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Thyroid UK
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Thyroxine induced osteoporosis?

Hello,

I have Hashimotos Thyroidism, diagnosed decades ago and have been going along on Thyroxine quite happily. Suddenly my GP suggests I may be a little overmedicated and sends me for a DEXA (bone density scan). Results show I have osteoporosis! My GP believes thyroxine is the reason for the bone loss. I am due to see a endocrinologist in about 4 wks.

I am in my late 50's, female, and until last week considered myself fit, strong and healthy. I power walk at least 10 km daily, do weight training 3 times a week, abdominal work and stretching daily. Vit D ( i take a supplement) and Calcium levels tested as normal.

My blood test results are T4 20.3 (normal 19.0 - 25.0), T3 4.8 (normal 3.5 - 6.5), TSH 0.01 (normal 0.5 - 5.0) . My TSH has always been very low, but my doctor has never flagged it as an issue before. I need to try to reduce my dose of thyroxine, get the TSH into the normal range, without going hypo! I have dropped my dose slightly from 150 to 142 thyroxine daily.

Anyone else out there like me, with thyroid disease and osteoporosis, already exercising heaps anyway? I am already doing all the right things for bone health.

Thanks so much for any help, this diagnosis of osteoporosis really rocked my world, and not in a good way!

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Snap.

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Omg for years my Tash has been high as high as 125 when should be under .5 back now with endocrinologist have plasma test but main issue is bone issues calcification etc makes sense was at the stage I thought I had rhemitiod arthritis can’t walk without pain

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Tsh

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T4 20.3 (normal 19.0 - 25.0) Is this a typo? Should the reference interval read (normal 9.0 - 25.0)? 19.0 - 25.0 looks very unusual.

Whatever the fT4 reference interval is your fT4 and fT3 look very reasonable, your low TSH is inconsistent with your thyroid hormone levels and so I wouldn't pay too much attention to it. You would really need a DEXA scan taken when you start on levothyroxine to see if it is affecting your bones. It used to be thought that a suppressed TSH causes osteoporosis but the evidence is that this is not so unless the thyroid hormones are high. Other factors can affect bone loss in hypothyroid patients. These include femail hormone levels, a period of thyrotixicity before hypothyroidism is diagnosed and thyroid disorders affecting the parathyroids (these control bone metabolism).

You can try reducing your levothyroxine a touch and if you still feel fine then stay on the lower dose but I would not take a reduction that makes you feel bad. It's good you are going to see an endocrinologist, I would ask them to look for other causes of bone loss. Also point out that your TSH is very low for someone with normal fT4 and fT3.

Your fitness routine is remarkable, makes most of us tired just reading it! Would be interested to know the results of your DEXA scan, the T score and Z score. Also do you know your iron levels (ferritin)? Check if you are taking any medications that affect bone density.

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Thanks for your feedback. No that is not a typo, 19.0 to 25.0 is the reference range given. I am on no other medications, only thyroxine and Vit D. I have just started taking Vit K2.

My DEXA scores are spine T -2.11, Z -1.39, hip T -2.74, Z -1.81. My GP is convinced the very low TSH is to blame, but I will be interested to hear the endocrinologist's opinion. I am not really happy with my GP at the moment! As far as I know there is no history of osteo in my family.

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Have you checked out all the other supplements required for osteoporosis on Dr Myhills informative website ?

drmyhill.co.uk

What is your diet like ? How much VitD are you taking and what was your last result ? B12 also involved ....

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Don't freak out, your doctor doesn't have a clue.

TSH was never meant to be an indicator of anything other than being the pituitary signal to the thyroid for more hormone.

It is a mistake for doctors to use TSH the way they do. It is more a diagnostic tool to indicate whether more tests are needed for hypo or hyper conditions. TSH was most certainly never meant to be the end-all measurement by which to lower or stop a patient's treatment because of fear of osteoporosis -- or even that they may be "going hyper." It's ridiculous.

