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Imazu N, Naito K, Kawakita S, Suzuki T, Yamamoto Y, Kawamura K, Ishijima M. Levels of free thyroxine are higher in displaced pediatric supracondylar humerus fractures compared with non‑displaced fractures. Exp Ther Med 2024; 28:404. [PMID: 39234584 PMCID: PMC11372249 DOI: 10.3892/etm.2024.12693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024] Open
Abstract
Relationships between bone metabolic biomarkers and fracture displacement have been reported in the elderly. However, factors related to bone metabolism that predict fracture displacement remain unclear in children. The present study investigated bone metabolic biomarkers associated with the displacement of pediatric supracondylar humerus fractures. A total of 19 patients (7 male and 12 female patients; mean age, 6.3 years) with pediatric supracondylar humerus fractures who underwent surgical treatment at Juntendo University Hospital (Tokyo, Japan) between December 2020 and September 2022 were included. They were divided into two groups according to the Gartland classification: 14 type II patients (6 male and 8 female patients; mean age, 6.3±3.0 years) and 5 type III patients (1 male and 4 female patients; mean age, 6.4±4.0 years). The following bone metabolic biomarkers were examined: 25-hydroxyvitamin D [25(OH)D], intact parathyroid hormone (iPTH), calcium, phosphate, thyroid-stimulating hormone, free triiodothyronine and free thyroxine (FT4). These markers were also compared between the two groups. A total of 16 out of 19 patients (84%) had insufficient serum 25(OH)D levels. Although iPTH levels were elevated, other bone metabolic biomarkers were within normal ranges. When the serum levels of bone metabolic biomarkers were compared, FT4 levels were significantly higher in type III patients than in type II patients (P=0.009). No significant differences were observed in other bone metabolic biomarkers between the two groups. The present results suggest that high FT4 levels are associated with the displacement of pediatric supracondylar humerus fractures.
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Affiliation(s)
- Norizumi Imazu
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Kiyohito Naito
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - So Kawakita
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Takamaru Suzuki
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Yasuhiro Yamamoto
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Kenjiro Kawamura
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
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Dziedzic M, Bonczar M, Ostrowski P, Stachera B, Plutecki D, Buziak-Bereza M, Hubalewska-Dydejczyk A, Walocha J, Koziej M. Association between serum TSH concentration and bone mineral density: an umbrella review. Hormones (Athens) 2024; 23:547-565. [PMID: 38581565 DOI: 10.1007/s42000-024-00555-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/26/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The aim of this study was to summarize the results of previous studies, standardize the data, and present new statistical results in order to provide physicians with clinically significant outcomes regarding the association between serum TSH concentration and bone mineral density (BMD). METHODS To perform this umbrella review, a systematic search was conducted in which major online medical databases, such as PubMed, Web of Science, Embase, Scopus, Cochrane Library, and Google Scholar, were searched for meta-analyses and systematic reviews regarding the effect of TSH on BMD. Furthermore, all primary studies were screened for statistical analysis. RESULTS The statistical outcomes of the present study were based on the data of 75,898 patients. The pooled risk ratio of any kind of fracture in patients with subclinical hyperthyroidism was estimated to be 1.36 (95% CI: 1.18-1.56; p < 0.001). The SMD for BMD in the distal radius in male patients receiving L-thyroxine suppression therapy was estimated to be -0.61 (95% CI: -1.10-(-0.11); p = 0.02). Furthermore, the pooled risk ratio of any fracture in patients receiving L-thyroxine suppression therapy was estimated to be 1.98 (95% CI: 0.98 - 3.98; p = 0.06). In these patients, the BMD may significantly differ from that in non-treated patients. However, the difference depends on the type of bone. CONCLUSIONS Our data confirmed that subclinical hyperthyroidism has a detrimental effect on bones, causing decreased BMD. Based on the obtained results, the authors suggest that a reduced TSH serum level itself may be an individual factor associated with decreased BMD and, thus, with a greater risk of bone fracture. Nevertheless, it should be noted that the effects of TSH suppression therapy differ between areas of interest for assessing BMD. Furthermore, the results have shown that this issue may, in specific areas, concern not only postmenopausal women but also male patients. These conclusions should contribute to a careful consideration of the application of TSH suppressive therapy in all patients. Particular attention should be given to patients after DTC, while all the advantages and disadvantages of implementing L-thyroxine therapy should be individually considered.
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Affiliation(s)
- Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.
- Youthoria. Youth Research Organization, Kraków, Poland.
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Bartłomiej Stachera
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Dawid Plutecki
- Youthoria. Youth Research Organization, Kraków, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Monika Buziak-Bereza
- Department of Endocrynology, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria. Youth Research Organization, Kraków, Poland
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Kim SM, Sultana F, Korkmaz F, Rojekar S, Pallapati A, Ryu V, Lizneva D, Yuen T, Rosen CJ, Zaidi M. Neuroendocrinology of bone. Pituitary 2024:10.1007/s11102-024-01437-5. [PMID: 39096452 DOI: 10.1007/s11102-024-01437-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
The past decade has witnessed significant advances in our understanding of skeletal homeostasis and the mechanisms that mediate the loss of bone in primary and secondary osteoporosis. Recent breakthroughs have primarily emerged from identifying disease-causing mutations and phenocopying human bone disease in rodents. Notably, using genetically-modified rodent models, disrupting the reciprocal relationship with tropic pituitary hormone and effector hormones, we have learned that pituitary hormones have independent roles in skeletal physiology, beyond their effects exerted through target endocrine glands. The rise of follicle-stimulating hormone (FSH) in the late perimenopause may account, at least in part, for the rapid bone loss when estrogen is normal, while low thyroid-stimulating hormone (TSH) levels may contribute to the bone loss in thyrotoxicosis. Admittedly speculative, suppressed levels of adrenocorticotropic hormone (ACTH) may directly exacerbate bone loss in the setting of glucocorticoid-induced osteoporosis. Furthermore, beyond their established roles in reproduction and lactation, oxytocin and prolactin may affect intergenerational calcium transfer and therefore fetal skeletal mineralization, whereas elevated vasopressin levels in chronic hyponatremic states may increase the risk of bone loss.. Here, we discuss the interaction of each pituitary hormone in relation to its role in bone physiology and pathophysiology.
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Affiliation(s)
- Se-Min Kim
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Farhath Sultana
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Funda Korkmaz
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Satish Rojekar
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Anusha Pallapati
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Vitaly Ryu
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Daria Lizneva
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Tony Yuen
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | | | - Mone Zaidi
- Mount Sinai Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Svensson J, Ohlsson C, Karlsson MK, Herlitz H, Lorentzon M, Lewerin C, Mellström D. Higher serum free thyroxine levels are associated with increased risk of hip fractures in older men. J Bone Miner Res 2024; 39:50-58. [PMID: 38630877 PMCID: PMC11207919 DOI: 10.1093/jbmr/zjad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 04/19/2024]
Abstract
Overt and subclinical hyperthyroidism are associated with an increased fracture risk, but whether thyroid hormones are associated with fracture risk in individuals with normal thyroid-stimulating hormone (TSH) has mostly been investigated in women. Therefore, we investigated if serum levels of free thyroxine (FT4) or TSH are associated with fracture risk in Swedish men. We followed (median 12.2 yr) elderly men (n = 1825; mean age 75, range 69-81 yr) participating in the Gothenburg and Malmö subcohorts of the prospective, population-based MrOS-Sweden study. The statistical analyses included Cox proportional hazards regression. Men receiving levothyroxine treatment were excluded. In our total cohort, serum FT4 (per SD increase) was associated with increased risk of major osteoporotic fractures (MOFs; n = 479; fully adjusted hazard ratio [HR] 1.14, 95% CI, 1.05-1.24) and hip fractures (n = 207; HR 1.18, 95% CI, 1.04-1.33). Also, in men with normal TSH (n = 1658), FT4 (per SD increase) was significantly associated with increased risk of MOF and hip fractures. Furthermore, men in the highest FT4 quartile had a 1.5-fold increase in hip fracture risk compared with men in the three lower FT4 quartiles, both in the total population and in men with normal TSH (fully adjusted: HR 1.45, 95% CI, 1.04-2.02 and HR 1.51, 95% CI, 1.07-2.12, respectively). In contrast, the risk of MOF was not statistically different in the highest FT4 quartile compared with the three lower FT4 quartiles. Finally, serum TSH was not associated with fracture risk after full adjustment for covariates. In conclusion, serum FT4, but not serum TSH, is a predictor of hip fracture risk in elderly Swedish men. Additionally, there was an association between FT4 (per SD increase) and the risk of MOF.
