Bone Mineral Density After Surgical Treatment for Graves' Disease

Arata, Naoko; Momotani, Naoko; Maruyama, Hiroshi; Saruta, Takao; Tsukatani, Kouji; Kubo, Atsushi; Ikemoto, Kumiko; Ito, Kunihiko

doi:10.1089/thy.1997.7.547

Cited by 23 publications

(15 citation statements)

References 28 publications

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“…Subclinical hypothyroidism was reported to be associated with somewhat higher bone density compared to healthy subjects [18]. In our study, mean value of U-DPD in subclinical hypothyroid patients was not different from that of the control group and they had lower osteocalcin levels than control group.…”

Section: Discussioncontrasting

confidence: 47%

Bone and Calcium Metabolism in Subclinical Autoimmune Hyperthyroidism and Hypothyroidism

et al. 2003

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Abstract. Bone turnover is reported to increase in favour of resorption in overt hyperthyroidism and the rate of resorption is associated with the levels of thyroid hormones. Hypothyroidism, on the other hand, was shown to cause no disturbance of calcium kinetics and found to associate lower trabecular resorption surfaces and increased bone cortical thickness. Similar studies are very rare in subclinical thyroid disorders and consequently we aimed to examine calcium and bone metabolism in subclinical thyroid disorders. Thirteen patients with subclinical hyperthyroidism secondary to untreated Graves' disease, 20 patients with subclinical hypothyroidism and 10 healthy subjects participated in this survey. Briefly calcium, phosphorus, and creatinine (Cre), urinary deoxypyridinoline (U-DPD) and serum osteocalcin (OC) were measured as biochemical markers for calcium metabolism. Concerning serum Ca and phosphorus levels, there were no differences between three of the groups, but urinary Ca excretion was higher in subclinical hyperthyroid patients compared to control and hypothyroid subjects. Hypothyroid patients had similar U-DPD levels with control subjects (p = 0.218). Serum OC and U-DPD were higher in subclinical hyperthyroid compared to control subjects ( p<0.001 and p<0.001 respectively). We demonstrated a higher bone turnover and greater calcium excretion in subclinical hyperthyroid patients. Additionally, we found that subclinical hypothyroidism is not associated with disturbed calcium metabolism. As persistent increase in bone turnover is responsible for accelerated bone loss, patients with Graves' disease may have increased risk for osteoporosis. THE combination of an undetectable serum thyrotropin concentration, as measured by an assay with a threshold of detection 0.1 mU per liter or less, and normal serum triiodothyronine and thyroxine concentrations (usually at the upper end of the normal range) is known as subclinical hyperthyroidism. It is not a rare finding; rates between 0.2% and 11.8% have been reported in different groups, according to age, sex, etc [1]. The etiology is usually the same as that of overt hyperthyroidism [1]. The health implications include general symptoms, effects on the cardiovascular system, and decreased bone density. Subclinical hypothyroidism is defined as a state where the patient is eumetabolic but has a modest increase in the serum TSH level (5 to 15 mU/L), a normal serum T 3 concentration, and low-normal or slightly decreased serum fT 4 levels. The overall prevalence has been reported to range from 4-10% in large general population screening surveys [2].There are a few studies performed to examine calcium and bone metabolism in subclinical thyroid disorders with conflicting results. Bone turnover is increased in favour of resorption and the rate of resorption is associated with the serum levels of thyroid hormones in hyperthyroidism [3]. Thyroid hormone exerts its effect on osteoblasts via nuclear receptors to stimulate osteoclastic bone resorption [4,5]; hyperthyroidism is...

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Section: Discussioncontrasting

confidence: 47%

Bone and Calcium Metabolism in Subclinical Autoimmune Hyperthyroidism and Hypothyroidism

et al. 2003

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“…In the subgroup analysis however, a significant reduction in 1CTP was seen only in the group with preoperative subclinical hyperthyroidism and a postoperative decrease in both free T 4 and T 3 levels. In this group we expected a postoperative increase in bone density, since a negative correlation between free T 3 and BMD has previously been recognized [29, 30]. Even if most locations of bone density assessment did not change, a significant decrease was noticed in Ward’s triangle.…”

Section: Discussionmentioning

confidence: 75%

Decreased Levels of Ionized Calcium One Year after Hemithyroidectomy: Importance of Reduced Thyroid Hormones