TSH should not be used when a patient has reached 1.5 or lower. It's of no use after that because "hyperthyroidism" is relative to the individual, not the numbers from TSH. Going by how the patient feels is usually good enough when relying on Free T4 and Free T3 (and sometimes Reverse T3 if warranted) -- but not on TSH.

I do believe the mistake as to why doctors panic when they see low TSH has been the confusion of the long-time known association between unchecked hyperthyroidism and osteoporosis. Someone made the leap between taking too much synthetic thyroid hormone and the same, and using TSH to record it. It's illogical.

Please read the following. Though written by a layperson (but well-known) who has learned much in her journey with the lack of adequate thyroid treatment, she cites recognized authorities on the subject of osteoporosis and long-term use of thyroid hormone:

thyroid-info.com/articles/o...

Excess thyroid hormone for an individual will manifest as symptoms of hyperthyroidism. That fact and how the patient feels will be sufficient indicators as to whether or not their current treatment is optimal. If assurance to that is needed, then the Free T4 and Free T3 will confirm. If those are not over range, then all is fine.

It is well known that those with unchecked hyperthyroidism (my Grave's went unchecked for ten years and it was full blown) have a higher likelihood of getting osteoporosis. That is because the tremendous excess of T3 in overt hyperthyroidism speeds up all functions in the body and therefore can cause breakdown in the bones. That is the thyroid condition that can cause bones to become weak and porous.

It is not excess T4 that does harm to the body, but the lack of understanding by doctors that all the T4 in the world won't produce adequate T3 in the cells if the patient cannot convert T4 to T3 effectively. They just keep pushing more and more T4. Overages of T4 become Reverse T3 (RT3) that block the cell receptors set for T3 to gain access.

Most conventional doctors believe the illusion that women who have been on higher doses of T4 thyroid hormone for long periods of time will be more prone to bone breaks and weak bones than those who have been on minimal T4 thyroid hormone. The logical conclusion should be that without ample T3 in the cells, the patient will be prone to a host of dysfunctions throughout the body: including osteoporosis. Whether too little T3 in the cells or too much T3... osteoporosis may not be far away.

But blaming it on too much T4 just doesn't make sense. If it does, then it means we truly need to treat with either Natural Desiccated Thyroid (NDT) which has natural T4 and T3, or we need to always treat with synthetic T3 when giving T4. Then it's less likely that a patient would need to be on high T4 doses. IF they really thought T4 was the problem.

wilsonssyndrome.com/bones-t...

That's all I need to know in order to tell my doctor to get into the 21st century and open some books. It's time they learn. They can't blame their ignorance on their medical school training anymore. Can't they see that what they do simply isn't helping their patients?

When doctors make the leap that low TSH is equal to excess thyroid hormones, they hurt us all. Too little T3 or too much T3 in the cells can make one prone to osteoporosis. A Sex Hormone Binding Globulin (SHBG) test could help prove to your doctor that perhaps you don't have excess thyroid hormone in your cells.

restartmed.com/shbg/

No worries with low TSH. It is commonly known that the healthiest people on the planet share a TSH that is less than 2.5 and ideally 1.0 or less. Organ damage beings at TSH of 2.0 Those who have thyroid dysfunction, most are happiest when their TSH is fully suppressed. It works for me. Had to figure it out myself. You can too. Be your best advocate for proper healthcare. Demand it.

I hope this helps you. Don't panic. I've been where you are and had no clue. Now I do.

Hugs!

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Well written! ⭐️

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It's important to point out too that excess T3 can speed up bone formation as well as breakdown. It speeds up all metabolic processes.

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Hi there Hillwoman, thank you so much for your reply.

You write truth, as it is well known that excess T3 in children will speed up bone maturation, as they are still growing. I've learned it is a bit different with adults, however the increased speed of excess T3 does still relate -- it's just affects adults differently. I found the manner in which this occurs as being quite interesting and hope you do as well:

"While hyperthyroidism during childhood enhances bone mineralization and accelerates epiphyseal maturation, in adults it induces bone loss by predominant activation of osteoclast activity."

courses.lumenlearning.com/n...

