Possible Limited Bone Loss with Suppressive Thyroxine Therapy Is Unlikely to Have Clinical Relevance

Müller, C.; Bayley, T. A.; Harrison, Joan E.; Tsang, Reginald C.

doi:10.1089/thy.1995.5.81

Cited by 57 publications

(55 citation statements)

References 34 publications

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“…A number of long-term safety issues surround THST, particularly in growing patients who are likely to receive the modality for a very long time (Muller et al 1995, Shapiro et al 1997, Horne et al 2004, Botella-Carretero et al 2004. Potential THST side effects may include osteoporosis (Schneider & Reiners 2003), and of special concern, cardiovascular complications, particularly ventricular hypertrophy (Biondi et al 1993, Fazio et al 1995, Matuszewska et al 2001).…”

Section: Goal Of Ablation Rationalementioning

confidence: 99%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

171

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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Section: Goal Of Ablation Rationalementioning

confidence: 99%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

171

160

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“…Some reports, including a meta-analysis by Wü ster (9), have suggested that the bone mineral density (BMD) is reduced in patients taking long-term treatment to suppress thyroid stimulating hormone (TSH) (levothyroxine, L-T 4 ) compared with controls (10-13). However, other studies have failed to confirm this decremental effect of L-T 4 treatment on BMD (14)(15)(16)(17) or on the prevalence of fracture (18,19). L-T 4 treatment that does not suppress TSH seems to have little effect on bone (20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

The effect of long-term, non-suppressive levothyroxine treatment on quantitative ultrasonometry of bone in women

Hadji

Hars²,

Sturm³

et al. 2000

European Journal of Endocrinology

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Objective: To evaluate the impact of long-term, non-suppressive levothyroxine (L-T 4 ) treatment on quantitative ultrasonometry in women.Design: This was a case-control study. Subjects and methods: Altogether 667 women (mean age Ϯ S.D., 49.5 Ϯ 13.1 years) were studied. Of these, 156 (23%) had non-toxic goitre or hypothyroidism and had been taking L-T 4 (75-100 mg/day) for at least 5 years (mean Ϯ S.D., 12.5 Ϯ 7.5 years); the remaining 511 (77%) women were not receiving L-T 4 . All women had completed a questionnaire on risk factors for thyroid dysfunction and osteoporosis, and those with diseases or treatments known to effect bone metabolism -other than thyroxine or hormone replacement therapy (HRT) -were excluded. Women underwent quantitative ultrasonometry (QUS) at the heel. Speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (SI) were compared, first, in all women taking L-T 4 and controls and, secondly, in women taking L-T 4 and controls pair-matched for age, weight, body mass index (BMI), menopausal status and HRT use. Results: Even after matching for age, weight, BMI, menopausal and HRT status, women taking L-T 4 had significantly lower values for SOS and SI (P < 0.05), but not for BUA. However, absolute T-and Z-scores for SI were not low in either the study or control groups. Lower values were associated, but not significantly so, with years since the menopause and duration of L-T 4 treatment. Conclusions: Long-term, non-suppressive L-T 4 treatment in women with goitre or hypothyroidism was associated with a slight reduction in QUS values, which was more pronounced in postmenopausal women. This group could be at higher risk for osteoporotic fracture.

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“…Rezente Studien versuchten eine weitere Differenzierung in Bezug auf die Dosierungen der suppL-T4-Medikation vorzunehmen. In der Studie von Müller et al [63] wurden bei 50 Frauen (25 mit Struma nodosa, 25 mit DTC) die Veränderungen der BMD im Vergleich zu einer euthyreoten Kontrollgruppe untersucht. Die mittlere L-T4 Tagesdosis …”

Section: Opg/rankl Und Schilddrüseunclassified

“…In der Studie von Toivonen et al [69] erhielten die Patienten 215 µg L-T4/d; ein Unterschied der BMD zwischen L-T4 therapierten Patienten und Kontrollpersonen konnte nicht festgestellt werden. In der Publikation von Müller et al [63] war die mittlere L-T4 Tagesdosis bei Strumapatientinnen 150 µg/d, bei Patientinnen mit DTC 230 µg/d. Nur bei Patientinnen mit DTC konnte ein gerade signifikanter BMD Verlust von 5 % an den Extremitäten erhoben werden.…”

Section: Bmd Und Knochenstoffwechsel In Abhängigkeit Der Tagesdosisunclassified

Auswirkungen von Schilddrüsenfehlfunktionen auf den Knochen

Mikosch

2005

Wien Med Wochenschr

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Interactions between thyroid hormones and the bone are complex and are still not fully understood. During development, thyroid hormone is essential for the recruitment and maturation of bone cells. A deficit of thyroid hormone during pregnancy and in the newborn leads to retardation of the skeleton. Hypothyroidism during later life causes a relevant decrease of bone turnover. Excessive amounts of thyroid hormone induce increased activity of osteoblasts and osteoclasts leading to high bone turnover and a loss of BMD, as the activity of osteoclasts predominates over the activity of osteoblasts. In subclinical hyperthyroidism, premenopausal women show no significant BMD loss, whereas postmenopausal women face a significant BMD loss. Men seem to have a limited, but significant bone loss in subclinical hyperthyroidism. Therapeutic consequences focus on the normalization of thyroid function, which can lead to restoration of BMD and normalization of bone turnover. In particular, patients on long-term suppressive L-thyroxine therapy or anti-thyroid drug medication benefit from additional antiresorptive treatment. This article surveys the complex interactions between thyroid hormones and bone cells and their effects on bone turnover, BMD and fractures according to the different states of thyroid function.

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Possible Limited Bone Loss with Suppressive Thyroxine Therapy Is Unlikely to Have Clinical Relevance

Cited by 57 publications

References 34 publications

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

The effect of long-term, non-suppressive levothyroxine treatment on quantitative ultrasonometry of bone in women

Auswirkungen von Schilddrüsenfehlfunktionen auf den Knochen

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