ostase is 8-16 μg/L). CONCLUSION From this study, an inference can be drawn that a routine estimation of serum ostase level in hyperthyroid cases will help in proper monitoring of decrease bone turnover as indicated by increase serum ostase level. Besides, the estimation of serum ostase level in hyperthyroid cases it is found to be valid in this study, which can turn to be an important guiding parameter to the treating physician to formulate necessary protocols and guidelines for prophylaxis, treatment and to monitor the response to therapy in cases of reduced bone turnover related to hyperthyroid state.
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Affiliation(s)
| | - Arup Jyoti Baruah
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Ranendra Hajong
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Chandan Kumar Nath
- Assistant Professor, Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | - Bhupen Barman
- Assistant Professor, Department of General Medicine, NEIGRIHMS, Shillong, Meghalaya, India
| | - Happy Chutia
- Assistant Professor, Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | - Kalyan Sarma
- PGT, Department of Radiology, NEIGRIHMS, Shillong, Meghalaya, India
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Abstract
The skeleton is an exquisitely sensitive and archetypal T3-target tissue that demonstrates the critical role for thyroid hormones during development, linear growth, and adult bone turnover and maintenance. Thyrotoxicosis is an established cause of secondary osteoporosis, and abnormal thyroid hormone signaling has recently been identified as a novel risk factor for osteoarthritis. Skeletal phenotypes in genetically modified mice have faithfully reproduced genetic disorders in humans, revealing the complex physiological relationship between centrally regulated thyroid status and the peripheral actions of thyroid hormones. Studies in mutant mice also established the paradigm that T3 exerts anabolic actions during growth and catabolic effects on adult bone. Thus, the skeleton represents an ideal physiological system in which to characterize thyroid hormone transport, metabolism, and action during development and adulthood and in response to injury. Future analysis of T3 action in individual skeletal cell lineages will provide new insights into cell-specific molecular mechanisms and may ultimately identify novel therapeutic targets for chronic degenerative diseases such as osteoporosis and osteoarthritis. This review provides a comprehensive analysis of the current state of the art.
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Affiliation(s)
- J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
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15
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Papaleontiou M, Hawley ST, Haymart MR. Effect of Thyrotropin Suppression Therapy on Bone in Thyroid Cancer Patients. Oncologist 2016; 21:165-71. [PMID: 26659220 PMCID: PMC4746080 DOI: 10.1634/theoncologist.2015-0179] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The thyroid cancer incidence is rising. Despite current guidelines, controversy exists regarding the degree and duration of thyrotropin suppression therapy. Also, its potential skeletal effects remain a concern to physicians caring for thyroid cancer patients. We conducted a review of published data to evaluate existing studies focusing on the skeletal effects of thyrotropin suppression therapy in thyroid cancer patients. MATERIALS AND METHODS A systematic search of the PubMed, Ovid/Medline, and Cochrane Central Register of Controlled Trials databases was conducted. The retained studies were evaluated for methodological quality, and the study populations were categorized into premenopausal women, postmenopausal women, and men. RESULTS Twenty-five pertinent studies were included. Seven studies were longitudinal and 18 were cross-sectional. Of the 25 included studies, 13 were assigned an excellent methodological quality score. Three of 5 longitudinal studies and 3 of 13 cross-sectional studies reported decreased bone mineral density (BMD) in premenopausal women; 2 of 4 longitudinal studies and 5 of 13 cross-sectional studies reported decreased BMD in postmenopausal women. The remaining studies showed no effect on BMD. The only longitudinal study of men showed bone mass loss; however, cross-sectional studies of men did not demonstrate a similar effect. CONCLUSION Studies to date have yielded conflicting results on the skeletal effects of thyrotropin suppression therapy and a knowledge gap remains, especially for older adults and men. Existing data should be cautiously interpreted because of the variable quality and heterogeneity. Identifying groups at risk of adverse effects from thyrotropin suppression therapy will be instrumental to providing focused and tailored thyroid cancer treatment. IMPLICATIONS FOR PRACTICE The standard treatment for thyroid cancer includes total thyroidectomy with or without radioactive iodine ablation, often followed by thyrotropin suppression therapy. Despite current guidelines, controversy exists regarding the degree and duration of thyrotropin suppression therapy, and discordant results have been reported on its adverse effects on bone. The present review provides physicians with existing data on the skeletal effects of thyrotropin suppression therapy, highlighting the need for further research to identify the groups at risk of adverse skeletal effects. This knowledge will aid in developing tailored thyroid cancer treatment.
