Low BMI and low TSH value as risk factors related to lower bone mineral density in postmenospausal women under levothyroxine therapy for differentiated thyroid carcinoma.

Thaís Gomes De Melo,Denise Engelbrecht Zantut-Wittmann,Allan De Oliveira Santos,Lígia Vera Montalli Da Assumpção

doi:10.1186/s13044-015-0019-1

Thaís Gomes De Melo, Denise Engelbrecht Zantut-Wittmann + Show 2 more

Open Access

https://doi.org/10.1186/s13044-015-0019-1

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Journal: Thyroid Research	Publication Date: Jun 2, 2015
Citations: 33	License type: CC BY 4.0

Affiliation: Universidade Estadual de Campinas

Abstract

ObjectiveTreatment of differentiated thyroid carcinoma (DTC) includes suppression of TSH with levothyroxine therapy, which may negatively influence bone mineral density (BMD), but the effects are controversial. We aimed to evaluate the relationship between TSH-suppressive therapy and BMD in postmenopausal women with DTC.MethodologyCross-sectional study that assessed BMD by densitometry and risk factors for decreased BMD in 109 postmenopausal women under TSH-suppressive therapy for DTC, compared to an age-matched euthyroid women control group. Conditions that might have affected BMD were exclusion criteria.ResultsPatients were 58.4 ± 8.3 years-old, mean serum TSH was 0.21 ± 0.28μIU/ml. In BMD evaluation, T-scores were −1.09 ± 1.43 SD (lumbar spine) and −0.12 ± 1.18 SD (total femur). No significant differences were found between lumbar or femoral T-scores of patients and control group. Multivariate logistic regression analysis evidenced that low BMI and low mean TSH levels (assessed in the year of BMD measurement) were factors significantly related to lower lumbar and spinal BMD.ConclusionAlthough low TSH levels and low BMI were correlated with lower BMD, it was not observed an increased prevalence of osteopenia or osteoporosis in this cohort of post-menopausal women under levothyroxine treatment for DTC, when compared to age-matched control women. Nevertheless, such risk factors should be carefully observed in individual patients at high risk of decrease in BMD.

Highlights

Suppression of thyroid-stimulating hormone (TSH) with supraphysiological doses of levothyroxine (LT4) is one component of the treatment of differentiated thyroid carcinoma (DTC), after surgery and radioiodine therapy, aiming to reduce the risk of tumor recurrence [1]
Multivariate logistic regression analysis evidenced that low body mass index (BMI) and low mean TSH levels were factors significantly related to lower lumbar and spinal bone mineral density (BMD)
After signing the informed consent form, patients were surveyed in order to assess risk factors that could be associated to low BMD, according to the National Osteoporosis Foundation [12] and the World Health Organization (WHO) guidelines [14]

Summary

Introduction

Suppression of thyroid-stimulating hormone (TSH) with supraphysiological doses of levothyroxine (LT4) is one component of the treatment of differentiated thyroid carcinoma (DTC), after surgery and radioiodine therapy, aiming to reduce the risk of tumor recurrence [1]. Guidelines for TSH suppression therapy in the treatment of DTC have changed, due to the excellent. Published data about the implications of TSH suppression on BMD in patients with DTC are conflicting [2]. In postmenopausal women, several authors have reported a negative effect of long-term TSH suppressive treatment on the BMD of patients with DTC [4,5,6,7], while other studies have not confirmed such negative effect [8,9,10,11]. We have not found studies with definite results about the correlation of TSH suppressive therapy for DTC and osteoporosis or osteopenia in post-menopausal women [13]

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Conclusion