Effects of TSH suppressive therapy on bone mineral density (BMD) and bone turnover markers (BTMs) in patients with differentiated thyroid cancer in Northeast China: a prospective controlled cohort study

Abstract

This study aimed to evaluate the effects of thyroid-stimulating hormone (TSH) suppressive therapy on bone mineral density (BMD) and bone turnover markers (BTMs) in differentiated thyroid cancer (DTC) patients after postoperative 1-2 years in Northeast China. MethodsFive male, sixteen premenopausal, and eight postmenopausal female DTC patients receiving TSH suppressive therapy after thyroidectomy were enrolled. Patients were matched with healthy controls in a ratio of 1:2. All participants completed postoperative 1-year follow-up, and postmenopausal women completed 2-year follow-up. We measured BMD of the lumbar spine (LS), femoral neck (FN), and total hip (TH) using dualenergy X-ray absorptiometry (DXA). Bone formation marker P1NP and bone resorption marker β-CTX were also evaluated. Fracture risks were assessed by FRAX. ResultsThere was no difference in BMD and BTMs between DTC patients and controls in the male group at 1-year follow-up. In the premenopausal women, the LS-BMD, FN-BMD, and TH-BMD in DTC patients were all higher than those in controls, but only FN-BMD showed a signi cant difference. The change rate of P1NP showed a signi cant difference between DTC patients and controls, while no difference was found in the β-CTX level. In the postmenopausal women, no difference in BMD and BTMs were observed between DTC patients and controls at the 1-year and 2-year follow-up. ConclusionOur study indicated that postoperative 1-year TSH suppressive therapy did not show detrimental effects on BMD and BTMs in men, premenopausal, and postmenopausal DTC patients. The 2-year postoperative TSH suppressive therapy did not lead to additional loss of bone mass in postmenopausal DTC patients.Up to date, few prospective longitudinal studies [5-9] have been reported and the studies in mainland China are limited [10,11]. To the best of our knowledge, no prospective cohort study has been conducted in China. This prospective controlled cohort study aimed to evaluate BMD and BTMs in male, premenopausal female and postmenopausal female DTC patients receiving TSH suppressive therapy at postoperative 1 year in northeast China. Postoperative 2-year follow-up was conducted in postmenopausal female DTC patients. Materials And Methods Patients and selection criteriaThe study population consisted of patients who underwent operation for DTC from 2012 to 2014 at the First A liated Hospital of China Medical University. The following inclusion criteria were used: (1) patients who were diagnosed with DTC underwent total or subtotal thyroidectomy; (2) BMD was tested and serum sample was obtained before operation; (3) TSH suppressive therapy using LT4 was conducted immediately after thyroidectomy, the goal of TSH suppressive level was less than 0.5 mIU/L. The exclusion criteria included: (1) recurrence and distant metastasis; (2) parathyroid injury presented with abnormal serum calcium, phosphate, and parathyroid hormone due to thyroidectomy; (3) showing symptoms of thyrotoxicosis and forced to stop TSH suppressive therapy; (4) use of drugs affe...

Comparison of BMD and TBS Scores in Patients with and without Vertebral Fractures and Thyroid Cancer with Long-Term TSH-Suppressed Therapy

“…In contrast, TBS scores were significantly decreased in this period. This is in agreement with previous reports, that a significative BMD loss is only found after a long disease duration [12]. Also, bone microarchitecture was found to diminish more in patients who had incidental VFs during this long period.…”

Effects of short- and long-term TSH suppression on lumbar bone mineral density in both genders using PET/CT

“…This result also correlates with a study from Gürlek et al, who evaluated 15 premenopausal women with endogenous subclinical hyperthyroidism for between six and 11 months, and who did not show reduced BMD 36 . A more recent study from Wang et al observed 29 DTC patients 1–2 years postoperatively in whom there was no significant effect on BMD 32 . Most likely, these outcomes are related to the short time window between the two measurements.…”

“…On the one hand, some studies indicate that suppressed TSH levels cause lower BMD 29 – 31 . On the other hand, various studies demonstrate the opposite and report that there is no significant difference regarding BMD in those patients 32 – 35 . Primarily due to these controversies and because of the clinical importance, we decided to examine bone densities in two age- and sex-matched cohorts with significantly different TSH values over a long period of time.…”

“…Second, to provide longitudinal analyses and validate other studies with shorter intervals of TSH suppression 32 , 36 , we also measured BMD^HU within those patients who received a second PET/CT scan.…”

Application of power battery under thermal conductive silica gel plate in new energy vehicles

“…This is similar to the cooling principle of an air conditioner. The refrigerant changes between gaseous, liquid, high-pressure, or low-pressure 33 . From the outside, the refrigerant passes through the compressor, condenser, expansion valve, and evaporator, constantly releasing or absorbing heat.…”