New study: "Low bone mineral density is related to high physiological levels offT4 not to TSH levels below lower reference range."

[Hansaplatz]

I came across an interesting study in my weekly alerts from pubmed I have setup, that I should might be useful to some here and I couldn't see it already linked.

"Low bone mineral density is related to high physiological levels offT4 not to TSH levels below lower reference range."

ncbi.nlm.nih.gov/pubmed/243...

There's full text available - in Spanish? and English from what I can see - but I can only see it available for purchase for a pricy sum or via an instituion login. Anyhow, the summary etc is below. Please forgive the all caps but this is how it was written on their site:

"OBJECTIVETO DETERMINE WHETHER THYROID HORMONE (FT4) RATHER THAN THYROTROPHIN (TSH) IS DIRECTLY RELATED TO BONE MINERAL DENSITY (BMD).DESIGNCROSS-SECTIONAL POPULATION COHORT STUDY OF PERIMENOPAUSAL WOMEN.METHODSOF A SAMPLE OF 6846 PERIMENOPAUSAL DUTCH WOMEN WHO PARTICIPATED IN AN OSTEOPOROSIS SCREENING PROGRAM, A COHORT OF 2584 WAS RANDOMLY SELECTED FOR ASSESSMENT OF THYROID FUNCTION (TSH, FT4 AND THYROID PEROXIDASE ANTIBODIES, TPO-AB). TPO-AB POSITIVE WOMEN, WOMEN WITH A PREVIOUS HISTORY OF THYROID DYSFUNCTION, OVERT THYROID DISEASE, SUBCLINICAL HYPOTHYROIDISM, OSTEOPOROSIS OR BILATERAL OOPHORECTOMY, AND THOSE RECEIVING THYROID HORMONE OR HORMONE REPLACEMENT THERAPY, WERE EXCLUDED. OF 1477 ELIGIBLE WOMEN, 1426 HAD TSH AND FT4 WITHIN THE REFERENCE RANGE AND 51 HAD LOW OR UNDETECTABLE SERUM TSH. BMD WAS MEASURED AT THE LUMBAR SPINE AND LOW BMD WAS DEFINED AS 0.937G/CM2.RESULTSTHE MEAN BMD IN THE 51 WOMEN WITH LOW OR UNDETECTABLE SERUM TSH WAS 0.984 G/CM2 COMPARED TO 1.001 G/CM2 IN THE REMAINING 1426 (T=0.94, P=0.35). 33% OF WOMEN WITH LOW OR UNDETECTABLE SERUM TSH HAD LOW BMD COMPARED TO 34% IN 1426 EUTHYROID WOMEN. HIGH FT4 BUT NOT LOW TSH IN EUTHYROID WOMEN WAS RELATED TO LOW BMD BY MULTIPLE LOGISTIC REGRESSION CORRECTED FOR AGE, BMI AND SMOKING (OR: 1.30, 95% CI 1.02-1.69).ConclusionsHigher FT4 levels within the normal reference range but not low or undetectable serum TSH were independently related to decreased BMD at lumbar spine in perimenopausal women."

[roslin]

I wonder why they didnt include T3/

Roslin

[Hansaplatz in reply to roslin]

Not sure, it would have been nice to know if over range fT3 has an effect on bone density. It seems likely it will if high fT4 is associated that that will mean high fT3 for most people who don't have further problems like conversion failure but it would be much better to have actual proof one way or the other, all the facts as it were.

[helvella]

Hansaplatz,

I am very pleased to know you have a PubMed alert set up. I've had some for years and they produce a never-ending stream of information. Whilst I sometimes post a handful here, there are far too many to do them justice, and I could very well miss some of the very best and most interesting. As indeed is the case here - I either have not read the alert yet or went straight past without realising the significance. Thanks for posting.

Drat - usual paywall:

Pay per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00.

Does anyone have access? Although we cannot re-publish while papers here, a summary of the salient points would be very interesting to read.

Rod

[Hansaplatz in reply to helvella]

I got the alerts setup a long time ago. Admittedly a lot of studies go over my head, and generally the important ones I see you post, but I like to have a look at what comes out in order to glean whatever information I can about thyroid function and medication options.

No surprise that my alerts set for natural dessicated thyroid and armour never seem to turn anything up but I also have ones for triiodothyronine and hyperthyroid and hypothyroid which do usually have about 4-20 hits each week.

[nobodysdriving]

well, I am ok then as I have low fT4 and suppressed TSH with over the range fT3

jokes apart, I know I am ok as since started T3 therapy and having a suppressed TSH my bone density has 'improved significantly'

[Clarebear in reply to nobodysdriving]

*Like

I have mid range fT4 and suppressed TSH, so I should be find too xx

[sirmot in reply to nobodysdriving]

I was very encouraged to hear about your bone density improving, as I am on a combined T4/T3 therapy, which has also suppressed my TSH (0.01), though my T4 and T3 are in normal range. While I feel so much better with the combined treatment, I have been worried about my bone density, as I have osteopenia. I have not had a bone density scan since my TSH has been suppressed. Could you give more details about your bone density scans - how much it improved and over what period of time? Thanks!