"In adults, T3 regulates bone turnover and bone mineral density. Overt hyperthyroidism is associated with accelerated bone remodeling, reduced bone density, osteoporosis, and an increase in fracture rate. The bone density changes may or may not be reversible with therapy. These changes in bone metabolism are associated with negative calcium balance, hypercalciuria, and rarely, hypercalcemia.

"

uptodate.com/contents/bone-...

Thus, normal euthyroid status is essential to maintain optimal bone strength.

But most times, returning a patient to "normal" (ugh!) euthyroid status is not achieved unless ensuring nutrient levels are optimized. This is a pitfall of conventional medicine. Their "normal" aka "within reference range" illogical way of measuring health has the opposite effect: it hurts progress by keeping those who have peripheral issues due to thyroid dysfunction (such as malabsorption causing nutrient deficiencies). Most of these things are never discovered because the "within reference range" mentality covers it up. They measure by TSH (which makes no sense whatsoever) to state that we're fine even when we know we are not. What's needed are Free T3, Free T4 and Reverse T3 (RT3 only when FT3 and FT4 don't seem to make sense).

To recap:

"Modeling primarily takes place during a bone's growth. However, in adult life, bone undergoes remodeling, in which resorption of old or damaged bone takes place on the same surface where osteoblasts lay new bone to replace that which is reabsorbed."

courses.lumenlearning.com/n...

Really amazing, what our body does, how it functions, and what it needs to keep functioning on an optimal level.

On another note, with what excess T3 does to all metabolic process, another issue comes to mind. Everyone knows how those with hyperthyroidism can lose tons of weight before realizing they are hyperthyroid. The problem comes when other systemic issues surface that impede weight loss even when hyperthyroid. One can gain weight when very overtly hyperthyroid due to havoc created in the body by estrogen dominance, high cortisol, nutrient deficiencies, and/or inflammation (or other interferences). Scientists have shown that the difference between being hypothyroid and hyperthyroid is very slight. Many of us have both Hasimoto's antibodies as well as Grave's (Disease) antibodies (as myself) and know the twists and turns of which conventional doctors are ignorant.

naturalendocrinesolutions.c...

"The relationship between Graves’ disease and Hashimoto’s thyroiditis has been debated for decades. Although initially considered to be two separate diseases, the present view is that they represent the opposite sides of the same coin, or the two ends of a spectrum."

academic.oup.com/endo/artic...

everydayhealth.com/thyroid-...

Thanks again for your comment. It got me to thinking again. I hope this information is interesting to you (and to others). The more we know, the more we'll know what to do to improve our own health.

Hugs!

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Very interesting, and thanks for all the research! :-)

I'm trying to remember where I read that the effects on bone metabolism in hypothyroid adults with excess T3 can differ depending on whether the excess is endogenous (or was, in the case of Graves') or exogenous (via T3 over-replacement). I think it may have been in one of the papers recently published by Dr John Midgley's research group, but I can't swear to it. If I find it, I'll add it here.

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Omg for years my Tsh has been high as 125 when should be under .5 back now with endocrinologist have plasma test but main issue is bone issues calcification etc makes sense was at the stage I thought I had rhemitiod arthritis can’t walk without. Every bone in my body cracks with movement even fingers they are the worst beside foot 😡

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Are you on or have you been taking HRT?

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No, managed to get through menopause without any medications. I only take Thyroxine, Vit D, Vit K2.

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Thanks for replying

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Hi, I apologize for interrupting, but your info is worth a pound of gold! My dr., needs a copy of this, your referred sites, please I've gotten more help in advise from this site. My dr., is lowering my armour-compounded from 60mg to 50mg, due to my blood results remaining low. Only what I've learned here, I've been on several different thyroid meds, before she agreed to the armour, abt one yr., however my blood remains lower, I feel really bad, appears she is going in wrong direction w meds!!! I'll bring her copies of your info, but how do you get a go, from a hospital rated #1, in the state, to listen to you? Please advise, thank you

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Maybe you need to be taking other supplements too - as indicated in the link I posted for you above ! Boron Magnesium and more ...

