Thyroid hormone treatment aiming at reduced, but not suppressed, serum thyroid‐stimulating hormone levels in nontoxic goitre: effects on bone metabolism amongst premenopausal women

Knudsen, Nils; Faber, Jens; Sierbaek-Nielsen, A; Vadstrup, S; Ha, Sørensen

doi:10.1046/j.1365-2796.1998.00258.x

Cited by 22 publications

(15 citation statements)

References 17 publications

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“…This is in agreement with the well-known enhanced bone turnover in subclinical hyperthyroidism, both exogenous (due to T 4 treatment) and endogenous (21). However, no difference was found in the PINP levels of patients on T 4 vs T 3 monotherapy (12). It is not clear whether our findings are beneficial to bone heath.…”

Section: Discussionsupporting

confidence: 86%

“…Treating nontoxic goiter patients with small doses of T 4 or T 3 as a once daily regimen for a similar and a modest reduction in TSH levels without inducing overt hyperthyroidism resulted in increased PINP levels (12). This is in agreement with the well-known enhanced bone turnover in subclinical hyperthyroidism, both exogenous (due to T 4 treatment) and endogenous (21).…”

Section: Discussionsupporting

confidence: 80%

“…We measured SHBG, PINP, and NT-proBNP as all these markers have been shown to be sensitive parameters of changes in peripheral thyroid hormone action. SHBG levels reflected stimulation of hepatic function (11), PINP levels reflected a stimulation of collagen production during bone formation (12), and NT-proBNP levels reflected the direct stimulation of cardiomyocytes (13, 14).…”

Section: Discussionmentioning

confidence: 99%

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Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study

Schmidt

Nygaard

Jensen

et al. 2013

Endocrine Connections

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BackgroundA recent randomized controlled trial suggests that hypothyroid subjects may find levothyroxine (l-T4) and levotriiodothyronine combination therapy to be superior to l-T4 monotherapy in terms of quality of life, suggesting that the brain registered increased T3 availability during the combination therapy.HypothesisPeripheral tissue might also be stimulated during T4/T3 combination therapy compared with T4 monotherapy.MethodsSerum levels of sex hormone-binding globulin (SHBG), pro-collagen-1-N-terminal peptide (PINP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) (representing hepatocyte, osteoblast, and cardiomyocyte stimulation respectively) were measured in 26 hypothyroid subjects in a double-blind, randomized, crossover trial, which compared the replacement therapy with T4/T3 in combination (50 μg T4 was substituted with 20 μg T3) to T4 alone (once daily regimens). This was performed to obtain unaltered serum TSH levels during the trial and between the two treatment groups. Blood sampling was performed 24 h after the last intake of thyroid hormone medication.ResultsTSH remained unaltered between the groups ((median) 0.83 vs 1.18 mU/l in T4/T3 combination and T4 monotherapy respectively; P=0.534). SHBG increased from (median) 75 nmol/l at baseline to 83 nmol/l in the T4/T3 group (P=0.015) but remained unaltered in the T4 group (67 nmol/l); thus, it was higher in the T4/T3 vs T4 group (P=0.041). PINP levels were higher in the T4/T3 therapy (48 vs 40 μg/l (P<0.001)). NT-proBNP did not differ between the groups.ConclusionsT4/T3 combination therapy in hypothyroidism seems to have more metabolic effects than the T4 monotherapy.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study

Schmidt

Nygaard

Jensen

et al. 2013

Endocrine Connections

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“…35,36 If treatment is aimed at reduced but not totally suppressed TSH values, there is less effect on the skeleton. 37 Overall, the consequences of low level subclinical thyroid disease (serum TSH 0.1-0.45 mU/L) seem to be minimal, and there is insufficient evidence 38,39 to support complications, except in pregnant women, women older than 60 years, and others with cardiovascular morbidity. 40 By contrast, there was fair-to-good evidence for increased cardiac manifestations among patients with serum TSH levels below 0.10 mIU/L, although the evidence for bone alterations in these patients was less impressive.…”