[nobodysdriving in reply to sirmot]

sure Sirmot, I'll go and 'dig out' the reports and come back to reply here soon (within next hour). I have to say that I have also 'worked' on improving it anyway (ie in my case I take high dose vitamin D for example, which I need to keep my vit D >70 nmol/L )

[sirmot in reply to nobodysdriving]

thanks a lot for the trouble. I am also doing other things, like taking vit D and am also using natural progesterone, as well as calcium and magnesium. though I don't have my vit D as high as yours

[bantam12 in reply to sirmot]

Do be careful taking VitD, calcium and magnesium, that combination can send your calcium too high which is serious. A friend is currently suffering with hypercalcemia and magnesium toxicity because of the supplements, she is very unwell.

[sirmot in reply to bantam12]

Thank you very much for warning. I am having regular blood and urine tests to check calcium and magnesium levels, so I think I'm safe but will reduce my calcium anyway, based on the reply from nobodysdriving too and talk to my doctor.(private)

[bantam12 in reply to sirmot]

Go easy on the Vit D as well, hypercalcemia is horrible, I have it due to parathyroid disease, my Vit D level is on the floor and I also have osteopenia but I can't take supps because my calcium is high.

[Hidden in reply to bantam12]

I worry about folk taking calcium, isn't Vit D, mg and K2 enough? however parathyoid changes the equation, also calcitonin in NDT I believe - sorry trying to find out more about all this (as someone with abnormal calcium deposits would) J

[sirmot in reply to Hidden]

I have found that natural progesterone is very effective. It helped me in the past when I had much worse osteopenia. Now I have started using it again, together with my thyroid treatment. I would recommend John Lee's book on natural progesterone and other literature about this, in case you haven't tried that. good luck.

[sirmot in reply to bantam12]

Thank you hypohen. I will bear this in mind. I'm so sorry about your hypercalcemia. I hope it will get better. So what do you do for your osteopenia? Are you on thyroid medication as well?

[bantam12 in reply to sirmot]

As the treatment for osteopenia is calcium I am a bit stuck as I mustn't take calcium. The hypercalcemia will hopefully get better once I have had the Parathyroid surgery. Yes I'm on levo, have been hypo for many years after RAI for Graves.

[sirmot in reply to bantam12]

Have you looked into Strontium Citrate, recommended by nobodysdriving? From the reviews it sounds amazing, though I don't know if its suitable for your condition. It may be worth checking out. Calcium may not be the most important ingredient.

[nobodysdriving in reply to sirmot]

Hi Sirmot, here we are:

AP Spine L2-L4 BMD (g/cm2) 2011 is 0.954 T-score -2.0 Z Score -2.7

2013 is 1.046 T-score -1.3 Z Score -1.7

Dual Femoral Neck

Left BMD 2011 is 0.876 T-score -1.1 Z Score -1.4

2013 is 0.879 T-score -0.8 Z Score -0.9

Right 2011 is 0.888 T-score -0.8 Z Score -1.1

2013 is 0.947 T-score -0.3 Z Score - 0.4

My 2013 report says that there has been an improvement in Bone density in my spine of 9.6% (5.2% per year average), in my Left Hip of 3.9% (2.1 per year average) and Right Hip of 6.7% (3.6% per year average)

I had my 2011 Dexa in September 2011, diagnosed Hypo January 2012 and started meds then, gone onto T3 only in May/June 2012, Dexa N2 in September 2013 (after one year and 4 months of T3 only therapy and suppressed TSH since February 2012)

PS I never take any calcium, I was advised by my private doctor to STOP all calcium supplements and even stop all dairy products

[sirmot in reply to nobodysdriving]

Hi nobodysdriving,

Thanks a million for your detailed response. These are amazing results. Congratulations! I'm so happy to see that this is all possible with a suppressed TSH. I am extremely encouraged.

I have also noted what you said about the calcium. I don't take too much but will reduce it further and talk to the private doctor (functional medicine) who I see.

Thanks a again and wish you continued success with your treatment.

[nobodysdriving in reply to sirmot]

you're welcome, good luck

PS My endo was 'speechless' when he saw the above results, I don't think he could believe what he was seeing LOL

[sirmot in reply to nobodysdriving]

I'm not surprised at your endo's reaction. these are incredible results!

btw - what else did you take and do other than vit D?

Also - have you ever checked your liver enzymes? I have found that my liver enzymes are increasing as I increase my T4/T3 dosage, although I am drinking much less alcohol and very careful with diet. My T3 is still within the lower range of normal, though much improved. My T4 is also in the lower range, so it can't be that I have too much of them. I imagine it's because the liver has to process the hormones taken orally and is working harder, but would be very interested to hear if you have seen any change in your liver profile, if you've had it checked.

thanks a lot for the good wishes.

[nobodysdriving in reply to sirmot]

Hi, no, my liver enzymes remain normal, I get full blood works every 3 months or so (that is FBC, liver/renal/vitamin D/bone profile (includes calcium), parathyroid hormone, thyroid profile with fT3 etc) and everything is always fine.

I did take 'strontium citrate' regularly, I have stopped it in last 3 months, due to restart. I take this one: iherb.com/Doctor-s-Best-Str...

[sirmot in reply to nobodysdriving]

Hi, thanks. so maybe my liver enzymes are not connected to the thyroid medication. I need to look into this a bit more. I just read the reviews of strontium citrate. It sounds amazing. I will try that too. Thanks a lot for your help!

[sirmot in reply to nobodysdriving]

Hi again, I had one more question. Don't know where you are based but I was wondering if you would mind sharing the name and contact details of your endo, in case I decide to change mine. Yours sounds very good.