TSH and Bone Health

[helvella]

It can be interesting when papers published at the same time are in conflict.

Yet again, concentrating on TSH - not on thyroid hormone levels. Of course, this we recognise as it is near-universal. And any review or meta-analysis inevitably uses what is available.

Se also this recent post/thread: healthunlocked.com/thyroidu... by greygoose

J Bone Metab. 2019 Feb;26(1):45-50. doi: 10.11005/jbm.2019.26.1.45. Epub 2019 Feb 28.

Risk of Osteoporotic Fractures after Thyroid-stimulating Hormone Suppression Therapy in Patients with Thyroid Cancer.

Lee Y1, Yoon BH2, Lee S3, Chung YK4, Lee YK5.

Author information:

1. Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea.

2. Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea.

3. Department of Surgery, National Cancer Center, Goyang, Korea.

4. Department of Obstetrics and Gynecology, National Cancer Center, Goyang, Korea.

5. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

Background:

The effects of subclinical hyperthyroidism on fracture risk induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with thyroid cancer still remains controversial. We performed a meta-analysis and systematic review to evaluate the effects of TSH suppression therapy on osteoporotic fracture in patients with thyroid cancer.

Methods:

We performed a systematic search to identify studies which included osteoporotic fractures (hip fracture and vertebral fracture) in patients on TSH suppression therapy for thyroid cancer. Main outcome measures were occurrence and risk of osteoporotic fractures including hip and vertebral fractures between patients and controls.

Results:

A systematic search yielded a total of 8 studies appropriate for review which included osteoporotic fracture outcome in patients on TSH suppression therapy for thyroid cancer. Studies with larger number of subjects showed the higher risk of osteoporotic fracture in group with TSH suppression therapy, although studies with smaller sample size presented a similar risk of fracture with control group.

Conclusions:

Although studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the increased risk of osteoporotic fractures in patients with thyroid cancer.

PMCID: PMC6416149

PMID: 30899724

ncbi.nlm.nih.gov/pubmed/308...

J Bone Metab. 2019 Feb;26(1):31-38. doi: 10.11005/jbm.2019.26.1.31. Epub 2019 Feb 28.

Effects of Thyrotropin Suppression on Bone Health in Menopausal Women with Total Thyroidectomy.

Kim EH1, Jeon YK1, Pak K2, Kim IJ2, Kim SJ3, Shin S2, Kim BH1, Kim SS1, Lee BJ4, Lee JG5, Goh TS6, Kim K2.

Author information:

1. Division of Endocrinology and Metabolism, Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

2. Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

3. Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan Pusan National University Hospital, Yangsan, Korea.

4. Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

5. Department of Family Medicine, Pusan National University School of Medicine, Busan, Korea.

6. Department of Orthopaedic Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

Background:

This study examined the change in the trabecular bone score (TBS), areal bone mineral density (aBMD), and osteoporosis in postmenopausal women who underwent thyrotropin (TSH)-suppressive therapy for treating papillary thyroid cancer after a total thyroidectomy procedure.

Methods:

We evaluated 36 postmenopausal women who received a total thyroidectomy for papillary thyroid cancer and were undergoing TSH suppressive therapy with levothyroxine. Postmenopausal women (n=94) matched for age and body mass index were recruited as healthy controls. The aBMD and TBS of the lumbar spine were compared between dual energy X-ray absorptiometry (DXA) at baseline and at follow-up after an average of 4.92 years.

Results:

There was no significant difference in the rate of diagnoses of osteoporosis, osteopenia, or normal bone status between the 2 groups during the baseline DXA evaluation. However, the TBS was significantly lower whereas aBMD did not show significant difference at the time of baseline DXA measurement (1st DXA, 1.343±0.098 vs. 1.372±0.06317, P<0.001; 2nd DXA, 1.342±0.095 vs. 1.370±0.062, P<0.001). The TBS and aBMD did not differ significantly between the initial and follow-up DXA images in both groups of TSH suppressive patients and controls.

Conclusions:

The average value of TBS and aBMD did not significantly change during the follow-up period. The TSH suppressive therapy was revealed as not a significant factor for the progressive deterioration of bone status during long term follow-up.

PMCID: PMC6416151

PMID: 30899722

ncbi.nlm.nih.gov/pubmed/308...

[Marymary7]

Very interesting but my gp will stick to his teachings and theory. Has anyone that uses this site ever came on here to report bone loss from thyroid therapy .....not everyone has the scans I know. I've had two but only a slight worsening and still in Osteopenia stage.

[Sabine_es in reply to Marymary7]

I have low bone density and when it was discovered 7 years ago (osteopenia in the spine and osteoporosis in the hip) my TSH was perfect (as by doctors) but my hormones, especially T3 was bottom or below the range. Eventually I was given hormones both T4 and T3 and since two years take very steady dose. As a result my osteoporosis has reversed and osteopenia is low and not progressing. Of course I had vit. D supplementation as a treatment for it but no osteoporosis meds and no TSH

[Marymary7 in reply to Sabine_es]

That's good then. I have read that low thyroid hormones mean more bone loss...contradictions everywhere as the poster of this demonstrates. I hope mine has got better due to self treatment with T3 and supplements. Do you take Magnesium too, I think it's important.

