Is Partial or Total Thyroidectomy Associated with Risk of Long‐Term Osteoporosis: A Nationwide Population‐Based Study

Hung, Chien-Ling; Yeh, Chih‐Ching; Sung, Pi‐Shan; Hung, Chung-Jye; Muo, Chih‐Hsin; Sung, Fung‐Chang; Jou, I‐Ming; Tsai, Kuen‐Jer

doi:10.1007/s00268-018-4573-2

Cited by 17 publications

(12 citation statements)

References 30 publications

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“…Several studies, mainly population-based, have evaluated the relationship between treatment with LT4 and fracture risk in unselected patients treated with LT4 and, with few exceptions (58,59), an increased risk of osteoporotic fracture was found (34,60,61,62,63,64,65,66) (Table 2). Noteworthy, although these studies included a large number of patients with an extensive follow-up, important data was often missing, namely the indication of LT4 therapy, the previous history of hyperthyroidism, the dosage of LT4 therapy, and the serum TSH values (Table 2).…”

Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

TSH suppressive therapy and bone

Brancatella

Marcocci

2020

Endocrine Connections

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Thyroid hormones stimulate bone turnover in adults by increasing osteoclastic bone resorption. TSH suppressive therapy is usually applied in patients with differentiated thyroid cancer (DTC) to improve the disease outcome. Over the last decades several authors have closely monitored the potential harm suffered by the skeletal system. Several studies and meta-analyses have shown that chronic TSH suppressive therapy is safe in premenopausal women and men. Conversely, in postmenopausal women TSH suppressive therapy is associated with a decrease of bone mineral density, deterioration of bone architecture (quantitative computed tomography, QCT; trabecular bone score, TBS), and, possibly, an increased risk of fractures. The TSH receptor is expressed in bone cells and the results of experimental studies in TSH receptor knockout mice and humans on whether low TSH levels, as opposed to solely high thyroid hormone levels, might contribute to bone loss in endogenous or exogenous thyrotoxicosis remain controversial. Recent guidelines on the use of TSH suppressive therapy in patients with DTC give value not only to its benefit on the outcome of the disease, but also to the risks associated with exogenous thyrotoxicosis, namely menopause, osteopenia or osteoporosis, age > 60 years, and history of atrial fibrillation. Bone health (BMD and/or preferably TBS) should be evaluated in postmenopausal women under chronic TSH suppressive therapy or in those patients planning to be treated for several years. Antiresorptive therapy could also be considered in selected cases (increased risk of fracture or significant decline of BMD/TBS during therapy) to prevent bone loss.

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Section: Trabecular Bone Score (Tbs) and Quantitative Computed Tomogrmentioning

confidence: 99%

TSH suppressive therapy and bone

Brancatella

Marcocci

2020

Endocrine Connections

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“…Patients who underwent thyroidectomy totally or partially had a higher risk of osteoporosis about 1.43 times when compared with the patients who did not underwent thyroidectomy. The risk of post thyroidectomy osteoporosis is higher in women, subjects younger than 50 years old, and patients having comorbidities (Chien-Ling et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Weight bearing aerobic exercises versus whole body vibration on bone mineral density post thyroidectomy

Elsayeh¹,

Elbehery²,

Ali³

2021

Journal of Human Sport and Exercise - 2021 - Autumn Conferences of Sports Science

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One of the health problems occurring post thyroidectomy is osteoporosis which has a greater impact on the patients' lives as it affects the strength and quality of bone and increases the fracture risk. This study was conducted to identify the beneficial therapeutic effect of weight bearing aerobic exercises and whole-body vibration training on bone mineral density post thyroidectomy and also to compare between their effects. In this study, forty-five patients of both sexes underwent thyroidectomy and had osteoporosis were included. Fifteen patients performed weight bearing aerobic exercises in addition to their routine medications and fifteen patients were trained on whole body vibration in addition to their routine medications, while remaining fifteen cases received only their routine medications. Dual Energy X-ray Absorptiometry (DEXA) is used to evaluate the bone mineral density before and after six months of treatment (28 weeks) for all groups. The mean values of BMD of lumbar spine and neck of femur in all groups were significantly increased. The percentages of bone mineral density improvement for lumbar spine and femoral neck in the weight bearing exercise group were 18.63% and 19.82%, in the whole-body vibration group were 22.17% and 29.82%, while in the control group were 7.47% and 3.63%. So, it can be concluded that the weight bearing aerobic exercises and WBV training have a therapeutic beneficial effect on improving the bone mineral density in patient underwent thyroidectomy, but the whole-body vibration was more effective than weight bearing aerobic exercises.

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“…In clinical studies, the two conditions, displaying different equilibria, must not be aggregated and have to be analysed separately for the results to be informative on LT4 treatment. A failure to discriminate between subclinical and overt thyroid dysfunctions relates any study outcomes to the case mix rather than thyroid function, severely limiting the information contributed by a plethora of studies that have measured TSH only and reported on associated cardiovascular or bone risk 2,170,171. The dissociation between TSH and FT4 in predicting atrial fibrillation in euthyroid subjects has already been discussed earlier.…”

Section: Adverse Drug Effectsmentioning

confidence: 99%

“…Despite their apparent failure to account for collider stratification bias, numerous studies associating TSH concentrations with adverse treatment-related outcomes may still contribute epidemiological data and provide valuable information in relation to a population 2,3,169–171,183. However, conflicting and irreproducible results may be expected, depending on the respective patient mix aggregated in the study 10.…”

Section: Adverse Drug Effectsmentioning

confidence: 99%

Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options

Hoermann¹,

Midgley²,

Larisch³

et al. 2019

DIC

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Levothyroxine (LT4) therapy has a long history, a well-defined pharmacological profile and a favourable safety record in the alleviation of hypothyroidism. However, questions remain in defining the threshold for the requirement of treatment in patients with subclinical hypothyroidism, assessing the dose adequacy of the drug, and selecting the best treatment mode (LT4 monotherapy versus liothyronine [LT3]/LT4 combinations) for subpopulations with persisting complaints. Supplied as a prodrug, LT4 is enzymatically converted into the biologically more active thyroid hormone, triiodothyronine (T3). Importantly, tetraiodothyronine (T4) to T3 conversion efficiency may be impaired in patients receiving LT4, resulting in a loss of thyroid-stimulating hormone (TSH)-mediated feed-forward control of T3, alteration of the interlocking equilibria between serum concentrations of TSH, free thyroxine (FT4), and free triiodothyonine (FT3), and a decrease in FT3 to FT4 ratios. This downgrades the value of the TSH reference system derived in thyroid health for guiding the replacement dose in the treatment situation. Individualised conditionally defined setpoints may therefore provide appropriate biochemical targets to be clinically tested, together with a stronger focus on clinical presentation and future endpoint markers of tissue thyroid state. This cautionary note encompasses the use of aggregated statistical data from clinical trials which are not safely applicable to the individual level of patient care under these circumstances.

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Is Partial or Total Thyroidectomy Associated with Risk of Long‐Term Osteoporosis: A Nationwide Population‐Based Study

Abstract: Thyroidectomy significantly increased the long-term risk of OP. Younger patients, women, patients with comorbidities, and patients receiving chronic thyroxin treatment should be monitored for changes in postoperative bone density.

Cited by 17 publications

References 30 publications

TSH suppressive therapy and bone

TSH suppressive therapy and bone

Weight bearing aerobic exercises versus whole body vibration on bone mineral density post thyroidectomy

Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options

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