Risk Factors for Predicting Osteoporosis in Patients Who Receive Thyrotropin Suppressive Levothyroxine Treatment for Differentiated Thyroid Carcinoma.

Objectives: Endogenous hyperthyroidism accelerates bone turnover and shortens the normal bone remodeling cycle, which results in reduced bone density. It is estimated that suppressive levothyroxine (LT4) therapy also decreases bone density. The aim of this study was to define risk factors for osteoporosis development in patients under thyrotropin-stimulating hormone (TSH) suppressive treatment for differentiated thyroid cancer (DTC). Methods: Patients with a diagnosis of low or intermediate risk group DTC according to the American Thyroid Association 2015 guidelines and who have been receiving LT4 suppression therapy and were physically fit to undergo femur and lumbar vertebra bone density study were included in the study. Patients lacking information on demographic data, medical history, preoperative thyroid hormone status, or routine follow-up data were excluded from the study. A study form consisting of patient information on possible risk factors for osteoporosis such as gender, age, menopausal status, smoking, family history of osteoporosis, preoperative thyroid hormone status, postoperative hypoparathyroidism history, mean serum TSH levels, and duration of TSH suppression was created and filled out for each participant. Bone mineral densitometries of the femur and lumbar vertebrae were measured along with serum vitamin D and parathyroid hormone levels. Results: During TSH suppression (mean 7.2±4.5 years, range: 1-26), osteoporosis was detected in 89 (9.6%) patients. The mean time to develop osteoporosis was significantly different in patients with or without a family history of osteoporosis (15.3±0.4 versus 20.3±0.6 years; p=0.002). Similarly, the mean time to develop osteoporosis for was found to be significantly shorter in postmenopausal patients than that for premenopausal women (18.6±0.7 versus 20.4±0.4 years; p<0.001). Male gender (p<0.001), a family history of osteoporosis (p=0.001) and menopausal state (p<0.001) were identified as independent predictive factors for developing osteoporosis. Conclusion: Postmenopausal women, men, and patients with a family history who receive TSH-suppression treatment have a tendency to develop osteoporosis. [ABSTRACT FROM AUTHOR]

Amaç: Endojen hipertiroidi kemik turn-overini hızlandırır ve normal kemik remodeling döngüsünü kısaltır, bu da azalmış kemik yoğunluğuyla sonuçlanır. Süpresif levotiroksin (LT4) tedavisinin de kemik yoğunluğunu azalttığı düşünülmektedir. Bu çalışmada, diferansiye tiroid kanseri (DTK) için tirotropin-stimüle edici hormon (TSH) süpresif tedavi altındaki hastalarda osteoporoz gelişimi için risk faktörlerinin tanımlanması amaçlanmıştır. Yöntem: Amerikan Tiroid Derneği 2015 rehberine göre düşük veya orta riskli DTK tanısı ile takipli, LT4 süpresyon tedavisi alan; bazal tedavi sonrası rutin klinik takip bilgilerine ulaşılan; hasta dahil etme formu doldurmak için gerekli ve yeterli demografik ve medikal takip bilgileri bulunan; genel durumu femur ve lumbal vertebra kemik dansitometri çalışması yapılması için uygun olan hastalar çalışmaya dahil edildi. Osteoporoz için olası risk faktörleri olan cinsiyet, yaş, menopoz durumu, sigara, ailede osteoporoz hikayesi, preoperatif tiroid hormon durumu, postoperatif hipoparatiroidi hikayesi, ortalama serum TSH düzeyi ve TSH süpresyon süresini içeren bir hasta dahil etme formu dolduruldu. Dahil edilen hastalara bu aşamada femur boynu ve lumbal vertebralardan kemik mineral dansitometrisi yapıldı, serum D vitamin ve parathormon düzeylerine bakıldı. Bulgular: Ortalama TSH süpresyon süresi 7,2±4,5 (aralık: 1-26) yıl idi, hastaların 89'unda (%9,6) osteoporoz saptandı. Postmenopozal olgularda osteoporoz gelişmesine kadar geçen ortalama süre premenopozal olgulardan anlamlı şekilde kısaydı (18,6±0,7'ye karşın 20,4±0,4 yıl; p<0,001). Erkek cinsiyet (p<0,001), aile hikayesi (p=0,001) ve menopoz durumu (p<0,001) osteoporoz gelişimi için bağımsız risk faktörleri olarak saptandı. Sonuç: TSH süpresyon tedavisi alan postmenopozal kadınlar, erkek ve aile öyküsü olan hastalar osteoporoz gelişimine eğilim göstermektedir. [ABSTRACT FROM AUTHOR]

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