Abstract
This study investigated the effect of long-term treatment upon bone density with L-Thyroxine in postmenopausal women compared with untreated postmenopausal women with climacteric symptoms. We measured spinal bone density in three groups (n=84) of postmenopausal women: (A) those treated with TSH-suppressive dosis of L-Thyroxine for a medium of 5 years after removal of thyroid cancer; (B) those on L-Thyroxine treatment for a median of 9 years after being diagnosed with chronic lynfocitic thyroiditis (CLT); and (C) those with no thyroid disease or other known pathology and without any treatment. There were no differences in dietary calcium intake and daily activity between untreated and L-Thyroxine-treated women. Measurements of bone mineral density were performed at spine level L1–L4 using a dual X-ray densitometer and serum thyroid-stimulating hormone (TSH), thyroid hormones, and bone markers (serum osteocalcin, procollagen I, urinary calcium), and PTH levels were assayed and found to be within normal ranges. Women receiving L-Thyroxine after thyroid cancer had slightly higher FT4 levels compared with women who had CLT and lower TSH levels, with serum T4 and T3 levels normal and similar in both groups. No significant differences were found in spinal bone density after L-Thyroxine treatment between Groups A and B and compared with Group C. Bone loss according to 2 SD below reference standards (age and sex matched) was found in the 12.9% of L-Thyroxine-treated patients versus 22.6% of untreated women. No correlation was found between bone loss and thyroid hormone levels and duration of treatment. Our data suggest that long-term L-Thyroxine therapy in postmenopausal women maintaining near physiological levels of thyroid hormones is not associated with significant axial bone loss, therefore other factors should be considered when this occurs.
Similar content being viewed by others
References
Smith DA, Fraser SA, Wilson GM (1973) Hyperthyroidism and calcium metabolism. Metabolism 2:332–354
Linde J, Friss T (1979) Osteoporosis in hyperthyroidism estimated by photon absorptiometry. Acta Endoctinol 91:437–448
Baran DT, Braverman LE (1991) Thyroid hormone and bone mass. J Clin Endocrinol Metab 72:1182–1183
Whitcroft SIJ, Stevenson JC (1992) Hormone replacement therapy: risk and benefits. Clin Endocrinol 35:15–20
Chabert-Orsini V, Conte Debolx B, Thiers-Bautrant, Atlan-Gepner C, Denizot A, Audiffret J, Henry JF, Codaccioni JL (1990) Densité osseuse après thyrotoxicose iatrogène infraclinique au long cours. Press Méd 19/37:1709–1711
Greenspan S, Greenspan FS, Resnick NM, Block JE, Friedlander AL, Genant HK (1991) Skeletal integrity in premenopausal and postmenopausal women receiving long-term L-Thyroxine therapy. Am J Med 91:5–14
Gam AN, Jensen GF, Hasseltron K, Osen M, Nielsen KS (1991) Effect of thyroxine therapy on bone metabolism in substituted hypothyroid patients with normal or suppressed levels of TSH. J Endocrinol Invest 14:451–455
Franklin JA, Betteridge J, Daykin J, Holder R, Oates GD, Parle JV, Lilley J, Heath DA, Sheppard MC (1992) Long-term thyroxine treatment and mineral density. Lancet 340:9–13
McDermott MT, Kidd GS, Blue P, Ghaed V, Hofeldt FD (1983) Reduced bone mineral content in totally thyrectomized patients: possible effect of calcitonin deficiency. J Clin Endocrinol Metab 56:936–939
Ross DS, Neer RM, Ridgway EC, Daniels GH (1987) Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with L-Thyroxine. Am J Med 82:1167–1170
Stall GM, Harris S, Sokoll JL, Dawson-Hugues B (1990) Accelerated bone loss in hyperthyroid patients overtreated with L-Thyroxine. Ann Intern Med 82:1167–1170
Adlin EV, Maurer AH, Marks AD, Channick BJ (1991) Bone mineral density in postmenopausal women treated with L-Thyroxine. Am J Med 90:360–366
Kung AWC, Pun KK (1991) Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine. JAMA 265:2688–2691
Diamond T, Nery L, Hales I (1991) Suppressive doses of thyroxine significantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab 72:1184–1188
Lehmke J, Bogner U, Felsenberg D, Peter H, Schleusener H (1991) Determination of bone mineral density by quantitative computed tomography absorptiometry in subclinical hyperthyroidism: a risk of early osteopenia in postmenopausal women. Clin Endocrinol 36:511–517
Bauer DC, Black DM, Ashby MA, Cummings SR (1993) Thyroid function and bone mass of the hip in postmenopausal women. In: Christiansen C, Riis B (eds) Proc 1993, 4th. Int. Symp. on Osteoporosis and Consensus Development Conference, Hong Kong. Handelstrykkeriet Aalborg ApS, Denmark, p 170
Seeman E, Wahner H, Offord KP, Kumar R, Johnson WJ, Riggs BL (1982) Differential effects of endocrine disfunction on the axial and the appendicular skeleton. J Clin Invest 69:1302–1309
Diez Curiel M, Castro N, on behalf of the Proyecto Multicentrico de Investigación, Madrid (1992) Bone mineral density in the Spanish population measured by dual x-ray absortiometry (DEXA). Bone Miner 17 (suppl) 133 (A)
Krolner B, Vertebral J, Nielsen SP (1983) Spinal bone mineral content in myxoedema and thyrotoxicosis. Effect of thyroid hormones and antithyroid treatment. Clin Endocrinol 33:143–153
Ribot C, Tremollier F, Poullies JM, Pouvet JP (1990) Bone mineral density and thyroid hormone therapy. Clin Endocrinol 33: 143–153
Paul TL, Kerrigan J, Kelly AM, Braverman, Baran DT (1988) Long-term L-Thyroxine therapy is associated with decreased bone density in premenopausal women. JAMA 259:3137–3141
Eurly F, Bauduceau B, Lechevalier D (1992) Bone density in differentiated cancer of the thyroid gland treated by hormone suppressive therapy. Study based on 51 cases. Rev Rhum Mal Osteoartic 59:247–252
Garton MJ, Murchison LE, Reid IW, Reid DM (1993) Bone mineral density in premenopausal women taking L-Thyroxine replacement therapy. Calcif Tissue Int 52:177(A)
Naessen T, Persson I, Ljunghall S, Bergstrom R (1992) Women with climacteric symtoms: a target group for prevention of rapid bone loss and osteoporosis. Osteoporosis Intern 2:225–231
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hawkins, F., Rigopoulou, D., Papapietro, K. et al. Spinal bone mass after long-term treatment with L-Thyroxine in postmenopausal women with thyroid cancer and chronic lymphocytic thyroiditis. Calcif Tissue Int 54, 16–19 (1994). https://doi.org/10.1007/BF00316283
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00316283