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Affiliation(s)
- Johan Svensson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Osteoporosis Center, Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Internal Medicine, Region Västra Götaland, Skaraborg Central Hospital, Skövde SE-541 85, Sweden
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Osteoporosis Center, Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Drug Treatment, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Skane University Hospital (SUS), Lund University, Malmö SE-205 02, Sweden
| | - Hans Herlitz
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
| | - Mattias Lorentzon
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Osteoporosis Center, Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Catharina Lewerin
- Department of Hematology and Coagulation, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
| | - Dan Mellström
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Osteoporosis Center, Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg SE-413 45, Sweden
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SeyedAlinaghi S, Yarmohammadi S, Dashti M, Ghasemzadeh A, Siami H, Molla A, Mahrokhi S, Qaderi K, Arjmand G, Parikhani SN, Amrollah MF, Mirghaderi P, Mehraeen E, Dadras O. The relationship of hip fracture and thyroid disorders: a systematic review. Front Endocrinol (Lausanne) 2023; 14:1230932. [PMID: 37881501 PMCID: PMC10597696 DOI: 10.3389/fendo.2023.1230932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Bone density regulation is considered one of the systems affected by thyroid hormones, leading to low bone density that can result in pathologic fractures, including hip fractures. This review aimed to update clinicians and researchers about the current data regarding the relationship between hip fractures and thyroid disorders. Methods English papers were thoroughly searched in four main online databases of Scopus, Web of Science, PubMed, and Embase. Data extraction was done following two steps of screening/selection using distinct inclusion/exclusion criteria. This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the Newcastle-Ottawa Scale (NOS) as bias assessment. Results In total, 19 articles were included in the research. The risk of hip fractures in women with differentiated thyroid cancer (DTC) is higher than hip fractures caused by osteoporosis. Men with hyperthyroidism and subclinical hyperthyroidism are at higher risk for hip fracture. Also, a decrease in serum thyroid stimulating hormone (TSH) may be associated with an increased risk of hip fracture. Conclusion Reaching a consensus conclusion regarding the association between subclinical thyroid dysfunction and hip fracture is not feasible due to the heterogenicity of evidence; however, there may be a higher risk of fracture in individuals with subclinical hyperthyroidism.
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Affiliation(s)
- SeyedAhmad SeyedAlinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohsen Dashti
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afsaneh Ghasemzadeh
- Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Siami
- School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Ayoob Molla
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Sona Mahrokhi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Kowsar Qaderi
- Department of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghazal Arjmand
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoomeh Fathi Amrollah
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Mirghaderi
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Omid Dadras
- Bergen Addiction Research, Department of Addiction Medicine, Haukland University Hospital, Bergen, Norway
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Hong AR, Kang HC. Evaluation and Management of Bone Health in Patients with Thyroid Diseases: A Position Statement of the Korean Thyroid Association. Endocrinol Metab (Seoul) 2023; 38:175-189. [PMID: 37150514 PMCID: PMC10164499 DOI: 10.3803/enm.2023.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Thyroid hormones play an important physiological role in maintaining adult bone structure and strength. Consequently, thyroid dysfunction is related to skeletal outcomes. Overt hyperthyroidism is an established cause of high bone turnover with accelerated bone loss, leading to osteoporosis and increased fracture risk. Hyperthyroidism induced by thyroid-stimulating hormone-suppressive therapy in patients with differentiated thyroid cancer is a cause of secondary osteoporosis. In contrast, there is a lack of evidence on the negative impact of hypothyroidism on bone health. Considering the clinical updates on the importance of bone health in thyroid dysfunction, the Task Force from the Clinical Practice Guidelines Development Committee of the Korean Thyroid Association recently developed a position statement on the evaluation and management of bone health of patients with thyroid diseases, particularly focused on endogenous hyperthyroidism and thyroid-stimulating hormone-suppressive therapy-associated hyperthyroidism in patients with differentiated thyroid cancer. Herein, we review the Korean Thyroid Association's position statement on the evaluation and management of bone health associated with thyroid diseases.
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Affiliation(s)
- A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Daya NR, Fretz A, Martin SS, Lutsey PL, Echouffo-Tcheugui JB, Selvin E, Juraschek SP. Association Between Subclinical Thyroid Dysfunction and Fracture Risk. JAMA Netw Open 2022; 5:e2240823. [PMID: 36346629 PMCID: PMC9644261 DOI: 10.1001/jamanetworkopen.2022.40823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Clinical hyperthyroidism accelerates bone resorption without compensatory bone formation, reducing bone density and increasing the risk of fracture. The association between subclinical hyperthyroidism and fracture risk is less clear. OBJECTIVE To investigate the association of endogenous subclinical thyroid dysfunction and fracture risk, independent of clinical confounders. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 10 946 participants from the Atherosclerosis Risk in Communities Study, an ongoing prospective cohort study of community-dwelling individuals conducted from 1987-1989 through December 31, 2019, in Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and the suburbs of Minneapolis, Minnesota. Participants were not taking thyroid medications and had no history of fractures. EXPOSURES Thyrotropin and free thyroxine levels were measured at visit 2 (1990-1992). Subclinical hyperthyroidism was defined as a thyrotropin level lower than 0.56 mIU/L, subclinical hypothyroidism as a thyrotropin level higher than 5.1 mIU/L, and euthyroidism as a thyrotropin level of 0.56 to 5.1 mIU/L, with normal free thyroxine levels from 0.85 to 1.4 ng/dL. MAIN OUTCOMES AND MEASURES Incident fracture was ascertained using hospitalization discharge codes through 2019 and linkage to inpatient and outpatient Medicare claims through 2018. RESULTS Of 10 946 participants (54.3% women; mean [SD] age, 57 [5.7] years), 93.0% had euthyroidism, 2.6% had subclinical hyperthyroidism, and 4.4% had subclinical hypothyroidism. During a median follow-up of 21 years (IQR, 13.0-27.3 years), there were 3556 incident fractures (167.1 per 10 000 person-years). The adjusted hazard ratios of fracture were 1.34 (95% CI, 1.09-1.65) for those with subclinical hyperthyroidism and 0.90 (95% CI, 0.77-1.05) for those with subclinical hypothyroidism compared with individuals with euthyroidism. Among those with normal free thyroxine levels, thyrotropin levels in the lower-than-normal range were significantly associated with higher fracture-related hospitalization risk; fracture risk was greater among individuals with thyrotropin concentrations below 0.56 mIU/L. CONCLUSIONS AND RELEVANCE This community-based cohort study suggests that subclinical hyperthyroidism was an independent risk factor associated with fracture. The increased risk for fracture among individuals with a thyrotropin level lower than 0.56 mIU/L highlights a potential role for more aggressive screening and monitoring of patients with subclinical hyperthyroidism to prevent bone mineral disease.
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Affiliation(s)
- Natalie R. Daya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anna Fretz
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco
| | - Seth S. Martin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - Justin B. Echouffo-Tcheugui
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen P. Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Fang H, Zhao R, Cui S, Wan W. Sex differences in major cardiovascular outcomes and fractures in patients with subclinical thyroid dysfunction: a systematic review and meta-analysis. Aging (Albany NY) 2022; 14:8448-8485. [DOI: 10.18632/aging.204352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Hongjuan Fang
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Runsheng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Neurological Diseases, Center for Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shuang Cui
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiqing Wan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Neurological Diseases, Center for Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Kim SM, Ryu V, Miyashita S, Korkmaz F, Lizneva D, Gera S, Latif R, Davies TF, Iqbal J, Yuen T, Zaidi M. Thyrotropin, Hyperthyroidism, and Bone Mass. J Clin Endocrinol Metab 2021; 106:e4809-e4821. [PMID: 34318885 PMCID: PMC8864741 DOI: 10.1210/clinem/dgab548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Thyrotropin (TSH), traditionally seen as a pituitary hormone that regulates thyroid glands, has additional roles in physiology including skeletal remodeling. Population-based observations in people with euthyroidism or subclinical hyperthyroidism indicated a negative association between bone mass and low-normal TSH. The findings of correlative studies were supported by small intervention trials using recombinant human TSH (rhTSH) injection, and genetic and case-based evidence. Genetically modified mouse models, which disrupt the reciprocal relationship between TSH and thyroid hormone, have allowed us to examine an independent role of TSH. Since the first description of osteoporotic phenotype in haploinsufficient Tshr +/- mice with normal thyroid hormone levels, the antiosteoclastic effect of TSH has been documented in both in vitro and in vivo studies. Further studies showed that increased osteoclastogenesis in Tshr-deficient mice was mediated by tumor necrosis factor α. Low TSH not only increased osteoclastogenesis, but also decreased osteoblastogenesis in bone marrow-derived primary osteoblast cultures. However, later in vivo studies using small and intermittent doses of rhTSH showed a proanabolic effect, which suggests that its action might be dose and frequency dependent. TSHR was shown to interact with insulin-like growth factor 1 receptor, and vascular endothelial growth factor and Wnt pathway might play a role in TSH's effect on osteoblasts. The expression and direct skeletal effect of a biologically active splice variant of the TSHβ subunit (TSHβv) in bone marrow-derived macrophage and other immune cells suggest a local skeletal effect of TSHR. Further studies of how locally secreted TSHβv and systemic TSHβ interact in skeletal remodeling through the endocrine, immune, and skeletal systems will help us better understand the hyperthyroidism-induced bone disease.