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Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan R Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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16
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Gorka J, Taylor-Gjevre RM, Arnason T. Metabolic and clinical consequences of hyperthyroidism on bone density. Int J Endocrinol 2013; 2013:638727. [PMID: 23970897 PMCID: PMC3736466 DOI: 10.1155/2013/638727] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 06/25/2013] [Indexed: 11/23/2022] Open
Abstract
In 1891, Von Recklinghausen first established the association between the development of osteoporosis in the presence of overt hyperthyroidism. Subsequent reports have demonstrated that BMD loss is common in frank hyperthyroidism, and, to a lesser extent, in subclinical presentations. With the introduction of antithyroid medication in the 1940s to control biochemical hyperthyroidism, the accompanying bone disease became less clinically apparent as hyperthyroidism was more successfully treated medically. Consequently, the impact of the above normal thyroid hormones in the pathogenesis of osteoporosis may be presently underrecognized due to the widespread effective treatments. This review aims to present the current knowledge of the consequences of hyperthyroidism on bone metabolism. The vast number of recent papers touching on this topic highlights the recognized impact of this common medical condition on bone health. Our focus in this review was to search for answers to the following questions. What is the mechanisms of action of thyroid hormones on bone metabolism? What are the clinical consequences of hyperthyroidism on BMD and fracture risk? What differences are there between men and women with thyroid disease and how does menopause change the clinical outcomes? Lastly, we report how different treatments for hyperthyroidism benefit thyroid hormone-induced osteoporosis.
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Affiliation(s)
- Jagoda Gorka
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada S7N 0W8
| | - Regina M. Taylor-Gjevre
- Division of Rheumatology, Department of Medicine, University of Saskatchewan, Saskatoon, Canada S7N 0W8
| | - Terra Arnason
- Division of Endocrinology and Metabolism, Department of Medicine, University of Saskatchewan, Saskatoon, Canada S7N 0W8
- *Terra Arnason:
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17
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Abstract
Euthyroid status is essential for normal skeletal development and the maintenance of adult bone structure and strength. Established thyrotoxicosis has long been recognised as a cause of high bone turnover osteoporosis and fracture but more recent studies have suggested that subclinical hyperthyroidism and long-term suppressive doses of thyroxine (T4) may also result in decreased bone mineral density (BMD) and an increased risk of fragility fracture, particularly in postmenopausal women. Furthermore, large population studies of euthyroid individuals have demonstrated that a hypothalamic-pituitary-thyroid axis set point at the upper end of the normal reference range is associated with reduced BMD and increased fracture susceptibility. Despite these findings, the cellular and molecular mechanisms of thyroid hormone action in bone remain controversial and incompletely understood. In this review, we discuss the role of thyroid hormones in bone and the skeletal consequences of hyperthyroidism.
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Affiliation(s)
- Jonathan J Nicholls
- Molecular Endocrinology Group, Department of Medicine, Imperial College London, Hammersmith Campus, Room 7N2b, Commonwealth Building, Du Cane Road, London W12 0NN, UK
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La Vignera S, Condorelli RA, Vicari E, Nicoletti C, Calogero AE. Bone demineralization in postmenopausal women: role of anamnestic risk factors. Int J Endocrinol 2012; 2012:837187. [PMID: 22899918 PMCID: PMC3412114 DOI: 10.1155/2012/837187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 06/13/2012] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the effects of LT4 administration on the bone mineral density (BMD) in physiological postmenopausal women after two years of continuative treatment. 110 postmenopausal women with nodular goiter aged between 50 and 55 years were examined before and after 2 years of therapy with a fixed dose of LT4 (1.6 mcg/kg/die) for the treatment of nodular thyroid disease. The results showed that the patients on treatment with LT4 have a slight, but significant reduction of the BMD after 2 years of treatment, associated with increased serum levels of alkaline phosphatase and urinary excretion of hydroxyproline, confirming our data conducted on the same group after one year of therapy. Comparison between patients receiving LT4 (group A) or not (group B) showed that group A patients had significantly lower BMD. We demonstrated the statistically significant influence of the following risk factors on BMD: (1) body mass index <19 kg/m(2); (2) the onset of menarche after the age of 15 years; (3) positive history for period of amenorrhoea; (4) nulliparity.
