Changes of bone mineral density and bone metabolic marker in patients with subclinical hypothyroidism

[helvella]

Can someone please explain why medics are utterly obsessed with over-treatment causing lowered bone density. And completely ignore (or are unaware of) subclinical hypothyroidism being a cause? Indeed, even overt hypothyroidism!

Sichuan Da Xue Xue Bao Yi Xue Ban. 2014 Jan;45(1):66-9, 83.

[Changes of bone mineral density and bone metabolic marker in patients with subclinical hypothyroidism].

[Article in Chinese]

Liang LB1, Wang YJ2, Zhang M3, Huang HJ3, Li SQ1.

Abstract

OBJECTIVE:

To investigate the change of bone mineral density and bone metabolism biochemical markers in subclinical hypothyroidism.

METHODS:

This study included total 122 patients with subclinical hypothyroidism and 153 healthy age and gender matched people as control. All the patients and controls were subjected to the measurements of bone density by dual energy X-ray absorptiometry (DEXA), and serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), Ca2+, PO4(3+), alkaline phosphatase (ALP) levels. All the data was analyzed statistically with the stratification of gender and menopause status.

RESULTS:

Compared to the control, the patients with subclinical hypothyroidism had significantly higher incidence of bone mass loss (P < 0.005) and lower level of Serum Ca2+ (P < 0.05) and higher levels of serum PO4(3+), T-value and Z-value (P < 0.05). Furthermore, premenopausal women had higher Z-value (P < 0.01) , but no significantly differences of T-value, serum PO4(3+) was found either in pre-menopause or post-menopause women when compared to the control. Multiple linear regression analysis showed gender (B = 0.543, P < 0.0001) was positive correlation with T value, female had lower T values. Moreover, T value was negative correlated to menopausal status (B = -0.274, P = 0.001), age (B = -0.161, P < 0.0001) and TSH (B = -0.108, P < 0.0001).

CONCLUSION:

Subclinical hypothyroism appears decreased serum calcium and low bone density.

PMID: 24527585 [PubMed - in process]

ncbi.nlm.nih.gov/pubmed/245...

Rod

[Aurealis]

Thank you, this is the first I've heard of this!

[sisa1975]

This is very interesting. My mum saw her Endocrinologist yesterday and her Endo wants her to lower her daily Thyroxine dose because of her bad bone density test results. She also prescribed vitamin D. My mums latest TSH result was 0.65. Her FT4 was 10.0 (haven't got the range unfortunately). Her TSH nine months ago was 11.0 and her TSH six months before then was 4.32 . Her Endo keeps playing with her dose all the time, no wonder my poor mum is not feeling that great. I will tell my mum about this article. Thank you for sharing.

[helvella in reply to sisa1975]

I bet she didn't have regular bone density tests which would allow you to track the density against thyroid hormone levels and/or TSH. That, with suitable care and attention, might reveal the true picture.

Rod

[sisa1975 in reply to helvella]

I am not sure exactly what sort of scan she had but she called it densitometry. I only spoke to her on the phone. My mum lives abroad, she had it done at this clinic: novamed.sk/sluzba/1_39_53/d... . It was interesting that they prescribed Vitamin D based on the findings of this scan. She was told something about her calcium levels too. I will ask her for more details when I speak to her next.

[TSH110 in reply to helvella]

Rod I wonder how long it is before ones bones are affected by thyroid hormone levels/ensuing deficiencies is it weeks or months or years?

[helvella in reply to TSH110]

If I tried to answer,it would be a guess. I'd rather not do that and possibly mislead anyone who reads my response.

Nevertheless, it is a good question.

Rod

[TSH110 in reply to helvella]

Interesting. I was intrigued because about 5 yrs ago my ribs broke in a cycling accident and my ribs rebroke c 1 year back after doing some horrendously hard digging (the joys of being an archaeologist are manifold). Doc blamed my levo dose said I was hyper (I felt as close on it to how I was before being ill) and had spent most of the last 12 mths very seriously hypo with one quick bout of crazy hyper as my thyroid kicked the bucket. I had major hypo symptoms for many years before that too and only last 2 mths before rib refracture were hyper. My dose was reduced and I had a dexa scan 4 mths later, my bones were deemed as tough as a human can have.

Bar the ribs (I nutted the road at 20mph - something had to give!) I never broke anything. Without knowing how quickly bone density can be affected by thyroxine levels how can I (or the doc) know if the hypo or hyper was significant in the rebreak, if at all. I will see if I can find any info on it.