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Affiliation(s)
- Se-Min Kim
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Vitaly Ryu
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sari Miyashita
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Funda Korkmaz
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Daria Lizneva
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Sakshi Gera
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Rauf Latif
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Terry F Davies
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jameel Iqbal
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Tony Yuen
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mone Zaidi
- The Mount Sinai Bone Program, Departments of Pharmacological Sciences and of Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence: The Mount Sinai Bone Program, Departments of Pharmacological Sciences and Medicine, and Center of Translational Medicine and Pharmacology, Icahn School of Medicine at Mount Sinai, 1428 Madison Avenue, 4th Floor, Box 1055, New York, NY 10029, USA.
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10
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Svensson J, Ohlsson C, Karlsson MK, Lorentzon M, Lewerin C, Mellström D. Subclinical hyperthyroidism is associated with increased risk of vertebral fractures in older men. Osteoporos Int 2021; 32:2257-2265. [PMID: 34013460 PMCID: PMC8563553 DOI: 10.1007/s00198-021-05964-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED In elderly men included in MrOS-Sweden, subclinical hyperthyroidism (SHyper) was markedly associated with increased risk of vertebral fractures. INTRODUCTION Overt hyperthyroidism is associated with increased risk of fractures. However, only a few studies have investigated whether SHyper is associated with fracture risk in elderly men. We therefore investigated if SHyper was a risk factor for fractures in Swedish men. METHODS We followed (median 9.8 years) elderly men (n = 1856; mean age 75, range 69-81 years) participating in the Gothenburg and Malmö subcohorts of the prospective, population-based MrOS-Sweden study. The statistical analyses included Cox proportional hazards regression. SHyper was defined as serum thyroid-stimulating hormone (TSH) < 0.45 mIU/L (n = 38). RESULTS SHyper was associated with increased risk of all fractures [n = 456; hazard ratio (HR) adjusted for age, study center, and levothyroxine treatment = 1.99, 95% confidence interval (CI): 1.20-3.32], major osteoporotic fractures (MOF, n = 338; HR 2.44, 95% CI: 1.42-4.21), and vertebral fractures (n = 176; HR 3.79, 95% CI: 2.02-7.11). These associations remained after full adjustment for covariates including total hip bone mineral density and in subanalyses including only men with serum free thyroxine ≤ the upper normal limit. However, after exclusion of men receiving levothyroxine treatment, the associations with all fractures and MOF lost significance. CONCLUSIONS In elderly Swedish men, there was a strong association between SHyper and increased risk of vertebral fractures, whereas the associations with all incident fractures and MOF need to be confirmed in further studies.
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Affiliation(s)
- J Svensson
- Center for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Internal Medicine, Region Västra Götaland, Skaraborg Central Hospital, Skövde, Sweden.
- Department of Internal Medicine, Sahlgrenska University Hospital, Gröna Stråket 8, SE-413 45, Gothenburg, Sweden.
| | - C Ohlsson
- Center for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Malmö, Sweden
| | - M Lorentzon
- Center for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - C Lewerin
- Department of Hematology and Coagulation, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Mellström
- Center for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Ahmad T, Muhammad ZA, Nadeem S. Is Hypothyroidism Associated With Outcomes in Fracture Patients? Data From a Trauma Registry. J Surg Res 2021; 268:527-531. [PMID: 34464889 DOI: 10.1016/j.jss.2021.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previous research reports suggesting the susceptibility of patients with hypothyroidism to fragility fractures. The current study aimed to compare injury factors, patient factors, and outcomes of fractures in patients with and without hypothyroidism. METHODS Study data were extracted from an ongoing single-center prospective orthopaedic trauma registry at a tertiary care hospital. Patients recruited between June 2015 and March 2020 were selected. Patients were grouped into those with and without hypothyroidism, and data on injury factors, management, clinical, and functional outcomes up to 6 mo were compared. Relation of fracture with TSH levels and age was analyzed, and prescription of bone-strengthening supplements was recorded in the hypothyroid group. RESULTS Among 1347 patients recruited in the trauma registry, 35 patients had hypothyroidism of which 77% were females compared to 30% of euthyroid subjects (P = 0.0001). The most commonly involved anatomic sites identified were the proximal femur and proximal humerus. Low-energy trauma more likely occurred in hypothyroid (71%) compared to 32% of euthyroid subjects (P < 0.001). Osteoporosis was identified in 90% of hypothyroid subjects who underwent a DEXA scan. The clinical and functional outcomes of patients seem to be similar in both groups, possibly due to adequate control of hypothyroidism or the effect of bone-strengthening supplements given to hypothyroid patients. Serum TSH level and age were not related to low-energy trauma in hypothyroid patients. CONCLUSIONS The current study identified that patients with hypothyroidism presenting with fractures are more likely females with low-energy trauma, involving the proximal femoral, and humeral fractures. Thyroid status was not associated with post-management outcomes.
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Affiliation(s)
- Tashfeen Ahmad
- Department of Surgery, Aga Khan University, Karachi, Pakistan; Department of Biological & Biomedical Sciences, Aga Khan University, Karachi, Pakistan.
| | | | - Sarah Nadeem
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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12
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Romero-Márquez JM, Varela-López A, Navarro-Hortal MD, Badillo-Carrasco A, Forbes-Hernández TY, Giampieri F, Domínguez I, Madrigal L, Battino M, Quiles JL. Molecular Interactions between Dietary Lipids and Bone Tissue during Aging. Int J Mol Sci 2021; 22:ijms22126473. [PMID: 34204176 PMCID: PMC8233828 DOI: 10.3390/ijms22126473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 01/06/2023] Open
Abstract
Age-related bone disorders such as osteoporosis or osteoarthritis are a major public health problem due to the functional disability for millions of people worldwide. Furthermore, fractures are associated with a higher degree of morbidity and mortality in the long term, which generates greater financial and health costs. As the world population becomes older, the incidence of this type of disease increases and this effect seems notably greater in those countries that present a more westernized lifestyle. Thus, increased efforts are directed toward reducing risks that need to focus not only on the prevention of bone diseases, but also on the treatment of persons already afflicted. Evidence is accumulating that dietary lipids play an important role in bone health which results relevant to develop effective interventions for prevent bone diseases or alterations, especially in the elderly segment of the population. This review focuses on evidence about the effects of dietary lipids on bone health and describes possible mechanisms to explain how lipids act on bone metabolism during aging. Little work, however, has been accomplished in humans, so this is a challenge for future research.
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Affiliation(s)
- Jose M. Romero-Márquez
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - Alfonso Varela-López
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - María D. Navarro-Hortal
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - Alberto Badillo-Carrasco
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
| | - Tamara Y. Forbes-Hernández
- Nutrition and Food Science Group, Department of Analytical and Food Chemistry, CITACA, CACTI, University of Vigo, 36310 Vigo, Spain;
| | - Francesca Giampieri
- Department of Clinical Sicences, Università Politecnica delle Marche, 60131 Ancona, Italy; (F.G.); (M.B.)
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Irma Domínguez
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain;
- Universidad Internacional Iberoamericana, Calle 15 Num. 36, Entre 10 y 12 IMI III, Campeche 24560, Mexico;
| | - Lorena Madrigal
- Universidad Internacional Iberoamericana, Calle 15 Num. 36, Entre 10 y 12 IMI III, Campeche 24560, Mexico;
| | - Maurizio Battino
- Department of Clinical Sicences, Università Politecnica delle Marche, 60131 Ancona, Italy; (F.G.); (M.B.)