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Affiliation(s)
- Sandro La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico, 95123 Catania, Italy
- *Sandro La Vignera:
| | - Rosita A. Condorelli
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico, 95123 Catania, Italy
| | - Enzo Vicari
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico, 95123 Catania, Italy
| | - Chiara Nicoletti
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico, 95123 Catania, Italy
| | - Aldo E. Calogero
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Policlinico, 95123 Catania, Italy
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Reverter JL, Colomé E, Holgado S, Aguilera E, Soldevila B, Mateo L, Sanmartí A. Bone mineral density and bone fracture in male patients receiving long-term suppressive levothyroxine treatment for differentiated thyroid carcinoma. Endocrine 2010; 37:467-72. [PMID: 20960170 DOI: 10.1007/s12020-010-9339-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
Studies on the effect of exogenous subclinical thyrotoxicosis on bone mineral density (BMD) in male patients treated with suppressive doses of levothyroxine for differentiated thyroid carcinoma (DTC) are not conclusive. In order to evaluate BMD (in femoral neck, lumbar spine, and distal radius) and bone fractures in men under long-term suppressive treatment with levothyroxine for DTC, we conducted a cross-sectional, retrospective study in 33 Caucasian men (mean ± SD age: 56 ± 14 years) under treatment for DTC. The control group comprised 33 healthy age- and body mass index-matched male volunteers. BMD was assessed by dual-energy X-ray absorptiometry (DXA). Bone turnover biomarkers (calcium, phosphate, alkaline phosphatase, PTH, vitamin D, urinary calcium, and N-Telopeptide/creatinine index) and testosterone were determined. Previous bone fractures were evaluated with a questionnaire and X-ray images of thoracic and lumbar vertebrae. Patients were treated for a mean duration of 15 ± 5 years. No differences were found between patients and controls in bone turnover biomarkers or areal BMD, T-scores or Z-scores in all sites evaluated. No earlier fractures or pain episodes were registered in either group and the incidence of asymptomatic vertebral fractures did not differ significantly between patient (18.8%) and control groups (16.7%), (P = 0.9). In conclusion, long-term suppressive treatment with levothyroxine in men with DTC does not appear to exert deleterious effects on bone mineral density or increase the prevalence of fracture.
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Affiliation(s)
- Jordi L Reverter
- Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital, Via Canyet s/n, 08916 Badalona, Barcelona, Spain.
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20
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Sabet A, Kim M. Postoperative Management of Differentiated Thyroid Cancer. Otolaryngol Clin North Am 2010; 43:329-51, viii-ix. [DOI: 10.1016/j.otc.2010.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gao Y, Lu H, Luo Q, Wu X, Sheng S. Predictive value of osteocalcin in bone metastatic differentiated thyroid carcinoma. Clin Biochem 2009; 43:291-5. [PMID: 19732762 DOI: 10.1016/j.clinbiochem.2009.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 08/16/2009] [Accepted: 08/22/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of serum osteocalcin in the detection of bone metastases from differentiated thyroid carcinoma (DTC). DESIGN AND METHODS Serum samples from DTC patients with (DTC BM+, n=19) or without bone metastases (DTC BM-, n=19), and matched healthy volunteers (n=30) were tested for serum osteocalcin with electrochemiluminescent immunoassay. RESULTS Osteocalcin was higher in DTC BM+ than in DTC BM- patients (+35.8%, p=0.002), acting as an independent risk factor for bone metastases (R(2)=0.142, p=0.039). The sensitivity was 78.9% and the specificity was 63.2% at a cut-off value of 11.2 microg/L. CONCLUSIONS Serial measurements of osteocalcin could be useful in the detection of bone metastases from DTC.
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Affiliation(s)
- Yunchao Gao
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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Civitelli R, Armamento-Villareal R, Napoli N. Bone turnover markers: understanding their value in clinical trials and clinical practice. Osteoporos Int 2009; 20:843-51. [PMID: 19190842 DOI: 10.1007/s00198-009-0838-9] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 12/12/2008] [Indexed: 12/30/2022]
Abstract
While bone mineral density (BMD) by dual-energy X-ray absorptiometry is the primary method of determining fracture risk, assessing bone turnover may add valuable information for the management of patients with low bone mass. Bone turnover markers (BTMs) are used in clinical trials where they can provide essential information on the biological efficacy of osteoporosis treatments. In such population-based studies, BTMs can predict fracture risk independent of BMD. When combined with BMD, they improve the fracture risk estimate above and beyond BMD alone in postmenopausal osteoporotic women. Since changes in bone turnover after the initiation of therapy with bone resorption inhibitors occur much more rapidly than changes in BMD, treatment efficacy could, in theory, be determined within weeks of using BTMs. However, such predictive value is limited by the large biological variability of these biochemical markers, even though newer automated methods have reduced their analytical variability. Consequently, widespread adoption as a means of predicting treatment efficacy in fracture prevention for individual patients cannot yet be recommended. BTMs may be useful for monitoring adherence to antiresorptive therapy and may aid in identifying patients for whom antiresorptive therapy is most appropriate. Thus, although BTMs are currently confined to clinical research applications, further improvement in assay precision may extend their diagnostic value in clinical settings.
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Affiliation(s)
- R Civitelli
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, 660 S. Euclid Ave., PO Box 8301, St. Louis, MO 63110, USA.
