Ann Surg Treat Res.  2014 Feb;86(2):55-60. 10.4174/astr.2014.86.2.55.

Bone mineral density and bone turnover markers in patients on long-term suppressive levothyroxine therapy for differentiated thyroid cancer

• Lee MY
• Park JH
• Bae KS
• Jee YG
• Ko AN
• Han YJ
• Shin JY
• Lim JS
• Chung CH
• Kang SJ

• KMID: 1908498
• DOI: http://doi.org/10.4174/astr.2014.86.2.55

Abstract

PURPOSE
Current management for patients with differentiated thyroid cancer includes near total thyroidectomy and radioactive iodine therapy followed by administration of supraphysiological doses of levothyroxine (L-T4). Although hyperthyroidism is a well known risk factor for osteoporosis, the effects of L-T4 treatment on bone mineral density (BMD) in patients with thyroid cancer do not appear to be as significant as with endogenous hyperthyroidism. In this study, we evaluated the impact of long-term suppressive therapy with L-T4 on BMD and bone turn over markers in Korean female patients receiving L-T4 suppressive therapy.
METHODS
We enrolled 94 female subjects (mean age, 50.84 +/- 11.43 years) receiving L-T4 after total or near total thyroidectomy and radioactive iodine therapy for thyroid cancer (mean follow-up period, 12.17 +/- 4.27 years). The subjects were divided into three groups by thyroid stimulating hormone (TSH) level (group 1 with TSH level < or =0.001 microIU/mL, group 2 with TSH level between 0.001 and 0.17 microIU/mL, group 3 with TSH level >0.17 microIU/mL) and four groups by quartile of free T4 level. L-T4 dosage, BMD (examined by dual-energy x-ray absorptiometry), and bone turnover markers were evaluated according to TSH and free T4 levels.
RESULTS
No significant decrease was detected in BMD or bone turnover markers according to TSH level or free T4 level. Also, the prevalence of osteoporosis and osteopenia was not different among groups.
CONCLUSION
Long-term L-T4 suppressive therapy after thyroid cancer management did not affect bone density or increase the prevalence of osteoporosis even though TSH levels were supraphysiologically suppressed.

Keyword

Thyroid neplasms; Levothyroxine; Bone mineral density; Osteoporosis; Osteopenia

MeSH Terms

Bone Density*
Bone Diseases, Metabolic
Female
Follow-Up Studies
Humans
Hyperthyroidism
Iodine
Osteoporosis
Prevalence
Risk Factors
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy
Thyrotropin
Thyroxine*
Iodine
Thyrotropin
Thyroxine

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