Lindblom¹,

Valdemarsson

Lindergård³

et al. 2001

Horm Res Paediatr

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Background: Previously we have found reduced levels of total serum calcium and 1,25(OH)₂D₃ despite an unaltered stimulated parathyroid hormone (PTH) secretion 1 year after hemithyroidectomy. The present study was undertaken to elucidate the possible relationship between calcium homeostasis, thyroid hormones and bone resorption in a group of 45 consecutive patients subjected to hemithyroidectomy because of a solitary nodule. All patients had free T₄ and T₃ levels within normal range preoperatively. Methods: Thyroid hormones, bone mineral and biochemical variables known to reflect calcium homeostasis were studied. Patients were divided into three separate groups depending on their pre- and postoperative thyroid hormone status. Results: One year postoperatively, serum levels of free T₄ were decreased and that of thyrotropin (TSH) increased in the entire group of patients. The concentration of ionized calcium was reduced from 1.25 ± 0.05 to 1.22 ± 0.04 (p < 0.001) despite an unaltered PTH value (2.8 ± 1.0 vs. 3.1 ± 1.5, p = 0.50). A significant reduction in C-terminal telopeptide type 1 collagen (1CTP) indicated decreased bone resorption 1 year after surgery (p < 0.05). Subgroup analysis showed that a reduction in ionized calcium was seen only among patients with a postoperative decrease in free T₄. Patients with subclinical hyperthyroidism preoperatively presented the lowest postoperative levels of ionized calcium, significantly reduced levels of 1CTP and increased levels of phosphate and creatinine. Multiple linear regression analysis showed that age (p < 0.05) and postoperatively changed serum levels of TSH (p < 0.05), creatinine (p < 0.05), phosphate (p < 0.001) and FT₄ (p < 0.01) were independently associated with altered levels of ionized calcium. Conclusion: We conclude that the reduction in ionized calcium 1 year after hemithyroidectomy was not due to PTH deficiency. Instead our results suggest that the reduced effects of thyroid hormones on bone and kidney function is essential.

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“…We have no information about bone loss caused by one month delay of ATD therapy, but it should be at a negligible level for the two following reasons: first, thyrotoxic bone disease is a reversible disorder [17][18][19][20][21]; and second, our subjects are young, premenopausal patients. Certainly, there is the possibility of atrial fibrillation, but administration of badrenergic antagonists may decrease its risk [22,23].…”

Section: Discussionmentioning

confidence: 99%

Transient Hyperthyroidism after Withdrawal of Antithyroid Drugs in Patients with Graves' Disease

Kubota

Tamai²,

Ohye

et al. 2004

Endocr J

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Abstract. The development of silent thyroiditis in patients with a history of Graves' disease is common, especially in the postpartum period. We describe herein patients with Graves' disease who developed transient hyperthyroidism but not silent thyroiditis after withdrawal of antithyroid drug (ATD). If such patients are diagnosed as recurrence of Graves' disease, they may receive ATD or radioiodine therapy unnecessarily. We investigated the characteristics of these patients to prevent unnecessary therapy. We retrospectively studied 22 patients with Graves' disease who showed transient thyrotoxicosis after withdrawal of ATD. Two of 22 patients were male and the mean ages (± SD) were 33.7 ± 12.6 yr. We observed these patients for 28.5 ± 12.8 (mean ± SD; range 12-53) months after transient thyrotoxicosis, and measured TSH, FT4, and TSH binding inhibitor immunoglobulin in sera. Radioiodine uptake was measured in 6 of them. The radioiodine uptake in the 4 patients was not suppressed (27.5%, 28.0%, 32.7%, 38.1%). These uptake levels indicate that their thyrotoxicosis was not caused by silent thyroiditis. Most of the 22 patients became euthyroid within 6 months. This study suggests a new therapeutic option as follows: in the case of young patients with mild thyrotoxicosis after withdrawal of ATD, physicians should follow them up for one month without medication unless they have unbearable symptoms or complications.

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Bone Mineral Density After Surgical Treatment for Graves' Disease

Cited by 23 publications

References 28 publications

Bone and Calcium Metabolism in Subclinical Autoimmune Hyperthyroidism and Hypothyroidism

Bone and Calcium Metabolism in Subclinical Autoimmune Hyperthyroidism and Hypothyroidism

Decreased Levels of Ionized Calcium One Year after Hemithyroidectomy: Importance of Reduced Thyroid Hormones

Transient Hyperthyroidism after Withdrawal of Antithyroid Drugs in Patients with Graves' Disease

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