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Sipos JA, Mazzaferri EL. The therapeutic management of differentiated thyroid cancer. Expert Opin Pharmacother 2009; 9:2627-37. [PMID: 18803450 DOI: 10.1517/14656566.9.15.2627] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The management of thyroid cancer is difficult because the tumors comprise a wide range of biologic behaviors, from small papillary thyroid microcarcinomas that pose little or no threat to survival for the patient, to anaplastic thyroid cancers that are arguably the most lethal tumor. Although it may be difficult initially to determine at which end of the prognostic spectrum a patient resides, one can ordinarily estimate a patient's risk for tumor recurrence and mortality based on a triad of features as simple as the patient's age at the time of diagnosis, the tumor stage at presentation, and its initial response to therapy. While staging systems are available to assist in the management process, all are inexact and leave wide gaps in the treatment plan for a given patient. This is largely because randomized controlled trials are lacking as a result of the low incidence and generally favorable prognosis of the disease. As a practical matter, it may sometimes be difficult to reassure a patient, given the generally favorable prognosis of this group of tumors, knowing that without adequate therapy some become unexpectedly aggressive and recur years after initial management. The treatment of these tumors rests on a fine balance of providing care that reflects the anticipated course of the disease without overtreating the patient or providing reassurance that is unfounded. OBJECTIVE To outline the treatment strategy for patients with differentiated thyroid cancer based on the available literature and to guide clinicians through a management algorithm utilizing patient and tumor characteristics. METHODS This review is limited to the treatment of patients with differentiated thyroid cancer - papillary and follicular thyroid cancer - and the standard therapy required for the majority of patients. RESULTS/CONCLUSION The treatment of differentiated thyroid cancer requires a multidisciplinary approach, involving an experienced surgeon, radiologists and an endocrinologist. There are many unanswered questions in the management algorithm and ongoing research is needed to further define the best treatment strategy for patients with differentiated thyroid cancer.
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Affiliation(s)
- Jennifer A Sipos
- University of Florida, 1600 Archer Road, PO Box 100226, Gainesville, FL 32610, USA.
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24
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Mikosch P, Kerschan-Schindl K, Woloszczuk W, Stettner H, Kudlacek S, Kresnik E, Gallowitsch HJ, Lind P, Pietschmann P. High cathepsin K levels in men with differentiated thyroid cancer on suppressive L-thyroxine therapy. Thyroid 2008; 18:27-33. [PMID: 18302515 DOI: 10.1089/thy.2007.0186] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroid hormone administration is associated with low bone density in some studies. The aim of the present study was to evaluate the influence L-thyroxine, in doses used to treat patients with a history of thyroid carcinoma, on serum cathepsin K and other markers of bone metabolism. Cathepsin K is thought to have a role in osteoclast mediated bone resorption. METHODS A group of male patients with differentiated thyroid cancer (DTC) on suppressive L-thyroxine therapy (DTC-group; n = 51; mean age 57 years; TSH < 0.1 mU/L) was selected as a model for hyperthyroidism. The results were compared to a group of healthy euthyroid men (control-group; n = 50; mean age 58 years; TSH 1.5 +/- 0.9 mU/L). RESULTS In the DTC-group the median value of cathepsin K was 6.9 pmol/L, in the control group 4.8 pmol/L (p = 0.0052; highly significant [h.s.]). There was a significant negative correlation of cathepsin K with age (r = -0.279, p = 0.028). The analysis of various bone associated parameters revealed an increase of serum crosslaps in the DTC-group versus euthyroid controls (p = 0.03). A significant correlation could be found for cathepsin K and osteoprotegerin (p = 0.002). CONCLUSION Cathepsin K is increased by a suppressive L-thyroxine therapy and decreases with increasing age. The increased cathepsin K levels seen in DTC-patients on suppressive L-thyroxine therapy are likely to contribute to accelerated bone degradation in these patients.
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Affiliation(s)
- Peter Mikosch
- Department of Internal Medicine II, Klagenfurt State Hospital, Klagenfurt, Austria.