- International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China
| | - José L. Quiles
- Department of Physiology, Institute of Nutrition and Food Technology ‘‘José Mataix”, Biomedical Research Centre, University of Granada, Armilla, Avda. del Conocimiento s.n., 18100 Armilla, Spain; (J.M.R.-M.); (A.V.-L.); (M.D.N.-H.); (A.B.-C.)
- Research Group on Foods, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain;
- Correspondence:
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13
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Effraimidis G, Watt T, Feldt-Rasmussen U. Levothyroxine Therapy in Elderly Patients With Hypothyroidism. Front Endocrinol (Lausanne) 2021; 12:641560. [PMID: 33790867 PMCID: PMC8006441 DOI: 10.3389/fendo.2021.641560] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/03/2021] [Indexed: 01/06/2023] Open
Abstract
Levothyroxine (L-T4) treatment of overt hypothyroidism can be more challenging in elderly compared to young patients. The elderly population is growing, and increasing incidence and prevalence of hypothyroidism with age are observed globally. Elderly people have more comorbidities compared to young patients, complicating correct diagnosis and management of hypothyroidism. Most importantly, cardiovascular complications compromise the usual start dosage and upward titration of L-T4 due to higher risk of decompensating cardiac ischemia and -function. It therefore takes more effort and care from the clinician, and the maintenance dose may have to be lower in order to avoid a cardiac incidence. On the other hand, L-T4 has a beneficial effect on cardiac function by increasing performance. The clinical challenge should not prevent treating with L-T4 should the patient develop e.g., cardiac ischemia. The endocrinologist is obliged to collaborate with the cardiologist on prophylactic cardiac measures by invasive cardiac surgery or medical therapy against cardiac ischemic angina. This usually allows subsequent successful treatment. Management of mild (subclinical) hypothyroidism is even more complex. Prevalent comorbidities in the elderly complicate correct diagnosis, since many concomitant morbidities can result in non-thyroidal illness, resembling mild hypothyroidism both clinically and biochemically. The diagnosis is further complicated as methods for measuring thyroid function (thyrotropin and thyroxine) vary immensely according to methodology and background population. It is thus imperative to ensure a correct diagnosis by etiology (e.g., autoimmunity) before deciding to treat. Even then, there is controversy regarding whether or not treatment of such mild forms of hypothyroidism in elderly will improve mortality, morbidity, and quality of life. This should be studied in large cohorts of patients in long-term placebo-controlled trials with clinically relevant outcomes. Other cases of hypothyroidism, e.g., medications, iodine overload or hypothalamus-pituitary-hypothyroidism, each pose specific challenges to management of hypothyroidism; these cases are also more frequent in the elderly. Finally, adherence to treatment is generally challenging. This is also the case in elderly patients, which may necessitate measuring thyroid hormones at individually tailored intervals, which is important to avoid over-treatment with increased risk of cardiac morbidity and mortality, osteoporosis, cognitive dysfunction, and muscle deficiency.
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Affiliation(s)
- Grigoris Effraimidis
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torquil Watt
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Endocrine Section, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology and Metabolism, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Cellini M, Rotondi M, Tanda ML, Piantanida E, Chiovato L, Beck-Peccoz P, Lania A, Mazziotti G. Skeletal health in patients with differentiated thyroid carcinoma. J Endocrinol Invest 2021; 44:431-442. [PMID: 32696339 DOI: 10.1007/s40618-020-01359-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Osteoporosis and fractures are important comorbidities in patients with differentiated thyroid cancer (DTC), with potential negative impact on quality of life and survival. The main determinant of skeletal fragility in DTC is the thyrotropin (TSH)-suppressive therapy, which is commonly recommended to prevent disease's recurrence, especially in patients with structural incomplete response after thyroid surgery and radio-iodine therapy. TSH-suppressive therapy can stimulate bone resorption with consequent bone loss, deterioration of bone microstructure and high risk of fragility fractures. The skeletal effects of TSH-suppressive therapy may be amplified when thyroid cancer cells localize to the skeleton inducing alterations in bone remodelling, impairment of bone structure and further increase in risk of fractures. The management of skeletal fragility in DTC may be challenging, since prediction of fractures is a matter of uncertainty and data on effectiveness and safety of bone-active agents in this clinical setting are still scanty. This review deals with pathophysiological, clinical and therapeutic aspects of skeletal fragility of patients with DTC.
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Affiliation(s)
- M Cellini
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - M Rotondi
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - M L Tanda
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - E Piantanida
- Department of Medicine and Surgery, Endocrine Unit, University of Insubria, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy
| | - L Chiovato
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy
| | - P Beck-Peccoz
- University of Milan, Via Pietro Custodi 16, 20136, Milan, Italy
| | - Andrea Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090, Milan, Italy
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15
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Lakatos P, Szili B, Bakos B, Takacs I, Putz Z, Istenes I. Thyroid Hormones, Glucocorticoids, Insulin, and Bone. Handb Exp Pharmacol 2020; 262:93-120. [PMID: 32036458 DOI: 10.1007/164_2019_314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Several endocrine systems have important effects on bone tissue. Thyroid hormones are essential for normal growth and development. Excess of these hormones will result in clinically significant changes that may require intervention. Glucocorticoids also have a marked effect on bone metabolism by several pathways. Their endogenous or exogenous excess will induce pathological processes that might elevate the risk of fractures. Insulin and the carbohydrate metabolism elicit a physiological effect on bone; however, the lack of insulin (type 1 diabetes) or insulin resistance (type 2 diabetes) have deleterious influence on bone tissue.
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Affiliation(s)
- Peter Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
| | - Balazs Szili
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Bakos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Istvan Takacs
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Putz
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Ildiko Istenes
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
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16
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Muller I, Taylor PN, Daniel RM, Hales C, Scholz A, Candler T, Pettit RJ, Evans WD, Shillabeer D, Draman MS, Dayan CM, Tang HKC, Okosieme O, Gregory JW, Lazarus JH, Rees DA, Ludgate ME. CATS II Long-term Anthropometric and Metabolic Effects of Maternal Sub-optimal Thyroid Function in Offspring and Mothers. J Clin Endocrinol Metab 2020; 105:5836234. [PMID: 32396189 DOI: 10.1210/clinem/dgaa129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/01/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT AND OBJECTIVES The Controlled Antenatal Thyroid Screening Study I (CATS-I) was a randomized controlled trial investigating the effects of levothyroxine therapy for suboptimal gestational thyroid function (SGTF), comparing outcomes in children of treated (SGTF-T) with untreated (SGTF-U) women during pregnancy. This follow-up study, CATS-II, reports the long-term effects on anthropometric, bone, and cardiometabolic outcomes in mothers and offspring and includes a group with normal gestational thyroid function (NGTF). DESIGN & PARTICIPANTS 332 mothers (197 NGTF, 56 SGTF-U, 79 SGTF-T) aged 41.2±5.3 years (mean±SD) and 326 paired children assessed 9.3±1.0 years after birth for (i) body mass index (BMI); (ii) lean, fat, and bone mass by dual-energy X-ray absorptiometry; (iii) blood pressure, augmentation index, and aortic pulse-wave-velocity; and (iv) thyroid function, lipids, insulin, and adiponectin. The difference between group means was compared using linear regression. RESULTS Offspring's measurements were similar between groups. Although maternal BMI was similar between groups at CATS-I, after 9 years (at CATS-II) SGTF-U mothers showed higher BMI (median [interquartile ratio] 28.3 [24.6-32.6] kg/m2) compared with NGTF (25.8 [22.9-30.0] kg/m2; P = 0.029), driven by fat mass increase. At CATS-II SGTF-U mothers also had higher thyroid-stimulating hormone (TSH) values (2.45 [1.43-3.50] mU/L) than NGTF (1.54 [1.12-2.07] mU/L; P = 0.015), since 64% had never received levothyroxine. At CATS-II, SGTF-T mothers had BMI (25.8 [23.1-29.8] kg/m2, P = 0.672) and TSH (1.68 [0.89-2.96] mU/L; P = 0.474) values similar to NGTF mothers. CONCLUSIONS Levothyroxine supplementation of women with SGTF did not affect long-term offspring anthropometric, bone, and cardiometabolic measurements. However, absence of treatment was associated with sustained long-term increase in BMI and fat mass in women with SGTF.