Section: Discussionmentioning

confidence: 99%

Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis

Yousef

Clark

Doi

2010

Clinical Medicine & Research

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Levothyroxine (LT4) suppressive therapy for solitary thyroid nodules is not popularly advocated presently because its clinical efficacy and safety are currently considered controversial. This metaanalysis aims to address efficacy issues by using rigorous methods to arrive at a pooled estimate. On the basis of the analysis, it is estimated that LT4 therapy is clearly associated with up to a two-fold increase in the chance of nodule reduction. This translates to a number needed to treat (NNT) of 6 or a 50% decrease in the risk of cancer given nodule reduction. Keeping this definition of efficacy in mind and a low incidence of adverse events with low level LT4 suppression, such an intervention might be appropriate in patients selected on the basis of a low risk for adverse effects. The natural history of thyroid nodules suggests that a third of benign nodules will spontaneously grow to more than 15% of its initial size within one year and this increases to almost all (89%) at five years if these nodules are not treated somehow. 1 The majority of growth has been found in those nodules that have a more solid component. Although the pathogenesis of such growth is poorly understood, thyroid-stimulating hormone (TSH) is presumed to be necessary if not sufficient, and therefore suppression of TSH secretion might be expected to result in a decrease in nodule size or at least prevent any further enlargement.Benign solitary nodules detected by physical examination represent two different pathological processes. In many of these patients, the palpated nodule could simply be the dominant nodule of a multinodular goiter while other solitary nodules are probably true solitary adenomas. The latter can be distinguished by ultrasound and nonrandomized, uncontrolled trials have found that patients with solitary nodules had lesser decreases in nodule size in response to thyroxine therapy than patients with nontoxic diffuse or multinodular goiters.2 Of the randomized trials that have been published, the majority demonstrated some degree of efficacy of thyroxine therapy for solitary thyroid nodules. Meta-analyses of these trials was first attempted in 1998 and showed a reduction in thyroid solitary nodule volume in 17% of patients treated with levothyroxine and inhibition of nodule growth in another 10%.3 A second meta-analysis found that nodules decreased by more than 50% in more patients who received thyroxine therapy, but the treatment response did not reach statistical significance (relative risk [RR] 1.9; 95% confidence interval [CI] 0.9 to 3.8).4 Also, there have been concerns about subclinical hyperthyroidism in treated patients who may be at increased risk for atrial

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“…Stall i saradnici [21] nisu pronasli statisticki znacajnu razliku izmedu nivoa jonizovanog kalcijuma kod bolesnika na supstitucionoj terapiji tiroksinom sa normalnim i suprimiranim vrednostima TSH u odnosu na kontrolnu grupu zdravih za razliku od drugih autora [22]. Nalaz signifikantne razlike u nivoima jonizovanog kalcijuma ispitivane grupe pre i u toku terapije moze da ukaze na ubrzanje kostanog rnetabolizma u toku supstitucione terapije primarnog hipotiroidizma.…”

Section: Rezultatiunclassified

Bone metabolism during substitution therapy of primary hypothyroidism

Pejin

Ćurić²,

Kovacev-Zavisic

et al. 2009

Med pregl

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It can be concluded that physiological doses of l-thyroxine therapy accelerate bone metabolism in hypothyroid patients. Thus, the argument against bone loss during physiological substitution is highly specific mutual correlation between bone formation and resorption parameters. These assumptions require further investigations in long-term prospective studies in patients on replacement l-thyroxine therapy.

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Thyroid hormone treatment aiming at reduced, but not suppressed, serum thyroid‐stimulating hormone levels in nontoxic goitre: effects on bone metabolism amongst premenopausal women

Cited by 22 publications

References 17 publications

Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study

Peripheral markers of thyroid function: the effect of T4 monotherapy vs T4/T3 combination therapy in hypothyroid subjects in a randomized crossover study

Thyroxine Suppression Therapy For Benign, Non-Functioning Solitary Thyroid Nodules: A Quality-Effects Meta-Analysis

Bone metabolism during substitution therapy of primary hypothyroidism

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