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25
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Mikosch P, Igerc I, Kudlacek S, Woloszczuk W, Gallowitsch HJ, Kresnik E, Stettner H, Grimm G, Lind P, Pietschmann P. Receptor activator of nuclear factor kappaB ligand and osteoprotegerin in men with thyroid cancer. Eur J Clin Invest 2006; 36:566-73. [PMID: 16893379 DOI: 10.1111/j.1365-2362.2006.01678.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suppressive thyroid hormone therapy is generally a lifelong treatment for patients with differentiated thyroid cancer (DTC). However, long-standing thyrotropin (TSH) suppression is a risk factor for osteoporosis. Osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB ligand (RANKL) are central regulators of bone turnover. The aim was to analyze the effects of a suppressive thyroid hormone therapy in males with DTC on the OPG/RANKL system and on bone metabolism. PATIENTS AND METHODS The OPG and soluble RANKL (sRANKL) were determined in 40 men (mean age, 53.2 years) with DTC on suppressive thyroid hormone therapy (TSH; 0.053 +/- 0.037 mU L(-1), duration 5.7 +/- 4.4 years) and 120 healthy controls matched for age. The markers of bone metabolism were C-terminal telopeptide of type I collagen in serum (sCTx) and osteocalcin (OC). RESULTS The control group had OPG values (mean +/- SD) of 1.9 +/- 1.0 pmol L(-1) and sRANKL values of 0.40 +/- 0.62 pmol L(-1). In patients with DTC, results for OPG were 3.03 +/- 1.04 pmol L(-1) (P < 0.05) and for sRANKL were 0.13 +/- 0.16 pmol L(-1) (P < 0.05). The control group presented values for sCTx of 2669 +/- 1132 pmol L(-1) and for OC of 17.89 +/- 6.5 ng mL(-1). Patients with DTC on suppressive thyroid hormone therapy had increased sCTx values of 3810 +/- 2020 pmol L(-1) (P = 0.03) but comparable OC values of 19.21 +/- 7.67 ng mL(-1) (NS). CONCLUSIONS Suppressive thyroid hormone therapy in men with DTC increased bone degradation and induced significant changes in the OPG/RANKL system. These changes include, besides the risk of osteoporosis, possible negative effects on the vascular function and an increased risk of cardiovascular disease.
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Affiliation(s)
- P Mikosch
- Department of Nuclear Medicine and Special Endocrinology, Klagenfurt State Hospital, Klagenfurt, Austria.
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Heemstra KA, Hamdy NAT, Romijn JA, Smit JWA. The effects of thyrotropin-suppressive therapy on bone metabolism in patients with well-differentiated thyroid carcinoma. Thyroid 2006; 16:583-91. [PMID: 16839260 DOI: 10.1089/thy.2006.16.583] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patients with differentiated thyroid carcinoma (DTC) are commonly treated long-term with thyrotropin (TSH)- suppressive thyroxine replacement therapy resolving in a state of subclinical hyperthyroidism. The relationship between subclinical hyperthyroidism and osteoporosis is not clear. In this review, we systematically selected and analyzed 21 studies addressing this issue. Although multiple methodological differences between studies prevented a structured meta-analysis, our data suggest that postmenopausal women with subclinical hyperthyroidism are most at risk, whereas no increased risk was observed in men and premenopausal women. Based on these findings we believe that measurement of bone mineral density is recommended in postmenopausal women with DTC starting TSH suppressive therapy. This should be subsequently regularly measured to enable timely intervention with bone protective agents.
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Affiliation(s)
- K A Heemstra
- Department of Endocrinology & Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Regalbuto C, Alagona C, Maiorana R, Di Paola R, Cianci M, Alagona G, Sapienza S, Vigneri R, Pezzino V. Acute changes in clinical parameters and thyroid function peripheral markers following L-T4 withdrawal in patients totally thyroidectomized for thyroid cancer. J Endocrinol Invest 2006; 29:32-40. [PMID: 16553031 DOI: 10.1007/bf03349174] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
After total thyroidectomy, differentiated thyroid cancer (DTC) patients have to undergo L-T4 withdrawal for measuring serum thyroglobulin and 131I whole-body scan (131I WBS) to evaluate residual/recurrent malignant disease. The aim of the present work was to study in these patients the effects of acute thyroid hormone deficiency on various target organs and tissues. Clinical parameters and thyroid function peripheral markers were evaluated in 20 DTC patients, both before and after L-T4 withdrawal. A 24-h urine collection, a fasting blood sample for laboratory examinations, a clinical score for hypothyroidism and cardiovascular, neurological and neuropsychological evaluations were carried out. After L-T4 withdrawal, the clinical score significantly increased, as well as total cholesterol, triglycerides, creatine kinase, lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase, whereas SHBG, osteocalcin and urine hydroxyproline levels significantly decreased. The acute thyroid hormone deficiency caused a systolic dysfunction of the left ventricle associated with an increase in systemic vascular resistance without cardiac contractility alterations. A significant increase in the left ventricular mass and thickness was also observed. Carpal tunnel syndrome appeared in 30% of patients and a significant reduction in the immediate auditive memorization and in attentive performance was also detected. These observations indicate that acute hypothyroidism causes significant clinical alterations of peripheral tissue function. In the follow-up of DTC patients, therefore, L-T4 withdrawal procedure should be restricted to cases where the cost/benefit ratio is favorable. Alternative procedures, such as the use of recombinant human TSH, should be used whenever possible.
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Affiliation(s)
- C Regalbuto
- Division of Endocrinology, Department of Internal and Specialistic Medicine, University of Catania, Italy.