[shaws in reply to sisa1975]

This is also an extract from Dr Lowe re adjusting doses and go to the date January 25, 2002 to read the whole article:-

If the goal of a doctor is metabolic health for his patient, he has no scientific basis for adjusting her thyroid hormone dose by her TSH level. If the doctor is going to make the imprudent choice of treating the patient with T4 (rather than T3 or a T3/T4 combination), he should be aware of the relevant physiology and treat her on the basis of it. Otherwise, he's likely to ruin her health, as your doctor appears to be doing to yours.

web.archive.org/web/2010103...

[Hidden]

the **angs report..

IS this purely from being hypo? (with risk of low vital minerals like VitD/calcium & the other fab4)

OR/and from Levo treatment (which doesn't take into consideration probable low level/deficiency above)

As a control group (of one untreated for 3 years) this would point to deficiency due to effects of hypo not necessarily Levo treatment, but the latter would make things worse/not work if underlying low vital minerals were not taken into account.

I feel a sense of dejaVu.... (again brain fog) J x

[Ruby1]

Hmmm sitting here with a broken pelvis reading this and been wondering whether I should ask for my bone density to be checked! It was a ski accident, so plainly my treatment on levo works for me

If bone density tests involve x-rays, then that explains why they wouldn't want to expose us to too many of those, and actually I'm all for that.

Are you sure this is what that conclusion means? It doesn't mention treated subclinical. I would read it as saying that untreated people who seemed to be suffering from hypothyroid symptoms, but whose blood tests don't seem to show it, have lower bone density. But I am a novice. What exactly does subclinical mean? Sorry if I'm a bit dim!

[Holly10 in reply to Ruby1]

Get a DEXA bone density scan, it is a very safe and simple procedure. I am surprised you haven't been offered one if you have a broken pelvis. If nothing else it will be a base line you can measure future events against. Ignorance is not bliss.

Holly

[Hidden]

I assumed that my osteoporosis was caused by lying on the sofa for 4 years without any thyroxine and 6 years with insufficient thyroxine to function. Prior to those 10 years I had led an active life: walking, running, dancing, etc.

[hairyfairy]

I`m trying to get my doctor to refer me for a bone scan, but she doesn`t seem to think I`m at risk. I had a scan 12 years ago that was normal, but i just want to make sure that everythings all right now.

[morebeans]

Each time I see my (very nice and helpful) endo, he tells me he has to warn me that to continue with a very suppressed TSH (mine is <0.1) will lead to bone density problems. The trouble is, on my current mix of T3 and T4 I feel close to 'normal'. He said there's new evidence to support this, but I didn't think to ask him where to find this. Not sure that I could give up my current quality of life for the promise of better bones down the line as, without my T3, I wouldn't have the energy to use and appreciate them.

[Hidden in reply to morebeans]

He warns but has he offered a Dexa scan? J

[helvella in reply to Hidden]

Indeed!

If he said "too much thyroid hormone" it is possible he is right. If he says too little TSH, I have my doubts. And the two are not necessarily as linked as they often claim. There s far too little understanding of whether TSH itself has other effects than its direct control of thyroid hormone production/release by the thyroid.

[morebeans in reply to helvella]

He did say 'overly suppressed TSH' ; I'll ask him where to find the evidence he was referring to - he's always happy to discuss issues with me.

[morebeans in reply to Hidden]

No, but there was a fair bit of other stuff being discussed at the time. I think he's been quite careful about getting me checked out for other autoimmune diseases etc, and he totally gets the whole quality of life thing. I'll swot up a bit about scans so I can talk to him properly about it next time I see him.

[TSH110]

Even ct scans give a comparatively low dose of radiation.

[TSH110]

Gosh I am sorry Londinium I am completely wrong - I had been led to believe that convention X-rays for investigations like colonoscopy gave a higher dosage - but that is not so. You are right to be concerned about them and I am grateful to you for being better informed. I have learnt a lot from the expertise here. It seems MRI scans which don't involve X-rays are not always best for giving detail depending on what's being investigated. You have probably read it but this is very interesting from Scientific American:

scientificamerican.com/arti...

I only had ultrasound on my thyroid revealing it had shrivelled away. I was pretty worried cos my mother died of cancer in hers and a sister had it too - it was removed and she is ok.

[TSH110]

That is dreadful Londinium I admire your pluck in challenging all those super glib assumptions and refusing to be irradiated. Just by strange coincidence my mother was from Hyde and knew quite a few of Dr Shipman's victims, it was only the forged will of Kathleen Grundy, whom my mother was well acquainted with, on his typewriter that actually nailed him! Without that he might never have been caught. Trust me I'm a doctor....I don't think so!

[TSH110]

A psycho for sure! Do you think yours was bopping people off - it must have been pretty serious to get life. Is that your stomach they claim to have removed even thyroid fog could not let you forget that! I wonder whose notes they have mixed up with yours or have they been forged on a brother typewriter lol?! I shouldn't laugh - it is awful