Impact of prolonged levothyroxine use...

[Clara62]

Today, a well-known doctor published this news without providing alternative solutions or answering patients' questions. The result? Panic among those who cannot do without levothyroxine.

What should we do?

In your opinion, how true is what he claims? Does natural desiccated thyroid (NDT) pose less risk to bones compared to levothyroxine? Thank you.

This is what he wrote:

The Impact of Prolonged Levothyroxine Use on Bone Health and Cardiovascular Risks

It has been highlighted that the prolonged use of levothyroxine may increase the risk of developing osteopenia. Levothyroxine, a medication commonly prescribed for hypothyroidism, has recently been linked to a greater loss of bone mass in elderly patients, even in those with normal thyroid function.

What Risks Do You Face?

Bone Mass Loss:

The use of levothyroxine can lead to a significant reduction in bone density, increasing the risk of osteopenia and osteoporosis, particularly in older adults.

Excess Thyroid Hormones:

Excess levothyroxine can have catabolic effects, not only on bones but also on other tissues, causing reabsorption of the bone's mineral and organic components. This excessive reabsorption can weaken the bones and contribute to bone mass loss.

Cardiovascular Risks:

Excess thyroid hormones can also affect the cardiovascular system, increasing the risk of arrhythmias and fluctuations in blood pressure, particularly in older adults.

It has long been known that an excess of levothyroxine may lead to bone mass loss. Excess thyroid hormones exert a catabolic effect on body tissues, leading to excessive bone resorption. This not only affects the bones but also poses a threat to the cardiovascular system, increasing the risk of arrhythmias and cardiovascular imbalances, especially in older individuals.

The Study

A study was conducted on 81 euthyroid patients undergoing levothyroxine therapy, compared to a control group of 364 volunteers. The participants, aged 65 and older, had consistently normal thyroid function and were monitored over a period of 6.3 years. The results revealed a greater loss of bone mass and density in patients receiving levothyroxine therapy compared to the control group.

This evidence underscores the importance of careful monitoring of thyroid hormone levels, particularly in elderly patients, to prevent excessive bone loss and reduce the risk of osteopenia, osteoporosis, and cardiovascular complications.

[SlowDragon Administrator]

The participants, aged 65 and older, had consistently normal thyroid function and were monitored over a period of 6.3 years. The results revealed a greater loss of bone mass and density in patients receiving levothyroxine therapy compared to the control group.

“Normal” is not necessarily optimal

If only testing TSH or TSH and Ft4 likely inadequate dose levothyroxine and/or poor conversion and/or poor vitamin levels as result

LOW Ft3 leads to osteoporosis……not just high Ft3

thyroidpatients.ca/2018/07/...

A high percentage of thyroid patients have very poor vitamin levels. All thyroid patients should be automatically tested annually - vitamin D, folate, B12 and ferritin

Low vitamin D and low magnesium linked to poor bone health

theros.org.uk/information-a...

theros.org.uk/information-a...

And low iron also linked to osteoporosis

Osteoporosis and iron deficiency

healthunlocked.com/thyroidu...

[Clara62 in reply to SlowDragon]

Thank you SlowDragon. I think the article is missing a lot of data.

[helvella]

Numerous issues with the article.

First, it was (I think I am right in saying) from the USA which means there are many differences which can easily be missed by simply applying it without due consideration.

Second, there are bone and heart issues associated with inadequate treatment with thyroid hormones.

Third, a large part of the reason patients end up on inappropriate doses is that annual tests are wholly inadequate. At best, they tell you that around the time of that blood draw the person might be under- or over-treated. By the time you include variables such as weather, effects of daylight hours, diet, variations in thyroid hormone product, and the fact that tests are poorly performed (little consideration of last dose, fasting, etc.) and susceptible to interference, annual is far from good enough.