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Ikehara T, Habu N, Nishino I, Kamimori H. Determination of hydroxyproline in rat urine by high-performance liquid chromatography with electrogenerated chemiluminescence detection using tris(2,2′-bipyridyl) ruthenium(II). Anal Chim Acta 2005. [DOI: 10.1016/j.aca.2004.12.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mazziotti G, Sorvillo F, Piscopo M, Cioffi M, Pilla P, Biondi B, Iorio S, Giustina A, Amato G, Carella C. Recombinant human TSH modulates in vivo C-telopeptides of type-1 collagen and bone alkaline phosphatase, but not osteoprotegerin production in postmenopausal women monitored for differentiated thyroid carcinoma. J Bone Miner Res 2005; 20:480-6. [PMID: 15746993 DOI: 10.1359/jbmr.041126] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2004] [Revised: 07/19/2004] [Accepted: 10/15/2004] [Indexed: 02/06/2023]
Abstract
UNLABELLED In women monitored for thyroid carcinoma, short-term stimulation with rhTSH induced an acute decrease in serum C-telopeptides of type-1 collagen and an increase in serum BALP levels without any effect on OPG production. The inhibitory effect of TSH on bone resorption occurred only in postmenopausal women who showed low BMD and a high bone turnover rate as an effect of L-thyroxine suppressive therapy. INTRODUCTION It has been recently shown that thyrotropin (TSH) has an inhibitory activity on skeletal remodeling in in vitro conditions. Here, we have aimed at evaluating whether TSH has similar effects in vivo. For this purpose, we have evaluated the sequential profile of serum bone metabolism markers during acute stimulation with recombinant human TSH (rhTSH) in thyroidectomized women monitored for thyroid carcinoma. MATERIALS AND METHODS The study group included 66 thyroidectomized patients, of whom 38 were premenopausal and 28 postmenopausal, who underwent routine rhTSH-assisted whole body radioactive iodine scanning for differentiated thyroid carcinoma. The patients were sequentially evaluated for TSH, free triiodothyronine (FT3), free thyroxine (FT4), bone alkaline phosphatase (BALP), C-telopeptides of type-1 collagen (CrossLaps), and osteoprotegerin (OPG) levels during rhTSH stimulation. The samples were drawn just before and 2 and 7 days after the first administration of rhTSH. BMD was evaluated by ultrasonography at baseline. Seventy-one healthy women (41 premenopausal and 30 postmenopausal) acted as a control group. RESULTS AND CONCLUSIONS At study entry, all patients had subclinical thyrotoxicosis as effect of L-thyroxine (L-T4) treatment. The patients had higher serum CrossLaps and OPG levels and lower BMD than healthy subjects. Postmenopausal patients showed comparable serum FT4 and FT3 concentrations with those found in premenopausal patients. However, postmenopausal patients showed higher serum CrossLaps (p < 0.001), OPG (p = 0.03), and BALP (p < 0.001) levels and lower BMD (p < 0.001) than those measured in premenopausal patients. Two days after the first administration of rhTSH, all patients had serum TSH values >100 mUI/liter. At this time, serum CrossLaps levels decreased significantly (p < 0.001) and BALP values increased (p = 0.001) with respect to the baseline values in postmenopausal but not in premenopausal patients. rhTSH did not induce any significant change in serum OPG values either in premenopausal or in postmenopausal patients. One week after the first rhTSH administration, serum CrossLaps values decreased again to values comparable with those measured at baseline, whereas serum BALP values remained high. This study shows that subclinical thyrotoxicosis is accompanied by high bone turnover rate with an increase in serum OPG levels compared with euthyroid healthy subjects. Acute increase in serum TSH levels is accompanied by a reversible inhibition of bone resorption. This effect is characterized by a decrease in serum CrossLaps and an increase in BALP levels without any evident effect on OPG production. The activity of TSH occurs specifically in postmenopausal women in whom the negative effects of L-T4 suppressive therapy on bone mass and metabolism are more marked compared with premenopausal women.
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Affiliation(s)
- Gherardo Mazziotti
- Department of Clinical and Experimental Medicine, F. Magrassi & A. Lanzara, Second University of Naples, Naples, Italy
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Abstract
Evaluation and treatment of thyroid disease is a common feature of primary care medicine. Nevertheless, the dose of thyroid hormone used to treat hypothyroidism is frequently not titrated to normalize the TSH, engendering the risks of under- or overtreatment. Other hypothyroid patients remain symptomatic even with normalized TSH on levothyroxine alone. Some of these patients improve symptomatically when liothyronine is added to the treatment regimen. Subclinical hypothyroidism and hyperthyroidism are also relatively common in primary care medical practice, and appropriately selected patients probably benefit from treatment. In the follow-up of patients treated for thyroid cancer, the use of rhTSH improves patient comfort considerably while allowing sensitive screening for persistent or recurrent cancer.