Good luck 😀

[Sabine_es in reply to Marymary7]

To be honest that was my big concern what would happen with the bones with at lest 60% higher T3 then it was and no TSH... But eventually looks like my body made a great use of it!! And yes I was told by my doctor that thyroid hormones are crucial to rebuild any tissue of the body. And yes as I take super high dose vitamin.D3 protocol by my doctor he prescribed also vitamin K2, b complex and magnesium (sometimes little calcium also). I can not say what worked for sure but probably the mix including exercises also that are so important. Good luck to you too! All is reversible that I am sure

[Pepekins in reply to Marymary7]

I have had serious bone loss in my hips after 18 years on Levo and had to have two hip replacements. I had my thyroid removed 18 years ago because of papilliary ca.

[Hidden]

Interesting read, as part of my exploration into what's happened to my body since having my TSH suppressed for three years after my TT in 2015 I am now going to have a Dexa scan next month to find out exactly if anything has changed.

I have already had my ECG done and my heart is fine.

[Marymary7 in reply to Hidden]

Can you let us know the result of your scan please. 😀😎

[Hidden in reply to Marymary7]

Yes I will.

[Hidden]

eje.bioscientifica.com/down...

I have posted this before within a thread. It relates to tsh suppression in thyroid cancer. It advocates a personalised approach considering risks and benefits of this on an individual basis. It also included some information on the role of TSH in various parts of the body including the immune system and brain, which was interesting. The sensitivity of TSH to osteoclasts is regulated by oestrogen... also interesting!

[Angel_of_the_North]

Well, I'm sure I read that T4 as associated with bone breakdown (osteoclasts) and T3 with bone synthesis (osteoblasts), so I'd want to know thyroid hormone levels as well, plus exercise levels and diet for the two groups if I was doing a similar study.

[helvella Administrator Thyroid UK in reply to Angel_of_the_North]

My latest post might just be of interest:

healthunlocked.com/thyroidu...

[Angel_of_the_North in reply to helvella]

Definitely

[Hidden]

jamanetwork.com/journals/ja...

This meta-analysis included T3 and T4 levels from my recollection....

[helvella Administrator Thyroid UK in reply to Hidden]

Still suffers because of lack of FT3 measurement:

Third, we defined subclinical hyperthyroidism by low TSH and normal FT4 levels because T3 levels were measured only in 4 cohorts.

[Hidden in reply to helvella]

They did look at the cohorts with and without T3 measurements separately, outlining lack of T3 measurement as a limitation as some subjects with T3 toxicosis may have been included under the definition of sublinical hyperthyroidism. They said outcomes were similar in both groups... well that was my interpretation of what was stated... It was a while ago I read it and have just skimmed over it...

[Greekchick]

Interesting papers. These folks have published a lot on thyroid generally because there is a high incidence of thyroid problems in Korea.

Before my TT I reviewed the medical literature on thyroid, (mostly for Graves, but came up with other papers on related issues). It was my impression from the articles I read that if you have either hypothyroidism or hyperthyroidism you also have a risk for osteoporosis in any case - and should get monitored with bone scans - so either way, with treatment or without, you may have bone problems. I was given a bone scan every other year to monitor my bones for the last 10 years and I will be asking my endo for one again post TT. Thanks for posting these!

[Lovecake in reply to Greekchick]

My endo (private) wrote to the GP and included a note about me getting a bone scan. That was over 2 years ago. GP said nothing. I think I’ll have to pay for one!

[Pascha1]

interesting my TSH is 0.004 not for cancer , it seems to be stuck , no GP neither 2 ends seems bothered about it...

I was recently talking to a GP as he knows genetics, he said My gene fault in TRHR homogenous. he said i would suffer with a bad back later on in life! I have a bad back already, he said no the TRHR genetic fault will cause you other back problems in about ten years... Im not looking forward to that.. I must ask him next time i go can i stop it doing my spine damage..

Just dont get enough time at GP appointments to ask so many questions

[Eddie83]

Reading these studies isn't worth my time. When these "experts" get smart and actually use FT3 and FT4 in their studies, as well as autoimmune status, then I might be interested.

[Kandahar]

Not sure what has caused it but I have gone from a Dexa test over 10 years ago that showed my bones as being 20% stronger than someone of my age (about 60). Then, in 2016, I was diagnose as just being osteoporosic. So where did it go?

I’d been on thyroxine for a similar amount of time and still lethargic, muzzy, overweight etc.

Did read that too much thyroxine could do it, but...?!

[galathea in reply to Kandahar]

There is no calcitonin in synthetic t4 or in synthetic t3. Calcitonin is made by the thyroid gland, (if itS working) and its pupose is to stop calcium leeching out of bones and into the blood stream.

Would be interested to see the difference in bone density between thise on ndt and those on synthetics.

X

[helvella Administrator Thyroid UK in reply to galathea]

I'd be interested to see any evidence that desiccated thyroid contains calcitonin that can be delivered, absorbed and have an effect on the person taking it.

There is logic that the original thyroid would contain calcitonin, and that it is not intentionally removed, which suggests that it is possible, even likely, the tablets contain some. But that is not evidence. And whether any calcitonin that is present could survive and pass into the bloodstream in a quantity that could make a difference is questionable.

Equally, I am not aware of any evidence to the contrary - that it doesn't contain any deliverable calcitonin.

At present, I am open to either possibility. It is something that really should have been studied sufficiently in the hundred-plus years that have elapsed since desiccated thyroid was introduced.