Fourth, the very fact that doctors don't consider dosing regimes important could well be a major contributory factor. There are members who feel better split dosing even levothyroxine. And that would be expected to reduce the peak FT4 level each day compared against single dosing with same dose.

[Clara62 in reply to helvella]

Thank you helvella, yes the article is from USA. It appeared in an Italian newspaper , I agree with you .

[jimh111]

Please give a link to the article and the study it references.

We know excess thyroid hormone therapy leads to bone loss but always not excess fracture rates. It's important to study the actual research because sometimes patients may have concurrent parathyroid disease. How the study is conducted (Methods) is important, so we need to see that actual research paper.

[Clara62 in reply to jimh111]

The article appeared in an Italian newspaper repubblica.it/salute/2024/1...

[RedApple]

Clara62, Thank you for bringing this to our attention. BUT, as per forum posting guideline 16, please link to the source for the information, and make sure you have not breached copyright rules by copying and pasting without permission.

16. Do not breach copyright rules by placing documents onto Thyroid UK unless you have permission from the author of the document. You can, however, post excerpts with links to the full text of the document. healthunlocked.com/thyroidu...

[Clara62 in reply to RedApple]

Thank you RedApple, the article appeared in an Italian newspaper and the doctor posted his opinion on social media. Here the link to the article: repubblica.it/salute/2024/1...

[elaar]

The medical industry like to keep on about the long term issues of excess Levothyroxine, whilst at the same time stating that Levothyroxine monotherapy is the only drug we should need, which often needs to be taken in the high normal range to feel well again (if at all).

We've all read the research about high levels of FT4 or high FT4/FT3, of which there's lots. So why dont the doctors, specialists and researchers have a chat among themselves, and decide upon a better accepted treatment method so they don't put alot of us into that situation in the first place?

[Clara62 in reply to elaar]

agree totally

[3-T1AM]

reg.meeting.rsna.org/flow/r...

[Clara62 in reply to 3-T1AM]

Thank you!

[jimh111]

Here is a link to the source press.rsna.org/timssnet/med... . It is basically a marketing device for an upcoming meeting, I've seen a similar post on a different topic a few weeks ago. It seems we are getting more of these ploys now, trying to get people to pay and attend the meeting. I suppose it beats watching two boxers staring each other out for eleven minutes.

The first thing to note is that about 7% of the US population are on levothyroxine as opposed to two to three percent in the UK. There is long standing evidence that lower TSH levels are associated with reduced bone density but the effects are not great. Also, bear in mind that no thyroid means no calcitonin. This might have some effect.

This study researchgate.net/publicatio... found that levothyroxine had beneficial effects on bone density. However, the levo group were a little younger and had higher average TSH, they appear to be a little undertreated.

I wouldn't worry about all this unless your TSH is quite low. Since we know a low TSH can cause some bone loss my advice is to take some vitamin D, try to do some weight bearing exercise and be happy, don't worry.

[RedApple in reply to jimh111]

'be happy, don't worry.'

Excellent advice jimh111 😊🎄

[Clara62 in reply to jimh111]

Thank you jimh111.

I am on 75 mcg thyroxine and 10 mcg liothyronine . My TSH is very suppressed for many years now due to taking T3 . It is 0.010 . I take 2000 iu daily vitamin D.

I hope I am doing the right thing. I am self medicated because I don’t trust the endo that wanted me to reduce my meds.

[jimh111 in reply to Clara62]

That's not a high dose. Sometimes TSH doesn't recover and you have to be guided by signs, symptoms, fT3 and fT4.

[Clara62 in reply to jimh111]

Thank you. 🙏

[serenfach]

Levothyroxine, a medication commonly prescribed for hypothyroidism, has recently been linked to a greater loss of bone mass in elderly patients, even in those with normal thyroid function.

I may be being thick here, but why are those with normal thyroid function taking Levo?

[3-T1AM]

American website suggesting annual testing and possibly taking anti resorption meds for bones.

palomahealth.com/learn/pros...