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Affiliation(s)
- Timothy C Evans
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98105, USA.
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Brenta G, Schnitman M, Fretes O, Facco E, Gurfinkel M, Damilano S, Pacenza N, Blanco A, Gonzalez E, Pisarev MA. Comparative efficacy and side effects of the treatment of euthyroid goiter with levo-thyroxine or triiodothyroacetic acid. J Clin Endocrinol Metab 2003; 88:5287-92. [PMID: 14602763 DOI: 10.1210/jc.2003-030095] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Euthyroid goiter is usually treated with TSH-inhibitory doses of levo-T(4) (L-T(4)). Because triiodothyroacetic acid (TRIAC) decreases TSH levels, the following study was perfomed: 36 euthyroid goitrous female patients (no cancer or chronic thyroiditis) were randomized to TRIAC (19.6 micro g/kg) (n = 19) or L-T4 (1.7 microg/kg) (n = 17) treatment during 11 months. Goiter volume; lumbar and femoral bone mineral density; serum osteocalcin; deoxypyridinoline; TSH; free T(4); total, high-density lipoprotein, and low-density lipoprotein cholesterol; and triglycerides were measured before and after the study period. Student's t test and chi(2) analysis were performed. TSH values (microunits per milliliter) in the TRIAC and L-T(4) groups were: 1.91 +/- 0.6 (basal) and 0.180 +/- 0.1 (after) and 2.1 +/- 2.5 (basal) and 0.180 +/- 0.3 (after), respectively. Thyroid volume decreased 37.9 +/- 35.4% in the TRIAC patients and 14.5 +/- 39.5% in the L-T(4) group (P = 0.069). Forty-two percent of the goiters with TRIAC reduced more than 50% their initial volume vs. 17.7% with L-T(4) (P = 0.15). With TRIAC, patients experienced fewer side effects. No differences in the changes of bone mineral density, serum deoxypyridinoline, osteocalcin, or the lipid profile were observed between both groups. The present results show that TRIAC is more effective than L-T(4) in the reduction of goiter size, with comparable effects on peripheral parameters.
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Affiliation(s)
- G Brenta
- Department of Endocrinology and Metabolism, French Hospital, Buenos Aires, Argentina
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Mikosch P, Obermayer-Pietsch B, Jost R, Jauk B, Gallowitsch HJ, Kresnik E, Leb G, Lind P. Bone metabolism in patients with differentiated thyroid carcinoma receiving suppressive levothyroxine treatment. Thyroid 2003; 13:347-56. [PMID: 12804103 DOI: 10.1089/105072503321669839] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Patients with differentiated thyroid carcinoma (DTC) must receive suppressive levothyroxine (LT(4)) therapy for the rest of their lives. The literature, however, presents conflicting results on how this affects bone metabolism. The aim of this study was to assess the influence of the estrogen status and LT(4) therapy, in particular LT(4) dosage in micrograms per kilograms (microg/kg), on bone metabolism in female patients with DTC. MATERIAL AND METHODS Three markers of bone metabolism (C-terminal telopeptide of type I collagen in serum [SCTx]; N-terminal telopeptide of type I collagen in urine [U-NTx]; and osteocalcin [OC]) were investigated in four groups: group REF (healthy premenopausal female controls), group DTC-ES (premenopausal women with DTC and normal estrogen levels), group DTC-ED (postmenopausal women with DTC and estrogen deficiency), and group DTC-HRT (postmenopausal women with DTC undergoing hormone replacement therapy [HRT]). All patients with DTC were on a well-adjusted suppressive LT(4) therapy with TSH levels 0.1 mU/L or less. RESULTS In group DTC-ES bone turnover was comparable to group REF, whereas in group DTC-ED, all three markers were significantly increased as compared to groups REF and DTC-ES. In group DTC-HRT, the HRT normalized U-NTx and OC. However, in this group S-CTx was not completely normalized by HRT in all patients, although also significantly lowered compared to group DTC-ED. The analysis of LT(4 )dosage per kilogram showed that premenopausal DTC-patients had increased markers of bone metabolism if LT(4) dosage exceeded 2.6 microg/kg. Estrogen-deficient patients with DTC, however, had a much lower critical LT(4) dosage, above which increased markers of bone metabolism were seen. CONCLUSION A well-adjusted suppressive LT(4) therapy of less than 2.6 microg/kg and normal estrogen levels do not seem to increase bone metabolism in estrogen-sufficient patients with DTC. The normalization of an estrogen deficiency by HRT or other antiresorptive therapies and minimal suppressive dosages of LT(4) are attempts to optimize the care of patients with DTC. In postmenopausal patients with DTC and patients with DTC who require LT(4) dosages in excess of 2.6 microg/kg, the information provided by markers of bone metabolism may help to prevent bone damage.
