Thyroxine and osteoporosis: I am taking 15... - Thyroid UK

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Thyroxine and osteoporosis


I am taking 150 levothyroxine following thyroid cancer 3 years ago. I also have osteoporosis for which I have been prescribed alenduric acid (which I am worried about taking) and calcichew tablets. However, I understand that thyroxine can be harmful to the bones...does anyone else manage both conditions successfully?

18 Replies

Thyroxine is only harmful to bones if you are taking too much. If your T3 is within range you should be fine.

Have you had your vitamin D checked? This is really important for bones.

It can be just as harmful to not be taking enough thyroxine as it is to take too much. If you are not experiencing symptoms of too much thyroid hormone, and your blood tests are ok, you should be fine :)

Carolyn x

GiGiPen in reply to PinkNinja

Thanks for your help Carolyn, I will get Vitamin D checked.


These are two links re osteoporosis and hypothyroidism.

GiGiPen in reply to shaws

Thanks for your help, interesting reading!

Hi Amongst other things I have had both for a number of years. There are some very good drugs for Osteoporosis. Alendronic acid is usually the starter one as the cheapest, not the best. however, it depends on your other medical conditions. They are all powerful, nasty drugs but well proven. I can only take Alendronic acid as other suitable drugs are contra indicated for me. The side effects are serious but rare.Make sure you follow the instructions implicitly for the Alendronic acid or you will have stomach problems. Also it takes a while to get used to it. I gave up once. often treatment is only for a few years depending on Dexa. it did not effect my stable thyroid.Regarding the calcium and vit D you are taking. That is good but you should have regular calcium blood tests as the" corrected " calcium must always be in range. Your D may be low and need boosting with extra vit D( script) you need a blood test for that. It is hormonal and low effects and goes with thyroid disease.

I hope this is some help to you. You will have a repeat Dexa in 3 years or 2 if like me, very severe osteoporosis.

Best wishes,


GiGiPen in reply to Jackie

Thank you Jackie, I appreciate your help.I am having a third Dexa shortly, will decide on the Alendronic acid based on the results. Had a blood test last week, will check on the calcium and vit D. Very encouraging to hear that you sound OK. I am usually positive but after nearly 60 years of excellent health everything hit me at one time!

Best wishes

Jackie in reply to GiGiPen

Hi Unfortunately just one of life`s little surprises. Be careful not to fall. That is what I am told, what a joke! Also lifting any thing especially kettles, do not put much water in . little things but important.My endo looks after my osteoporosis etc. as her field , with a little help from my rheumy!.

Best wishes,


GiGiPen in reply to Jackie right you are! Osteoporosis resulted from a diseased parathyroid, that's when they found the thyroid cancer. No breaks so far and I am feeling pretty good, just need to take care.

Thanks again!

Take your alendronic acid once a week, following the directions given by your doctor and pharmacist. As said above, it can take some weeks for your body to get used this medicine. If you are okay with calcichew then that's good, if like me, you 'gag' on them, your GP can offer an alternative. I'm prescribed sachets of soluble calcium with Vit D, fizzies up in a small amount of water and has a very pleasant taste. Unfortunately osteoporosis and thyroid problems often go hand in hand. The other thing to remember is some good impact exercise taken daily, 50 little jumps each morning is good, walking a bit more when you can. And have a good calcium rich diet.

GiGiPen in reply to BillieSt

Thanks for your advice, I can't believe how helpful everyone has been. OK with calcichew, will start taking Alendronic acid if the upcoming Dexa scan shows no improvement.

Scarfred in reply to GiGiPen

Hi Just a word of warning which nobody warns you about. Do not take your calci chew the same time as Levothroxine take it a few hours apart. I have Graves, and when I put on calcium tablets for Ostopenia I felt vey ill, had to do own reasearch, and found out calcium absorbs thyroxin. My GP knew when I told him as did my pharmacist. Also while visiting an Uncle in Northern Ireland, his Levothroxine had warning stickers on it to avoid Grapefruit. Mine didn't! Maybe it does now! Get well soon.

PinkNinja in reply to Scarfred

I've heard about the grapefruit thing too, but it doesn't seem to say on the patient leaflet. I was really surprised when someone told me, considering I'd been on it for so many years!

Scarfred in reply to PinkNinja

Hi Caroline I may have Brain fog getting worse by the day, Northern Ireland is In the UK so why are they warned and we are not. It was a sticker on the pack.

girl66 in reply to PinkNinja

I have been purposely EATING grapefruit every morning after my levo as I read on another site it can improve absorption - I am on 350 mcg and still feel 'under' . Any grapefruit advice gratefully received !

get researching on this site - very knowledgable peope here!

GiGiPen in reply to auldreekie

Thank you, the UK site was interesting too.

Just for info, same applied to any iron supplementation you may be on, take it four hours away from synthroid.