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Affiliation(s)
- Ilaria Muller
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Endocrinology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Peter N Taylor
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Rhian M Daniel
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Charlotte Hales
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Scholz
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Toby Candler
- MRC The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca J Pettit
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - William D Evans
- Radiology, Medical Physics and Clinical Engineering Directorate, University Hospital of Wales, Cardiff, UK
| | - Dionne Shillabeer
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mohd S Draman
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Colin M Dayan
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Hiu K C Tang
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
- Department of Oncology, Nottingham University NHS Trust, Nottingham, UK
| | - Onyebuchi Okosieme
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - John H Lazarus
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff, UK
| | - Marian E Ludgate
- Thyroid Research Group, Division of Infection & Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Xu N, Wang Y, Xu Y, Li L, Chen J, Mai X, Xu J, Zhang Z, Yang R, Sun J, Chen H, Chen R. Effect of subclinical hyperthyroidism on osteoporosis: A meta-analysis of cohort studies. Endocrine 2020; 69:39-48. [PMID: 32207036 DOI: 10.1007/s12020-020-02259-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The effect of subclinical hyperthyroidism (SH) on bone mineral density (BMD) remains unclear, as do the linking mechanisms. This review aims to investigate the relationship between SH and bone loss in terms of the gender-dependent effects of SH on BMD. METHODS The PUBMED, EMBASE, OVID, MEDLINE, SINOMED and COCHRANE LIBRARY databases (inception to August 12, 2019) were searched for cohort studies investigating the effects of SH on BMD. Eligible studies were subjected to qualitative and quantitative analysis using a random-effects model meta-analysis with the Cochrane systematic evaluation method. RESULTS Twelve cohort studies involving 275,086 participants who were followed for 3 months to 13 years were included based on predefined inclusion and exclusion criteria. The results indicated that SH did not affect lumbar spine BMD in females or males. However, a significant reduction in femoral neck BMD was observed in females, but not in males. Further, there was a significant increase in hip fractures events in both females and males with SH. CONCLUSIONS The present findings indicate that SH is significantly associated with hip fracture risk, and therefore, it is important to assess the risk of fractures in patients with SH. Future studies should focus on methods for accurately determining this risk in patients with SH and providing them with timely and efficient diagnosis and treatment.
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Affiliation(s)
- Ningning Xu
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yaxian Wang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuying Xu
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lishan Li
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiaqi Chen
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xudong Mai
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Xu
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen Zhang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Yang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Sun
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hong Chen
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Rongping Chen
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Hawkins Carranza F, Guadalix Iglesias S, Luisa De Mingo Domínguez M, Martín-Arriscado Arroba C, López Álvarez B, Allo Miguel G, Martínez Díaz-Guerra G. Trabecular bone deterioration in differentiated thyroid cancer: Impact of long-term TSH suppressive therapy. Cancer Med 2020; 9:5746-5755. [PMID: 32583973 PMCID: PMC7433843 DOI: 10.1002/cam4.3200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 01/16/2023] Open
Abstract
Background Conflicting results has been reported regard osteoporosis and fractures in patients with Differentiated Thyroid Cancer (DTC). Our objective was to evaluate the long‐term effects of TSH suppression therapy with Levothyroxine (LT4) on trabecular bone score (TBS) and bone mineral density (BMD) in females with DTC after thyroidectomy. Methods About 145 women with resected DTC and receiving long‐term TSH therapy, were stratified according to the degree of TSH suppression. Mean duration of follow‐up was 12.3 ± 6.1 years. BMD and TBS, were assessed using dual‐energy X‐ray absorptiometry (DXA) and TBS iNsight (Med‐Imaps), at baseline (1‐3 months after surgery) and at the final study visit. Results In patients stratified by duration of TSH suppression therapy (Group I, 5‐10 years; Group II, >10 years), slight increases from baseline TSH levels were observed. Significant decreases in LS‐BMD and FN‐BMD were seen in patients after >10 years. TBS values were lower in Groups I (1.289 ± 0.122) and II (1.259 ± 0.129) compared with baseline values (P = .0001, both groups). Regarding the degree of TSH suppression, TBS was significantly reduced in those with TSH < 0.1 µU/mL (P = .0086), and not in patients with TSH suppression of 0.1.‐0.5 or >0.5 µU/mL. Conclusions We found deterioration of trabecular structure in patients with DTC and TSH suppression therapy below 0.1 µU/mL and after 5‐10 years of follow‐up. Significant changes in BMD according to TSH levels were not observed. Trabecular Bone Score is a useful technique for identifying thyroid cancer patients with risk of bone deterioration.
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Colicino E, Pedretti NF, Busgang SA, Gennings C. Per- and poly-fluoroalkyl substances and bone mineral density: Results from the Bayesian weighted quantile sum regression. Environ Epidemiol 2020; 4:e092. [PMID: 32613152 PMCID: PMC7289141 DOI: 10.1097/ee9.0000000000000092] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/04/2020] [Indexed: 01/09/2023] Open
Abstract
Per- and poly-fluoroalkyl substances (PFAS) are chemicals, detected in 95% of Americans, that induce osteotoxicity and modulate hormones, thereby influencing bone health. Previous studies found associations between individual PFAS and bone mineral density in adults but did not analyze their combined effects. OBJECTIVE To extend weighted quantile sum (WQS) regression to a Bayesian framework (Bayesian extension of the WQS regression [BWQS]) and determine the association between a mixture of serum PFAS and mineral density in lumbar spine, total, and neck femur in 499 adults from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). METHODS We used BWQS to assess the combined association of eight PFAS, as a mixture, with bone mineral density in adults. As secondary analyses, we focused on vulnerable populations (men over 50 years and postmenopausal women). Analyses were adjusted for sociodemographic factors. Sensitivity analyses included bone mineral density associations with individual compounds and results from WQS regressions. RESULTS The mean age was 55 years old (SD = 1) with average spine, total, and neck femur mineral densities of 1.01 (SD = 0.01), 0.95 (SD = 0.01), and 0.78 (SD = 0.01) gm/cm2, respectively. PFAS mixture levels showed no evidence of association with mineral density (spine: β = -0.004; 95% credible interval [CrI] = -0.04, 0.04; total femur: β = 0.002; 95% CrI = -0.04, 0.05; femur neck: β = 0.005; 95%CrI = -0.03, 0.04) in the overall population. Results were also null in vulnerable populations. Findings were consistent across sensitivity analyses. CONCLUSIONS We introduced a Bayesian extension of WQS and found no evidence of the association between PFAS mixture and bone mineral density.
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Affiliation(s)
- Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicolo Foppa Pedretti
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stefanie A. Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
INTRODUCTION Hypothyroidism is a common but often unrecognized condition associated with significant morbidity in the older adult population. This study characterizes a large population of older adults diagnosed with hypothyroidism and examines concordance of their treatment with recommendations from expert bodies, e.g., the American Thyroid Association and American Association of Clinical Endocrinologists. METHODS Individuals seen in general and/or specialty practices who were age ≥ 65 years and diagnosed with hypothyroidism were included in this observational, retrospective cohort study using a large US claims database. Analyses describe the population and examine the prevalence of hypothyroidism, treatment with levothyroxine and, among those treated, whether TSH laboratory values are within a guideline-recommended target range. RESULTS Prevalence of hypothyroidism in this older adult population increased from 5.62% to 8.24% over the 2007-2015 period. Among older adults diagnosed with hypothyroidism (N = 4025), a substantial proportion (28.0%) did not receive levothyroxine therapy, and, of those who were receiving such therapy (N = 2899), 32.9% did not have evidence of being monitored to determine whether the dosage was appropriate. Moreover, the laboratory results of those who were treated suggest that a significant proportion (17.4%) had a TSH level above the recommended target range, while TSH levels for a smaller proportion (3.7%) were below target. CONCLUSIONS Many older adults diagnosed with hypothyroidism may not have received medical care complying with clinical practice guidelines. Results of this study reveal a number of areas to target to potentially improve the treatment of older adults with hypothyroidism.