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Affiliation(s)
- P Mikosch
- Department of Nuclear Medicine and Special Endocrinology, Klagenfurt State Hospital, Austria.
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Quan ML, Pasieka JL, Rorstad O. Bone mineral density in well-differentiated thyroid cancer patients treated with suppressive thyroxine: a systematic overview of the literature. J Surg Oncol 2002; 79:62-9; discussion 69-70. [PMID: 11754378 DOI: 10.1002/jso.10043] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The effects of subclinical hyperthyroidism on bone mineral density (BMD) induced by suppressive thyroxine therapy in patients with well-differentiated thyroid cancer (WDTC) remains unclear. An overview of the current literature was undertaken to evaluate studies to date. METHODS A systematic medline search yielded a total of 11 studies appropriate for review which included premenopausal women, postmenopausal women, and men on suppressive thyroxine post thyroidectomy for WDTC. Main outcome measures were bone mineral density and bone turnover markers. CONCLUSIONS Although studies were limited by small numbers and varying degrees of control for confounding variables, results suggested no significant change in bone mineral density for premenopausal women or men. Findings for postmenopausal women remain unclear with two of the best controlled studies reporting opposing results. Further studies for this population are recommended to help guide clinical practice.
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Affiliation(s)
- May Lynn Quan
- Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alberta, Canada
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Sorva A, Sorva R, Risteli J, Risteli L, Autio P. Familial high serum PICP: high even in skin interstitial fluid, suppressible by topical corticosteroid treatment. Clin Chim Acta 2001; 314:153-7. [PMID: 11718690 DOI: 10.1016/s0009-8981(01)00693-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Circulating C-terminal propeptide of type I procollagen (PICP), mostly originating from bone, is mainly cleared by mannose receptors (MRs) in liver endothelial cells (LECs). We hypothesized that skin macrophage MRs could also play a role in local (in situ) clearance of PICP originating from skin type I procollagen synthesis. We tested this hypothesis in a male subject with a genetic systemic clearance defect, apparently due to an abnormality in MR function in LECs (or in PICP structure). Since skin macrophages may express the same MRs as LECs do, the genetic defect could affect them as well; hence, if elevated PICP concentrations even in skin interstitial fluid (IF) were found in our subject, it would suggest a role for local MR-mediated PICP clearance in skin. Since glucocorticoids (GCs) upregulate MRs in vitro, we measured the effect of topical GC on suction blister fluid (SBF)-PICP of the test person as compared with normal subjects. SBF-PICP was elevated in the case, which was consistent with the hypothesis. Furthermore, the GC-induced decrease was accentuated. The results suggest that skin macrophage MRs can have a role in skin PICP clearance in situ.
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Affiliation(s)
- A Sorva
- Koskela Hospital, Käpyläntie 11, FIN-00600 Helsinki, Finland.
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Mikosch P, Jauk B, Gallowitsch HJ, Pipam W, Kresnik E, Lind P. Suppressive levothyroxine therapy has no significant influence on bone degradation in women with thyroid carcinoma: a comparison with other disorders affecting bone metabolism. Thyroid 2001; 11:257-63. [PMID: 11327617 DOI: 10.1089/105072501750159679] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to examine different influences on bone degradation (estrogen status, thyroid function, parathyroid function, bone metastases) with special interest focusing on the significance of suppressive levothyroxine therapy (LT4) on bone degradation in patients with differentiated thyroid carcinoma (DTC). Two markers of bone degradation (ELItest NTx = U-NTx; Serum CrossLaps = S-CTx) were used (1) to quantify the influence of different metabolic influences on bone degradation and (2) to compare these two markers with each other. One hundred forty samples of 98 female patients ages 23-86 years were analyzed. The correlation between the two assays of bone degradation was high (r = 0.825; p < 0.001). Both assays demonstrated that estrogen deficiency, hyperparathyroidism, and bone metastases caused significant increases of bone degradation. A suppressive LT4 therapy, as used for patients with DTC, led to no significant increases of S-CTx and U-NTx. The study indicates that a well-controlled suppressive LT4 therapy has only a minor effect on the degree of bone degradation and that a possible estrogen deficiency in patients with DTC has a greater impact on bone degradation. Thus, female patients with DTC on suppressive LT4 therapy and estrogen deficiency may benefit from hormone replacement therapy, as patients with DTC and normal estrogen levels presented similar results to euthyroid controls.
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Affiliation(s)
- P Mikosch
- Department of Nuclear Medicine and Special Endocrinology, State Hospital Klagenfurt, Austria.
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