Multiple Fractures in Patient with Graves' Disease Accompanied by Isolated Hypogonadotropic Hypogonadism

Abstract

Isolated hypogonadotropic hypogonadism (IHH) is known to decrease bone mineral density due to deficiency of sex steroid hormone. Graves' disease is also an important cause of secondary osteoporosis. However, IHH does not preclude the development of primary hyperthyroidism caused by Graves' disease, leading to more severe osteoporosis rapidly. Here, we describe the first case of 35-year-old Asian female patient with IHH accompanied by Graves' disease and osteoporosis-induced multiple fractures. Endocrine laboratory findings revealed preserved anterior pituitary functions except for secretion of gonadotropins and showed primary hyperthyroidism with positive autoantibodies. Sella magnetic resonance imaging showed slightly small sized pituitary gland without mass lesion. Dual energy X-ray absorptiometry revealed severe osteoporosis in lumbar spine and femur neck of the patient. Plain film radiography of the pelvis and shoulder revealed a displaced and nondisplaced fracture, respectively. After surgical fixation with screws for the femoral fracture, the patient was treated with antithyroid medication, calcium, and vitamin D until now and has been recovering fairly well. We report a patient of IHH with Graves' disease and multiple fractures that is a first case in Korea.

Changes in bone mineral density, 25‑hydroxyvitamin D3 and inflammatory factors in patients with hyperthyroidism

“…Of note, in this study, compared with the control group, it was demonstrated that the levels of FT3, FT4, TT3 and TT4 in the observation group were significantly increased, with significantly decreasing level of TSH, indicating that the thyroid function in patients with hyperthyroidism was abnormally enhanced. Moreover, the BMD in the observation group was significantly lower than that in the control group, which was in line with previous findings (14,15), indicating that in the case of excessive secretion of thyroid hormone, both the BMD and osteogenic function in the body are impaired. Importantly, in the observation group, the level of inflammatory factor IL-2 was significantly lower than that in the control group, while the levels of IL-6 and TGF-β were significantly higher, suggesting that the immune function of patients with hyperthyroidism is inhibited.…”

“…Hyperthyroidism is characterized as an endocrine disorder, which results in abnormality of hormone secretion and triggers various complications (13). In clinical practice, abnormal bone metabolism is found in patients with hyperthyroidism, and a majority of cases are accompanied with osteoporosis, thus it is proposed that hyperthyroidism is associated with bone mineral density (BMD) (14,15). In addition, hyperthyroidism is an autoimmune disease, and the immune function is impaired with abnormal secretion of inflammatory factors (16)(17)(18).…”

Evaluation of the rivastigmine role against botulinum toxin-A-induced osteoporosis in albino rats: A biochemical, histological, and immunohistochemical study

“…2 In addition, some diseases such as kidney diseases, endocrinal diseases, and anorexia may result in osteoporosis. 3,4…”

“…2 In addition, some diseases such as kidney diseases, endocrinal diseases, and anorexia may result in osteoporosis. 3,4 Clostridium botulinum bacteria is the source of production of botulinum toxin (BTX). It has seven toxin subtypes (A, B, C1, D, E, F, and G).…”