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The Influence of Thyroid Pathology on Osteoporosis and Fracture Risk: A Review. Diagnostics (Basel) 2020; 10:diagnostics10030149. [PMID: 32156092 PMCID: PMC7151086 DOI: 10.3390/diagnostics10030149] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/14/2022] Open
Abstract
Thyroid hormones are important factors that regulate metabolism and cell differentiation throughout the human body. A complication of thyroid pathology is represented by an alteration of the bone metabolism which can lead to osteoporosis and fragility fractures, known to have a high mortality rate. Although there is a consensus on the negative impact of hyperthyroidism on bone metabolism, when referring to hypothyroidism, subclinical hypothyroidism, or subclinical hyperthyroidism, there is no general agreement. The aim of our review was to update clinicians and researchers about the current data regarding the bone health in hypothyroidism, subclinical hypothyroidism, and subclinical hyperthyroidism patients. Thyroid disorders have an important impact on bone metabolism and fracture risk, such that hyperthyroidism, hypothyroidism, and subclinical hyperthyroidism are associated with a decreased bone mineral density (BMD) and increased risk of fracture. Subclinical hypothyroidism, on the other hand, is not associated with osteoporosis or fragility fractures, and subclinical hyperthyroidism treatment with radioiodine could improve bone health.
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Zhu H, Zhang J, Wang J, Zhao X, Gu M. Association of subclinical thyroid dysfunction with bone mineral density and fracture: a meta-analysis of prospective cohort studies. Endocrine 2020; 67:685-698. [PMID: 31721088 DOI: 10.1007/s12020-019-02110-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/01/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To comprehensively investigate the associations of subclinical thyroid dysfunction with BMD and fractures at various sites. METHODS Comprehensive electronic and manual searches of databases were systematically conducted to identify prospective cohort studies from the inception of the databases to May 2019. The summary results for fractures and BMDs at various sites were calculated by relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) using the random-effects model. RESULTS Seventeen prospective cohorts from 24 studies were identified and 313,557 individuals were recruited in a final analysis. The summary RR indicated that subclinical hyperthyroidism was associated with an increased risk of any fracture (RR, 1.17; 95% CI, 1.08-1.26; P < 0.001), hip fracture (RR, 1.27; 95% CI, 1.09-1.48; P = 0.003), spine fracture (RR, 1.97; 95% CI, 1.31-2.97; P = 0.001), and non-spine fracture (RR, 1.19; 95% CI, 1.04-1.37; P = 0.014). However, there were no significant associations of subclinical hypothyroidism with the risk of any fractures (P = 0.166), hip fracture (P = 0.068), spine fracture (P = 0.818), and non-spine fracture (P = 0.277). Finally, subclinical hyperthyroidism was associated with lower distal forearm BMD in women, and ultradistal forearm BMD in both men and women, whereas subclinical hypothyroidism was associated with higher femur neck BMD in women. CONCLUSION Subclinical hyperthyroidism could induce additional risk on fractures at any, hip, spine, and non-spine, whereas subclinical hypothyroidism did not have any impact on fractures. Moreover, BMD at the lower distal and ultradistal forearms might be affected by subclinical hyperthyroidism, and higher femur neck BMD could be affected by subclinical hypothyroidism.
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Affiliation(s)
- Hongling Zhu
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Second Military Medical University, Shanghai, 200135, China
| | - Jichen Zhang
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Second Military Medical University, Shanghai, 200135, China
| | - Jingnan Wang
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Second Military Medical University, Shanghai, 200135, China
| | - Xuemei Zhao
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Second Military Medical University, Shanghai, 200135, China
| | - Mingjun Gu
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Second Military Medical University, Shanghai, 200135, China.
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Bel Lassen P, Kyrilli A, Lytrivi M, Corvilain B. Graves' disease, multinodular goiter and subclinical hyperthyroidism. ANNALES D'ENDOCRINOLOGIE 2019; 80:240-249. [PMID: 31427038 DOI: 10.1016/j.ando.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/27/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022]
Abstract
Subclinical hyperthyroidism is a common clinical entity, defined by serum TSH below the reference range, with normal FT4 and FT3 levels in an asymptomatic patient. Whether or not subclinical hyperthyroidism should be treated remains a matter of debate. Cross-sectional and longitudinal population-based studies demonstrate association of subclinical hyperthyroidism with risk of atrial fibrillation and osteoporosis, and with cardiovascular and all-cause mortality. However, there are no randomized clinical trials addressing whether long-term health outcomes are improved by treating subclinical hyperthyroidism; in the absence of evidence one way or the other, it seems appropriate to use decision trees taking account of TSH concentration and presence of risk factors (age>65 years or post-menopause, osteoporosis and cardiac disease).
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Affiliation(s)
- Pierre Bel Lassen
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium; UMRS 1166 (Inserm), 91, boulevard de l'Hôpital, 75013 Paris, France.
| | - Aglaia Kyrilli
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
| | - Maria Lytrivi
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
| | - Bernard Corvilain
- Department of endocrinology, université Libre de Bruxelles, Erasme University Hospital, route de Lennik 808, 1070 Brussels, Belgium
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Abstract
Thyroid hormone suppression therapy is designed to lower serum thyrotropin (TSH) levels using doses of thyroid hormone in excess of what would normally be required to maintain a euthyroid state. The basis of this therapy is the knowledge that TSH is a growth factor for thyroid cancer, so that lower serum TSH levels might be associated with decreased disease activity. However, clinical studies have not documented improved outcomes with TSH suppression, except in patients with the most advanced disease. Furthermore, there are a number of negative outcomes related to aggressive thyroid hormone therapy, including osteoporosis, fracture, and cardiovascular disease. Therefore, a graded approach to TSH suppression is recommended by the American Thyroid Association, based on initial risk and ongoing risk assessment.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Naples 80131, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
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Yoon BH, Lee Y, Oh HJ, Kim SH, Lee YK. Influence of Thyroid-stimulating Hormone Suppression Therapy on Bone Mineral Density in Patients with Differentiated Thyroid Cancer: A Meta-analysis. J Bone Metab 2019; 26:51-60. [PMID: 30899725 PMCID: PMC6416150 DOI: 10.11005/jbm.2019.26.1.51] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background The effects of subclinical hyperthyroidism on bone mineral density (BMD) induced by thyroid-stimulating hormone (TSH) suppression therapy in patients with differentiated thyroid cancer (DTC) remains unclear. We conducted a meta-analysis to determine the influence of TSH suppression therapy on BMD. Methods We performed a systematic search to identify studies which included BMD measurement of femoral neck, total hip or lumbar spine in patients on TSH suppression therapy for DTC. Main outcome measures were difference of BMD of femoral neck, total hip or lumbar spine measured by dual energy X-ray absorptiometry between patients and controls. Results A systematic search yielded a total of 11 published controlled cross-sectional studies (including about 571 patients and 836 controls). TSH suppression therapy was associated with the lower BMD of total hip (weighted mean difference [WMD], -0.023; 95% confidence interval [CI], -0.047 to 0.000; P=0.050) and spine (WMD, -0.041; 95% CI, -0.057 to -0.026; P<0.001) in postmenopausal women with DTC, while it was not associated with that in premenopausal women and men with DTC. Conclusions Although the included studies were limited by small numbers, results suggested possible association between chronic TSH suppression therapy and the lower BMD of spine and total hip in postmenopausal women (but not in premenopausal women and men) with DTC. A large, well-designed study with long-term follow-up would provide further insight into the influence of TSH suppression therapy and loss of BMD.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Youjin Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Hyun Jin Oh
- Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea
| | - Sung Han Kim
- Department of Urology, Urological Cancer Center, National Cancer Center, Goyang, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Lee Y, Yoon BH, Lee S, Chung YK, Lee YK. Risk of Osteoporotic Fractures after Thyroid-stimulating Hormone Suppression Therapy in Patients with Thyroid Cancer. J Bone Metab 2019; 26:45-50. [PMID: 30899724 PMCID: PMC6416149 DOI: 10.11005/jbm.2019.26.1.45] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
- Youjin Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
| | - Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea
| | - Seeyoun Lee
- Department of Surgery, National Cancer Center, Goyang, Korea
| | - Youn Kyung Chung
- Department of Obstetrics and Gynecology, National Cancer Center, Goyang, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Abstract
BACKGROUND Both overt hypothyroidism as well as minor elevations of serum thyrotropin (TSH) levels associated with thyroid hormones within their respective reference ranges (termed subclinical hypothyroidism) are relatively common in older individuals. There is growing evidence that treatment of subclinical hypothyroidism may not be beneficial, particularly in an older person. These findings are relevant at a time when treatment with thyroid hormones is increasing and more than 10-15% of people aged over 80 years are prescribed levothyroxine replacement therapy. MAIN BODY The prevalence of hypothyroidism increases with age. However, the reference range for TSH also rises with age, as the population distribution of TSH concentration progressively rises with age. Furthermore, there is evidence to suggest that minor TSH elevations are not associated with important outcomes such as impaired quality of life, symptoms, cognition, cardiovascular events and mortality in older individuals. There is also evidence that treatment of mild subclinical hypothyroidism may not benefit quality of life and/or symptoms in older people. It is unknown whether treatment targets should be reset depending on the age of the patient. It is likely that some older patients with non-specific symptoms and incidental mild subclinical hypothyroidism may be treated with thyroid hormones and could potentially be harmed as a result. This article reviews the current literature pertaining to hypothyroidism with a special emphasis on the older individual and assesses the risk/benefit impact of contemporary management on outcomes in this age group. CONCLUSIONS Current evidence suggests that threshold for treating mild subclinical hypothyroidism in older people should be high. It is reasonable to aim for a higher TSH target in treated older hypothyroid patients as their thyroid hormone requirements may be lower. In addition, age-appropriate TSH reference ranges should be considered in the diagnostic pathway of identifying individuals at risk of developing hypothyroidism. Appropriately designed and powered randomised controlled trials are required to confirm risk/benefit of treatment of subclinical hypothyroidism in older people. Until the results of such RCTs are available to guide clinical management international guidelines should be followed that advocate a conservative policy in the management of mild subclinical hypothyroidism in older individuals.
