Osteoporosis in patients with subclinical hypothyroidism treated with thyroid hormone

Comorbidities possibly related to the fracture risk were identified in synthroid pastillas claims by the ICD-10 codes. Comedications such as corticosteroids, anti-coagulants, anti-epileptics, anti-depressants, benzodiazepines, proton pump inhibitors (PPI), and thiazolidinediones were considered potential risk factors for fracture. In contrast, bisphosphonates and raloxifene were considered protective factors against fracture 22. To evaluate the association between fracture risk and levothyroxine use in elderly women with hypothyroidism, according to previous osteoporosis history. Studies that analyzed the effect of subclinical hypothyroidism on lumbar spine bone mass density and femoral bone mass density.

Furthermore, our novel finding provides evidence for an association between the fracture risk and levothyroxine dosage, according to the osteoporosis status. Because some evidence shows that not everyone on levothyroxine has hypothyroidism—sometimes people with normal hormone levels take it for hypothyroidism symptoms—patients may want to review their diagnosis and treatment goals with their provider, Ghotbi said. As I’ve said for years, for many people, taking thyroid hormone replacement is barking up the wrong tree. You can chase the thyroid hormones ‘til the cows come home, including getting your dosing “adjusted” every few months, but “replacing” those hormones will do nothing for your immune system, leaving you chasing your tail, likely for years.

Thyroid Hormone Physiology

Osteoporosis (OP) is a skeletal disease characterized by reduced bone strength which predisposes to an increased risk of fracture. Bone density is expressed as grams of mineral per area or volume and in any given individual is determined by peak bone mass and the amount of bone loss. Bone quality refers to macro-and micro-architecture, bone turnover, size, accumulated damage (e.g. microfractures) and mineralization (1–3). There is no data in literature evaluating the fracture risk and the concentrations of bone turnover markers in premenopausal women treated with suppressive doses of levothyroxine by the reason of differentiated thyroid carcinoma. The main causes of hyperthyroidism are Graves’ disease, toxic multinodular goiter, and toxic adenoma (Table 1).

• Although an endogenous hyperthyroidism is a risk factor of secondary osteoporosis, the effects supraphysiological doses of levothyroxine on bone are still under discussion.
• The knockout of the thyroid hormone TRα gene results in delayed bone maturation, while the lack of all isoforms of TRβ has no effect on bone cells 18.
• The information on this website is not intended to diagnose, treat, cure, or prevent any disease or condition.
• These variables include nutrition, particularly calcium intake, delayed puberty, physical activity, a wide variety of intercurrent illnesses, and social factors such as low family income 2.

Hypothyroidism has controversial influence on bone metabolism but probably leads to increased fracture risk. The many studies reviewed above differed importantly in design, their populations, their durations and the indices of bone health measured, especially with regard to important clinical outcomes, such as fractures. In general, the use of LT4 to maintain euthyroid levels of thyroid hormones in patients with hypothyroidism, or even the use of TSH-suppressive therapy following removal of thyroid tumours, does not appear to carry a substantial risk of osteoporosis or fractures. Given that the loss of bone mass resulting from hyperthyroidism, is only partially reversible, it seems logical that we should treat this condition situation as soon as possible, if it is shown that it is altering the bone metabolism. However, in another study it has been confirmed that patients treated to maintain the euthyroid preserved bone density in the spine and hip, compared to untreated patients who suffered a 2% annual decline (19).

3. Effects of Thyrotropin-Suppressive Doses of Levothyroxine

Et al. observed a high prevalence of bone loss in patients treated with thyroxin.37 Vestergaard and Mosekilde studied 11,776 patients with hyperthyroidism and 4473 patients with hypothyroidism in terms of bone fracture. In hyperthyroid patients, the fracture risk was significantly increased only at the time of diagnosis, but after the diagnosis and treatment, fracture risk was reduced. Surgical treatment of hyperthyroidism reduces the risk of bone fractures, but fracture risk in hypothyroid patients both before and after diagnosis was significantly increased. They concluded that the risk of bone fractures in both hyperthyroidism and hypothyroidism are high.31 It seems that in adult patients with hypothyroidism, bone density increases but bone quality is poor, thus this may cause increased fracture risk in these patients.

Thyroid Hormone Diseases and Osteoporosis

• Without treatment, weight gain, fatigue, hair loss, and more serious complications can occur.
• No effect of prolonged L-T4 treatment on bone mass was observed in premenopausal women with reduced serum TSH in a meta-analysis report, whereas postmenopausal women with subclinical hyperthyroidism due to TSH-suppressive doses of L-T4 had reduced bone mass 80.
• A meta-analysis of 25 studies reported by Vestergaard 39 showed that BMD was decreased in untreated patients with hyperthyroidism, with an increased risk of hip fracture, which increases significantly with age.
• Secondly, some doctors know little to nothing about the importance of magnesium and bone health.

4Included patients who were diagnosed with osteoporosis, but were not prescribed bisphosphonate or raloxifene. 3Included patients who were diagnosed with osteoporosis and were prescribed bisphosphonate or raloxifene. 2Included patients who were diagnosed with osteoporosis, but were not prescribed bisphosphonate or raloxifene.

Subclinical hypothyroidism is defined as having an only an increased TSH level while the FT4 is in the normal range. As opposed to overt hypothyroidism, treatment with thyroid hormone in subclinical hypothyroidism is controversial. Most experts recommend treatment for subclinical hypothyroidism when TSH levels are above 7-10 mIU/ml.

Due to the hormonal and physiological dissimilarities and the differing nutritional needs of men and women, again, osteoporosis affects many more women than men. In fact, half of all women between the ages of show signs of osteopenia (low bone mass). Many women believe that they only need to be worried about this post-menopause given that the onset of “the change” causes bone loss to hasten due to decreased estrogen. But evidence indicates that osteoporosis can begin early in life and it’s yet another reason to feed ourselves and our children well, with lots of bone-strengthening, whole foods that will lay a foundation for a lifetime of structure. Many factors influence this process of bone replacement, including hormones, the amount of exercise you take and the amount of vitamin D and calcium in your diet.

Endogenous Subclinical Hyperthyroidism

The term osteoporosis, derived from Latin, literally means “porous bones.” It’s a progressive condition characterized by structural deterioration of bone tissue, which indeed, is living tissue. Bones become weaker and more brittle, making sufferers inordinately prone to fractures and causing marked changes in posture. The Royal Osteoporosis Society recommends a daily intake of 700mg of calcium for men and women, including pregnant women, or up to 1,000mg daily if you are on osteoporosis drug treatments.

The only exception to this rule is when treating patients on replacement after their thyroid is removed or destroyed secondary to cancer. In these cases, the amountof replacement given is greater, and results in a suppressionof TSH. If you have concerns about your bone density, you should speak with your physician about ways to assess your bone mass (a bone density test). In addition, you should seek out information on ways to maintain healthy bones such as calcium supplementation and weight bearing exercises.