The Negative Correlation between Thyrotropin Receptor–Stimulating Antibodies and Bone Mineral Density in Postmenopausal Patients with Graves’ Disease

Amashukeli, M; Korinteli, Maka; Zerekidze, T; Jikurauli, Nino; Shanava, Shorena; Tsagareli, Marina; Giorgadze, Elen

doi:10.2310/jim.0b013e31828fcafb

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…Bone mineral density was restored after successful stabilization of hyperthyroidism and the investigators concluded that the presence of TRAb could be a good marker of bone impairment during the hyperthyroid phase of Graves' disease. 27 In our investigation, TPOAb were found to be strongly linked with increased risk of any type of fractures, independently of TSH values. Women in whom TPOAb are present have lower BMD at the cytokines that also contribute to bone damage by potentiating the effects of RANK-RANKL signaling.…”

Section: Discussionsupporting

confidence: 48%

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

Polovina

Miljić

Zivojinović³

et al. 2017

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ObJeCTIVe: Skeletal development, linear growth, cartilage biology and bone turnover are highly dependent on the activity of thyroid hormones. Thyroid dysfunction affects the skeleton, and autoimmune thyroid disease, manifesting as a chronic inflammatory condition, may be an important contributing factor to impaired bone quality in these patients. MATeRIAlS AND MeTHODS: Measurement of TSH, FT4, TPOAb and bone mineral density and FRAX score calculations were performed in 189 postmenopausal women (110 euthyroid women and 79 women diagnosed with subclinical hypothyroidism) divided into subgroups according to the presence of TPOAb. ReSUlTS: In multivariate logistic regression analysis only TPOAb were found to be significantly related to fracture, independently of TSH values (p=0.018; OR=7.800; 95% CI 1.424-42.721). Lower bone mineral density and FRAX score for hip and for major osteoporotic fractures were associated with the presence of TPOAb in euthyroid postmenopausal women in an unadjusted logistic regression model, as well as in a model adjusted for age, bMI and smoking. TSH was a better predictive factor for fractures in women with subclinical hypothyroidism (FRAX main p <0.001; 95% CI for SE 0.858-0.959 and FRAX hip p <0.001; 95% CI for SE 0.628-0.854). CONCLUSION: Autoimmune thyroid disease is associated with decreased bone mineral density at both spine and hip and risk of future fracture incidence in euthyroid postmenopausal women. Presence of TPOAb is a potential marker of higher fracture risk in these patients. However, in subclinical hypothyroidism, TSH is a better indicator of future fragility fractures than TPOAb.

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Section: Discussionsupporting

confidence: 48%

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

Polovina

Miljić

Zivojinović³

et al. 2017

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“…Considering that the large portions of these patients still have TSH stimulating antibodies after reaching the remission status, the activated TSHR signaling might play a role in hyperthyroidism-related bone disease. Indeed, it has been reported that TSH stimulating antibody levels are positively correlated with bone turnover marker levels and negatively correlated with bone mineral density [ 25 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves’ Disease

et al. 2015

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Osteoporosis-related fractures are one of the complications of Graves’ disease. This study hypothesized that the different actions of thyroid-stimulating hormone receptor (TSHR) antibodies, both stimulating and blocking activities in Graves’ disease patients might oppositely impact bone turnover. Newly diagnosed premenopausal Graves’ disease patients were enrolled (n = 93) and divided into two groups: patients with TSHR antibodies with thyroid-stimulating activity (stimulating activity group, n = 83) and patients with TSHR antibodies with thyroid-stimulating activity combined with blocking activity (blocking activity group, n = 10). From the stimulating activity group, patients who had matched values for free T4 and TSH binding inhibitor immunoglobulin (TBII) to the blocking activity group were further classified as stimulating activity-matched control (n = 11). Bone turnover markers BS-ALP, Osteocalcin, and C-telopeptide were significantly lower in the blocking activity group than in the stimulating activity or stimulating activity-matched control groups. The TBII level showed positive correlations with BS-ALP and osteocalcin levels in the stimulating activity group, while it had a negative correlation with the osteocalcin level in the blocking activity group. In conclusion, the activation of TSHR antibody-activated TSH signaling contributes to high bone turnover, independent of the actions of thyroid hormone, and thyroid-stimulation blocking antibody has protective effects against bone metabolism in Graves’ disease.

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“…Simultaneously, previous studies have confirmed that TRAb plays a very important role in bone metabolism. These studies, conducted on both males and pre- or postmenopausal women, have consistently found a negative correlation between TRAb titers and bone mineral density [ 22 – 24 ]. Moreover, Kumeda et al [ 25 ] have reported a close association between TRAb and bone metabolic markers in Graves' disease.…”

Section: Discussionmentioning

confidence: 99%

Association between thymic hyperplasia and serum calcium level in Graves’ disease

Zeng,

Li,

Wei

2024

BMC Endocr Disord

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Background Graves' disease increases bone resorption in hyperthyroidism, leading to elevated serum calcium levels and a negative bone balance. Thymic hyperplasia is observed in some Graves' disease patients. What's more, there have been a few reports of increased serum calcium and severe osteoporosis induced by Graves’ disease with thymic hyperplasia. It remains unclear whether Graves’ disease with thymic hyperplasia is associated with higher serum calcium levels. Our study aimed to investigate the possibility of elevated serum calcium levels and aggravated bone mobilization in Graves’ disease patients with thymic hyperplasia. Methods Newly diagnosed and untreated patients with Graves' disease (n = 96) were enrolled. They were divided into two groups based on the incidental detection of thymic hyperplasia during imaging. Albumin, alkaline phosphatase, calcium, free triiodothyronine, free thyroxine, thyroid-stimulating hormone, and thyrotrophin receptor antibody (TRAb) were measured, and a computerized tomography of the chest was obtained. Results Patients with Graves’ disease who had thymic hyperplasia were notably younger (P=0.018) and exhibited higher serum calcium levels (P=0.001) compared to those with Graves’ disease without thymic hyperplasia. In the multiple regression analysis, thymic hyperplasia, TRAb, and female gender were significant variables associated with elevated serum calcium levels in patients with Graves' disease, collectively accounting for 31.7% of the variation in serum calcium. Conclusions Graves’ disease patients with thymic hyperplasia showed higher serum calcium levels. thymic hyperplasia, TRAb, and female gender were found to be correlated with increased serum calcium levels in Graves’ disease, suggesting a potential association between thymic hyperplasia and bone mobilization in Graves’ disease.

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The Negative Correlation between Thyrotropin Receptor–Stimulating Antibodies and Bone Mineral Density in Postmenopausal Patients with Graves’ Disease

Cited by 6 publications

References 36 publications

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

The impact of thyroid autoimmunity (TPOAb) on bone density and fracture risk in postmenopausal women

The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves’ Disease

Association between thymic hyperplasia and serum calcium level in Graves’ disease

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