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Affiliation(s)
- Owain Leng
- Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP UK
| | - Salman Razvi
- Department of Endocrinology, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Gateshead, NE9 6SX UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ UK
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Yang R, Yao L, Fang Y, Sun J, Guo T, Yang K, Tian L. The relationship between subclinical thyroid dysfunction and the risk of fracture or low bone mineral density: a systematic review and meta-analysis of cohort studies. J Bone Miner Metab 2018; 36:209-220. [PMID: 28357593 DOI: 10.1007/s00774-017-0828-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/15/2017] [Indexed: 12/19/2022]
Abstract
Our aim was to assess the risk of fractures or low bone mineral density (BMD) associated with subclinical thyroid dysfunction among cohorts. We systematically searched Medline (via PubMed), EMBASE, Cochrane Library, Web of Science, CENTRAL and SinoMed up to 31 July 2016 to identify cohort studies which have analyzed associations between subclinical thyroid dysfunction and fracture or BMD. A total of 19 population-based cohorts including 79,368 participants with relationships between subclinical thyroid dysfunction and fractures or BMD were identified as eligible for this meta-analysis. Subclinical hypothyroidism was associated with relative risks (RRs) of 1.34 (95% confidence interval [CI] 1.14, 1.58; I 2 = 32%) for hip fracture, 1.27 (95% CI 1.02, 1.58; I 2 = 51.9%) for any location of fracture, and 1.25 (95% CI 1.04, 1.50) for forearm fracture. Subclinical hyperthyroidism was associated with RRs of 1.71 (95% CI 1.06, 2.76; I 2 = 0.0%) for spine fracture, 1.20 (95% CI 1.03, 1.39; I 2 = 0.0%) for non-spine fracture, 1.44 (95% CI 1.21, 1.71; I 2 = 0.0%) for hip fracture, and 1.38 (95% CI 1.21, 1.58; I 2 = 0.0%) for any location of fracture. Subgroup analysis was conducted according to whether thyroid/anti-thyroid drug users were excluded or not and the results were similar. The change in BMD at the hip (weighted mean difference [WMD] = -0.060, 95% CI -0.116, -0.004; I 2 = 0.0%) and femoral neck (WMD = -0.046, 95% CI -0.077, -0.015; I 2 = 0.0%) was significantly decreased in the subclinical hyperthyroidism group compared with the euthyroidism groups in females. We failed to find any associations between the change in BMD and subclinical hypothyroidism. The overall quality of evidence was low in all outcomes. Subclinical hyperthyroidism and subclinical hypothyroidism were associated with an increased risk of fractures. Although subclinical hyperthyroidism was related to reduced BMD, no evidence could prove a definite association between subclinical hypothyroidism and the risk of low BMD.
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Affiliation(s)
- Ruifei Yang
- Department of Endocrinology, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Liang Yao
- Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Yuan Fang
- Department of Endocrinology, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Jing Sun
- Department of Endocrinology, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
- Institution of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Tiankang Guo
- Department of General Surgery, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China
| | - Kehu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| | - Limin Tian
- Department of Endocrinology, The Gansu Provincial Hospital, Donggang West Road, Lanzhou, 730000, Gansu, People's Republic of China.
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Mazziotti G, Formenti AM, Frara S, Olivetti R, Banfi G, Memo M, Maroldi R, Giubbini R, Giustina A. High Prevalence of Radiological Vertebral Fractures in Women on Thyroid-Stimulating Hormone-Suppressive Therapy for Thyroid Carcinoma. J Clin Endocrinol Metab 2018; 103:956-964. [PMID: 29121201 DOI: 10.1210/jc.2017-01986] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/01/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Bone loss and nonvertebral fractures have been reported in patients with differentiated thyroid carcinoma (DTC) undergoing thyroid-stimulating hormone (TSH) suppressive therapy. Radiological vertebral fractures (VFs) are an early and clinically crucial marker of bone fragility. OBJECTIVE AND DESIGN A cross-sectional study to evaluate the prevalence and determinants of radiological VFs in women receiving l-thyroxine (L-T4) therapy for DTC. PATIENTS AND INTERVENTIONS A total of 179 consecutive women (median age, 59 years; n = 178 postmenopausal) who had undergone thyroidectomy for DTC and were currently receiving L-T4 were evaluated for radiological VFs and bone mineral density (BMD). There were three TSH target levels [<0.5 mU/L, group 1 (n = 83); 0.5 to 1.0 mU/L, group 2 (n = 50); >1.0 mU/L, group 3 (n = 46)]. RESULTS VFs were found in 51 patients (28.5%), with significantly (P < 0.001) higher prevalence in group 1 (44.6%) as compared with group 2 (24.0%) and group 3 (4.3%). VF prevalence was not significantly different among patients in group 1 with normal BMD, osteopenia, or osteoporosis, whereas in groups 2 and 3, VFs were more frequent in patients with osteoporosis than in those with either osteopenia or normal BMD. In the whole population, VFs were significantly and independently associated with TSH level <1.0 mU/L; densitometric diagnosis of osteoporosis at lumbar spine, femoral neck, or total hip; age of patients; and duration of L-T4 therapy. CONCLUSION The prevalence of VFs was high in women with DTC who were undergoing long-term, suppressive L-T4 therapy.
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Affiliation(s)
| | - Anna Maria Formenti
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Stefano Frara
- Department of Endocrinology, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Olivetti
- Endocrine Unit, Azienda Socio-Sanitaria Territoriale, Mantua, Italy
| | - Giuseppe Banfi
- Department of Biochemistry, Vita-Salute San Raffaele University, Milan, Italy
- Laboratory of Experimental Biochemistry and Molecular Biology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Andrea Giustina
- Department of Endocrinology, Vita-Salute San Raffaele University, Milan, Italy
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Gao C, Wang Y, Li T, Huang J, Tian L. Effect of subclinical hypothyroidism on the skeletal system and improvement with short-term thyroxine therapy. Oncotarget 2017; 8:90444-90451. [PMID: 29163843 PMCID: PMC5685764 DOI: 10.18632/oncotarget.19568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/19/2017] [Indexed: 11/25/2022] Open
Abstract
The purpose of the study was to observe changes in the skeletal system of rats with subclinical hypothyroidism (SCH) and to determine whether L-thyroxine (L-T4) administration suppresses those changes. Sixty male Wistar rats were randomly divided into control, SCH, and SCH+T4 groups. SCH was induced in rats by administration of methimazole (MMI), and rats in the SCH+T4 group were treated with L-T4 after 45 days of MMI administration. The SCH group had higher thyroid-stimulating hormone (TSH) level than the control and SCH+T4 groups. There were no differences in serum thyroid hormone (FT4 and FT3) levels among the three groups. Bone mineral density; serum levels of BALP and TRACP-5b, two bone metabolic markers; and the biomechanical properties of the femurs were lower in the SCH group than in the control group. After L-T4 treatment, serum BALP and TRACP-5b levels and the femur biomechanical properties were higher in the SCH+T4 than the SCH group. Histopathological examination revealed damage to the structure of the femur trabecular bone network in rats with SCH, and L-T4 treatment improved this condition to some extent. These findings demonstrate that L-T4 treatment ameliorates the destructive effects of SCH on the skeletal system in rats.