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A small dose of bio identical Estrogen helps maintain bone strength

studd.co.uk/var_bone.php

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If you are on thyroid replacement, oestrogen can bind T4 and make Hypothyroidism worse. You should only take any form of oestrogen if your oestrogen levels are definitely too low.

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Ignore your GP...big pharma are pushing meds for OP but thats the very last thing you need they are lethal

Go to facebook and the group natural osteoporosis treatment you will learn loads

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Yes, I have done some research on OP drugs and I do not want to go there! I hope I can get the TSH in the normal range without going hypo, then address the OP naturally. Thanks. Love your nickname, I can relate!

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I have had thyroidectomy and have been diagnosed with osteoporosis. Endo has stopped my trial of T3 because he is worried what it will do to me as I have osteoporosis. (He knew that when he started the trial). My TSH has always been 0.0 something, occasionally 0.1 and no one has ever mentioned it as being a problem!

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Know just how you feel, am having the same discussion with my GP, but have not gone back to request a deca scan yet.

I wouidn’t be too hard on your GP. Having looked into the clinical literature , it’s all over the shop with conflicting opinions. Your GP has a duty of care and should bring this to your attention according to what GPs are “fed” with.

I looked into K2 supplementation but take warfarin anticoagulant & would need my GPS approval to take ‘cos will need to have frequent INR monitoring until re-balanced.

Seem to share approx the same thyroid test results as you do, mine being v suppressed TSH, near top of range FT4 and lowish in range FT3. So apparently not converting too well (150 mcg ) But my dilemma is knowing that T3 is so iumportant for heart function and with an ICD fitted & diliated cardiomyopathy the last thing I want to do is lower T4 causing lower T3.

So! ... osteoporosis or increasing risk of heart failure? & I have a relatively minimal exercise routine given a damaged/weak ankle joint from a fracture many years ago. Dexa scan next for me if my GP authorises. I’ve not looked into that at all yet, so don’t know what your results indicate in terms of severity ... have you established that? Also, how long have you been on K2 supplementation? I understand it can take quite a while for this to take effect? Also, sounds crazy, but have you checked whether over-exercising could be a factor?

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I think that over exercising could be a factor, at a minimum depletes the body of magnesium, which is very important for the bones (and also needed to for vitamin D absorption). So one needs to supplement magnesium. I have also read that people with autoimmune conditions tend to be vitamin D resistant, so being in the normal range may not mean much and it might be safer being a bit over the middle of the range, if not more.

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Hi, yes, you sound like me, my story is much the same, however, they found out my real cause for osteoporosis was a bad parathyroid that wasent found out till much later because it was still at a level considered normal, but it wasent normal. Iam 73 now, and have had a total thyroidectomy, I am feeling much better, no crushing fatigue like before. So, have your Dr. also check out your blood levels for excess calcium, that would point to a bad parathyroid that would be causing your osteoporosis. I am sorry this has happened to you, but finding out the cause is the key to getting better. So many times the Drs. are only interested in just treating a problem with medication, and not putting in the effort toward finding out what is causing the problem. This is especially true in the case of osteoporosis. So dont give up hope, lots can be done , but the Drs. need to find the cause, its worth trying and fighting for, my prayers are for you to find Drs. willing to do that for you, take heart, it can be done, my troubles begain at 57, Iam doing better, and you can too, blessings, Littlebowpeepxx

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My calcium tested right in the middle of the normal range. Thanks for your thoughts though, I will mention this to the endo when I see him.

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Your welcome, your not alone, blessings, Littlebowpeep xx

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I just had my synthyroid reduced for the same reason as you. My Dexa Scan said I had osteopenia (very low risk) didn't matter to my Endos they told me my bones are going to crumble and Im going to get heart disease from having a low TSH.....reduced my meds. I have no thyroid.

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OMG!

Heart “disease” in terms of hyper activity will come from hyperthyroid levels of T3. Suppressed TSH will not necessarily relate to that. On the other hand even sub-clinical low FT3 levels can & do/may lead to heart disease!

What are your FT4 & if you have them both FT3 levels with their ref ranges?