Calcium blocks absorbtion of lots of things so I would take it separately from any medication.

I didn't read the beginning of the thread but I know there is a link between thyroid disease and secondary hyperparathyroidism. It is vital that calcium is in range (Parathyroid hormone can be normal and calcium only slighty out of range for hyperparathyroidism to be present) this is the best site to learn about this problem..... Lots of doctors dismiss slightly raised calcium levels - also Vit D can be depressed to slow down calcium absorbtion - supplementation with Vit D CAN be dangerous in some cases.... (to convert from UK calcium level of 2.43 divide by .2495) normal people have range of 9 anything above that is suspicious and should be checked out by our doctor.

I have seen endos all of whom have told me I haven't got hyper parathyroidism, having ruled out osteo arthritis and osteporsis from the menopause I now know I have hyper parathyroidism because osteoporsis doesn't cause pain in legs and hip as is the case with osteoporosis caused by hyper parathyroidism.


Is it possible to have hyperparathyroidism and not have a high parathyroid hormone level?

ABSOLUTELY! This is an advanced paragraph, and it may confuse a lot of people. Remember, 75% of people with hyperparathyroidism will have high calcium levels and high PTH levels. Some will not be this simple. This section is about that 25% of people with high calcium levels and normal PTH levels, and less frequently, those with normal calcium levels and high PTH levels. See the colorful calcium graph below.

Although MOST people with hyperparathyroidism have the classic presentation of high calcium in the blood and high parathyroid hormone (PTH) in the blood, about 20% of people with very significant parathyroid disease will have high calcium and normal PTH levels. This is very important... it was discussed in the table above, but we are doing it here again because most of these patients are not being diagnosed correctly... it is overlooked by many endocrinologists (some endocrinologists just don't see many patients with this disease). Every DAY we operate on at least 2 patients with hyperparathyroidism who have high calcium levels but never had a high parathyroid hormone level. Every one of these patients is found to have a bad parathyroid gland (a parathyroid tumor) and they get better after the operation. How can this be? Well, think this through with us... The parathyroid glands control the calcium in the blood. If the calcium in the blood is ever high, "normal" parathyroid glands would sense the high calcium and turn themselves off--and the PTH level would be near zero. Thus, if the PTH level is in the normal range when the calcium is high, then there is something wrong with the parathyroid glands, and one (or more) of them has lost their ability to 'turn off' and it is stuck in the 'on' position. This bad parathyroid gland must be removed. Think of it this way... a "normal" parathyroid hormone level is only normal if your calcium is normal. If your calcium is high, then a "correct" parathyroid hormone would be near zero... if your parathyroid glands are normal. If not, then it is the parathyroid glands that are CAUSING the calcium to go high. Have we totally confused you yet?

75% of people with hyperparathyroidism will have high calcium and high PTH levels (like patients 1 through 6 in the table above). Many of these people will have labs that jump around, with the calcium going from high to normal and back to high; and PTH levels going up and down. It is very easy to make the diagnosis of hyperparathyroidism in these people and they will all get an operation sooner or later. Of course, waiting just makes things worse--discussed elsewhere.

About 20% of parathyroid patients will have high calcium levels but their PTH levels will be in the normal range (like patients 3, 7 and 8 in the table above). These people can be a little more difficult to diagnose, and quite a few doctors will not make the correct diagnosis (they don't see enough of these to have the experience). These people often will have lots of symptoms. Their calcium is high (typically around 10.5 to 11.6) but their PTH levels are still in the "normal" range. Most of these patients have PTH levels between 40 to 60. If your calcium is frequently or persistently high, and your PTH isn't below 25, then you very likely have hyperparathyroidism. There are many thousands of people in the US who are misdiagnosed every year because their doctors don't know this. These patients will go to the doctor for years getting their calcium and PTH checked every few months while the doctor waits for the stars to align and the patient to have high calcium AND high PTH on the same test. This is silly... but at least 10% of you reading this have gone through this exact situation. Be careful... we get some folks with one high calcium level, a bunch of normal calcium levels, and a bunch of normal PTH levels and they think they have a parathyroid tumor--they do not. The concept here is "trends over time" and repeated levels. Repeated calcium levels above 10.4 and repeated PTH levels above 25 in a person over the age of 40 is almost always a parathyroid tumor.

About 2-5% of parathyroid patients will have normal calcium levels and high PTH levels (like patient number 10 in the table above). These patient are some of the hardest to diagnose, but two things are very common in this group 1) high ionized calcium levels and 2) kidney stones. Thus, if you had a recent bout of kidney stones and your calcium is "normal", make sure you check ionized calcium levels and PTH levels. Checking the urine for the amount of calcium in the urine is also a good test for this group... (a test that is not very helpful or necessary for most patients)

Patients in all three categories have hyperparathyroidism, and all of them will need surgery. They will all benefit from surgery.


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