Changes of bone mineral density in pre-menopausal women with differentiated thyroid cancer receiving L‐thyroxine suppressive therapy

Abstract

L-T(4) suppressive therapy for at least 1 year in pre-menopausal women with DTC causes a reduction in BMD of the femoral neck, femoral trochanter and Ward's triangle.

Bone mineral density in treated at a young age for differentiated thyroid cancer after Chernobyl female patients on TSH-suppressive therapy receiving or not Calcium-D3 supplementation

“…On the other hand, examination of 26 pre-menopausal women with thyroid cancer demonstrated that L-T4 suppressive therapy prescribed for at least 1 year caused a reduction in BMD at the femoral neck, femoral trochanter and Ward's triangle [15]. However, in women of this age range, these reductions could not be used as a predictor of increased fracture risk later in life since there was no evidence for clinical significance.…”

“…Overt hyperthyroidism is associated with an increased risk of osteoporosis, while whether subclinical hyperthyroidism affects the skeleton is under debate [7,8]. Effects of the latter on bone mineral density (BMD) have been addressed in a number of studies with somewhat controversial results [9][10][11][12][13][14][15]. The current understanding is that subclinical hyperthyroidism is a risk factor for osteoporosis in postmenopausal women but not in premenopausal women or male patients [10].…”

Low bone turnover and increase of bone mineral density in a premenopausal woman with postoperative hypoparathyroidism and thyroxine suppressive therapy

“…A Japanese group demonstrated that postmenopausal women with hypoparathyroidism lose bone to a lesser extent than healthy controls [10]. This might indicate that oestrogen deprivation does not overrule the bone-conserving effects of hypoparathyroidism, underlining the results of [15] suggesting a hierarchical model of endocrine regulation of bone metabolism, with PTH deriving as strongest regulator compared to thyroxine [14,16] and menopausal status.…”

“…In contrast, postsurgical hypoparathyroidism had a positive effect on trabecular bone, giving a difference of 3.5 standard deviations compared to hypercortisolism [15]. A study by Mazokopakis et al described a deleterious effect of thyroxine suppressive therapy despite the protective effect of oestrogen in premenopausal women [14]. Very recently, thyroid function within the upper normal range was found to be associated with increased fracture risk [16].…”

“…Thyroxine stimulates both activities of osteoblasts as well as osteoclasts, but the greater effect on the latter seems to be responsible for the decreased bone mass seen in patients with hyperthyroxinaemia. A prospective evaluation of 26 premenopausal Greek women demonstrated a marked loss of BMD over a 48-month observation period [14].…”