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Well Mike I'm anything but hyper more like a slug but this doesn't matter to the accountants of the medical field they love those number it doesn't seem to matter that a human is attached to them as long as those numbers look good.

My recent lab test below.

FT4...1.29 (0.93 - 1.7)

FT3...2.95 (2.0 - 4.4)

T3.....105.7 (80 - 200)

TSH.... 0.116 (L) (0.27 - 4.20)

I've been told for over 16months by the accountants that I must have low TSH because of thyroid cancer and see their plan changes like the weather to suit their CRAZY math and a DEXA Scan. If I never did that Dexa scan these numbers would be magnificent. Now I'm going to crumble to dust or die of Heart disease and HD most likely since my cholesterol keeps rising ever since my Thyroidectomy.

Gosh I really can't stand these bozos.

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I know what you mean! I almost wish I had not had a DEXA scan, I was carefee and happy until then. I have been going along on the same dose of thyroxine for a couple of years now, all good, now Dr wants to shake it all up......sigh.

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I am in my early 40s and have Osteopenia (pre osteoporosis). Mine was found after my late diagnosis of Coeliac Disease..it was a was assumed to be caused by years of not absorbing enough calcium and vitamin D. VitD helps but having a calcium supplement would beneficial too? I take Adcal on prescription.

My Hashimotos was found at the same time but it isn't as severe on blood readings as other people's.

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I have seen in so many different medical sources, that calcium supplements are useless. Waist of money. However, Vitamin D plays a vital role in calcium absorption but it has to come from its natural sources, I guess.

To fight osteoporosis you need to strengthen your bones and weight exercise is the only possible way after certain age... guess we are all in the same boat here.

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Vit D, magnesium, boron, bamboo silica

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Interesting question. Personally I would say there was room for improvement on your FT3 levels.

I’m very impressed with your energy levels.

Doctors are very confused about suppressed TSH and osteoporosis. I found this paper which might be interesting for you to read- although a scientific page it is not too difficult to read. It’s concluding paragraph states: “Hypothyroidism has controversial influence on bone metabolism but probably leads to increased fracture risk”. ncbi.nlm.nih.gov/pmc/articl...

There will be more papers out there if you want to do your own research.

I can recommend a book by Dr Marilyn Grenville Phd - osteoporosis How to prevent, treat and reverse it. This contains natural alternatives.

Jo

Student naturopathic herbalist

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Thanks for the links, I will check them out.

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I am 62 and have hashimotos. Been on t4 and t3 . I have been taking vitamin d for ten years. I live in the northwest my vit d level was 10 . I just had a bone scan and it was normal. I dont get sny exercise due to 8 years of eye operations . Three cornea transplants cataract surgeries , prk, torn retina. Anyway I have read that a drink of alcohol helps older women from getting osteo . Google it. I think their is something to it.

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Researchers looked at the effects of moderate alcohol consumption on “bone turnover,” or the replacing of old bone cells with new ones, in healthy post-menopausal women. After menopause, women’s production of new bone cells slows, but the rate of shedding old cells does not slow as much. In other words, the “out with the old” outpaces the “in with the new,” leading to a porous skeleton that easily fractures.

But past studies have shown that women who drink moderately (one or two alcoholic beverages per day) have higher bone density than non-drinkers or heavy drinkers. Now, the new study suggests why: Alcohol appears to reduce bone loss in middle-age women by suppressing the rate at which their bones shed old cells.

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Never seen or heard of this before. Anyway. What helps the bones is weight exercise. Any type of weight lifting exercise. Maybe the effects come from lifting large crystal glasses full of wine or any other alcohol...

I wouldn't trust that. What studies has demonstrated are that any dose of alcohol causes more damage than good.

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Apparently not - remember that one day something is good for you and the next day bad - wine. coffee, butter, etc. Not so long ago, a glass of wine a day was good for you, and I've also read that organic champagne is good. I was brought up moral rearmament so I don't drink BTW, bu tI wouldn't believe the media or most studies, which appear to be cooked to produce the requested results.

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Exactly. Unfortunately science is not always a neutral initiative. Science can be bought as cheap as politicians and journalists. Big Pharma goes shopping every time they need to approve something or they need to reinforce their interests.

Fortunately today there are several research projects and institutes out there doing meta analysis of bulk of studies and helping find out the most likely truths behind scientific research. Not always easy but one must learn to select the sources of research.

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Well I think that probably there is some truth to that. Stress is known to have a bad effect on bone density, moderate drinking probably relaxes people and may even make them sleep better if done at night. So it follows that it might have some benefits.

However, it seems that lycopene is helpful in suppressing bone turnover

ncbi.nlm.nih.gov/pubmed/265...

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Your low TSH is likely the cause of your hypothyroidism in the first place. Its low in comparison to the actual hormone levels. So the chances are that your pituitary is just not pumping out enough TSH, and of course that would mean you didn't make enough hormone.

Very high T3 is associated with osteoporosis, but TSH in and of itself is immaterial and totally unconnected to OS. And since your T3 is normal (could be a little higher) then that won't be connected to the OS.

I would strongly advise against reducing your medication. You will feel terrible, and it won't help anything. I would also advise against using drugs to try and raise bone density. The price you pay is too high.

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Hi FitnessFreakOz,

Sorry to hear of your problems. You have such an amazing exercise routine, I wish I was able to do all that. Anyway I got very intrigued by your results. I can't really help you with tips but since you have such a healthy routine I could not stop myself from wondering if weight exercises really help strengthen the bones.

Thing is. My mother has had Hashimoto for nearly 30 years and a couple of months ago she found out she has osteoporosis in her column bones. My mom is in her late 70's and while doing tests for her knee arthritis she received a surprising diagnosis of osteoporosis. Irony, she took so much calcium supplements her entire life to avoid osteoporosis even though, for many years now, I have told her calcium supplements were useless.

So my mom started weight exercise as the doctors, both endo and knee doctor, recommended as the only way to strengthen bones. What to think now? Really disappointing when you come along and report your struggles.

Hope you find a way to reverse your osteoporosis. Best of luck.

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Do yourself a huge favor and read the book Stop the Thyroid Madness II and also visit their site stopthethyroidmadness.com. I have read the book and investigated their website, I have stopped going to the endocrinologist. I went to my GP two weeks ago and talk to him about my 36 years experience of taking synthetic T4 which has left me with a whole host of hypo symptoms. My body is on able to convert the synthetic T4 to the required T3. He is putting me on natural desiccated thyroid gland. He has had great success with other patients that have the same issue as mine. Although he is a conventional doctor he had patients come to his practice from the US with prescriptions for NDT. Because of this experience he has no more open minded in the treatment of thyroid conditions

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The issue is lack of progesterone. You can take natural hormone replacement. Read Dr John Reid Lee. Progesterone works better than any drug developed to build bones. Decreasing your thyroid medication will only make you sick again. I take nor and natural thyroid hormone.

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Dr John R. Lee , not reid

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Thanks i will look into that. Dr not keen on HRT for someone my age.

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having severe knee pain. Now I just can't walk. I'll have to check my uric acid levels too. I've been asked to walk as my X-ray shows normal. I'm over weight. Now the sad part is, I just can't walk, specially down slopes.

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Try taking Glucosamine-Chondritin. When I take that my knees feel normal, when I run out and procrastinate going to the pharmacy to buy more, after 3 days I am in pain again. Sadly they have gone a bit expensive - hence my hesitation between purchases. There is one made by Schiff which seems to work best.

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Thanks everyone for so many responses and ideas. I will take a lot of this to the endocrinologist and i will report back after I have seen him. I also know of a good GP with a strong interest in complimentary and natural remedies. She is hard for me to get to but if I am not happy with the endo's advice I may try to see her.

Until I see the endo (in 4 weeks) I will just keep going, I need to exercise, it makes me happy, but I did think it was also protecting my bones. :(

At least I do not feel so alone. Thank you.

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raypeat.com/articles/articl...

read it. understand it.

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