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Affiliation(s)
- Cuixia Gao
- Department of Ultrasonic Diagnosis, Gansu Provincial Hospital, Lanzhou, China
| | - Yu Wang
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Tingting Li
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Jing Huang
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
| | - Limin Tian
- Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, China
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Fussey JM, Khan H, Ahsan F, Prashant R, Pettit L. Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer: The role for a combined T3/T4 approach. Head Neck 2017; 39:2567-2572. [PMID: 28960722 DOI: 10.1002/hed.24926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 04/24/2017] [Accepted: 07/17/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In the management of differentiated thyroid carcinoma, surgery with or without postoperative radioiodine, and thyroid-stimulating hormone (TSH) suppression is the standard of care in most patients. Levothyroxine is recommended for long-term TSH suppression. For some patients, this may be difficult to tolerate due to adverse effects, such as impaired cognitive function. METHODS This article reviews the evidence for the role of combination treatment with triiodothyronine (T3) and levothyroxine (T4) in these patients. RESULTS The evidence for combination T3 and T4 treatment comes mainly from studies on hypothyroidism, and research into its use for TSH suppression is limited. CONCLUSION Although the evidence base is not strong, there is a small group of patients who may benefit from combination T3 and T4 treatment due to difficulty tolerating thyroxine. Until further evidence is available, a case-by-case approach is recommended.
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Affiliation(s)
| | - Habib Khan
- Department of Clinical Oncology, The Deansley Centre, Royal Wolverhampton Hospital, Wolverhampton, UK
| | - Farhan Ahsan
- Department of Otolaryngology, The Shrewsbury and Telford NHS Trust, Telford, UK
| | - Ravi Prashant
- Department of Clinical Oncology, The Shrewsbury and Telford NHS Trust, Telford, UK
| | - Laura Pettit
- Department of Clinical Oncology, The Shrewsbury and Telford NHS Trust, Telford, UK
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Barbosa AP, Mascarenhas MR, Bicho M, Janeiro J, Oliveira AG. The main autoimmune and nonautoimmune etiologies of endogenous hyperthyroidism do not seem to influence the increased prevalence of morphometric vertebral fractures and osteoporosis in Portuguese men. Osteoporos Sarcopenia 2017; 3:149-154. [PMID: 30775520 PMCID: PMC6372816 DOI: 10.1016/j.afos.2017.08.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/17/2017] [Accepted: 08/17/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the effects of hyperthyroidism and their etiology on bone mineral density (BMD), on body soft tissue composition, on the prevalence of vertebral fractures detected by vertebral fracture assessment (VFA) and on the trabecular bone score (TBS). METHODS From an initial population of 119 Portuguese men (78 with hyperthyroidism [HT]+ 41 controls [CTs]) admitted to the Endocrinology Department we selected 41 men aged over 50 with clinical hyperthyroidism to participate; each one was matched by age and height with a control person. BMD (g/cm2) at the lumbar spine, hip, radius 33% and whole body and the total body masses (kg) were studied by dual-energy X-ray absorptiometry (DXA). VFA with Genant semiquantitative method was used to detect fractures. The TBS was obtained from lumbar spine DXA images. No patient had been treated previously for hyperthyroidism or osteoporosis. Adequate statistical tests were used. RESULTS In the hyperthyroidism group, total lean mass (CT 58.16 ± 7.7 vs. HT 52.3 ± 5.7, P = 0.03) and distal radius BMD (CT 0.769 ± 0.05 vs. HT 0.722 ± 0.08, P = 0.005) were lower; there was a significantly higher prevalence of osteoporosis (CT 9.7% vs. HT 29.3%, P = 0.015) and vertebral fractures (CT 2.4% vs. HT 24.4%, P = 0.007). TBS was similar in both groups (CT 1.328 ± 0.11 vs. HT 1.356 ± 0.11, P = not significant). Comparing patients with Graves' disease with patients with toxic goiter, there were no differences regarding BMD, BMD qualification, prevalence of fractures and TBS and just total lean mass was significantly lower in patients with Graves' disease. CONCLUSIONS These results suggest that in a group of hyperthyroid men aged over 50 there are significant decreases in cortical bone BMD and lean mass and a higher prevalence of osteoporosis and silent vertebral fractures, but the etiology of the hyperthyroidism does not seem to influence it. Besides the antithyroid drugs, some patients may benefit from bone-directed treatments.
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Affiliation(s)
- Ana Paula Barbosa
- University Clinic of Endocrinology, Lisbon University Medical School, Lisbon, Portugal
- Endocrinology, Diabetes and Metabolism Department, Santa Maria University Hospital, Lisbon, Portugal
| | - Mário Rui Mascarenhas
- University Clinic of Endocrinology, Lisbon University Medical School, Lisbon, Portugal
- Endocrinology, Diabetes and Metabolism Department, Santa Maria University Hospital, Lisbon, Portugal
| | - Manuel Bicho
- Genetics Laboratory, Environmental Health Institute, Lisbon University Medical School, Lisbon, Portugal
| | - João Janeiro
- Imagiology Department, Santa Maria University Hospital, Lisbon, Portugal
| | - António Gouveia Oliveira
- Pharmacy Department, Health Sciences Center, Federal University Rio Grande do Norte, Natal, Brazil
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Abstract
Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH.
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Aubert CE, Floriani C, Bauer DC, da Costa BR, Segna D, Blum MR, Collet TH, Fink HA, Cappola AR, Syrogiannouli L, Peeters RP, Åsvold BO, den Elzen WPJ, Luben RN, Bremner AP, Gogakos A, Eastell R, Kearney PM, Hoff M, Le Blanc E, Ceresini G, Rivadeneira F, Uitterlinden AG, Khaw KT, Langhammer A, Stott DJ, Westendorp RGJ, Ferrucci L, Williams GR, Gussekloo J, Walsh JP, Aujesky D, Rodondi N. Thyroid Function Tests in the Reference Range and Fracture: Individual Participant Analysis of Prospective Cohorts. J Clin Endocrinol Metab 2017; 102:2719-2728. [PMID: 28482002 PMCID: PMC6283437 DOI: 10.1210/jc.2017-00294] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/26/2017] [Indexed: 01/07/2023]
Abstract
CONTEXT Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower thyroid-stimulating hormone (TSH) and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk. OBJECTIVE To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals. DESIGN Individual participant data analysis. SETTING Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. PARTICIPANTS Adults with baseline TSH 0.45 to 4.49 mIU/L. MAIN OUTCOME MEASURES Primary outcome was incident hip fracture. Secondary outcomes were any, nonvertebral, and vertebral fractures. Results were presented as hazard ratios (HRs) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45 to 0.99 mIU/L; 1.00 to 1.49 mIU/L; 1.50 to 2.49 mIU/L; 2.50 to 3.49 mIU/L; and 3.50 to 4.49 mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. RESULTS During 659,059 person-years, 2,565 out of 56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05 to 1.49) for TSH 0.45 to 0.99 mIU/L, 1.19 (1.01 to 1.41) for TSH 1.00 to 1.49 mIU/L, 1.09 (0.93 to 1.28) for TSH 1.50 to 2.49 mIU/L, and 1.12 (0.94 to 1.33) for TSH 2.50 to 3.49 mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 [HR (95% CI) 1.22 (1.11 to 1.35) per one standard deviation increase in FT4]. FT4 only was associated with any and nonvertebral fractures. Results remained similar in sensitivity analyses. CONCLUSIONS Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Carmen Floriani
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California 94143
| | - Bruno R da Costa
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin), University of Bern, 3012 Bern, Switzerland
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, 3010 Bern, Switzerland
| | - Daniel Segna
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes, and Metabolism, University Hospital of Lausanne, 1011 Lausanne, Switzerland
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota 55417
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455
| | - Anne R Cappola
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104
| | - Lamprini Syrogiannouli
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin), University of Bern, 3012 Bern, Switzerland
| | - Robin P Peeters
- Departments of Internal Medicine and Epidemiology, Erasmus University Rotterdam, 3062 Rotterdam, The Netherlands
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, N-7006 Trondheim, Norway
| | - Wendy P J den Elzen
- Leiden University Medical Center, Department of Clinical Chemistry and Laboratory Medicine, 2300 RC Leiden, The Netherlands
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, United Kingdom
| | - Alexandra P Bremner
- School of Population Health, University of Western Australia, Crawley, Perth, Western Australia 6009, Australia
| | - Apostolos Gogakos
- Molecular Endocrinology Laboratory, Hammersmith Campus, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom
| | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, South Yorkshire S10 2TN, United Kingdom
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, T12 PX46 Cork, Ireland
| | - Mari Hoff
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway
| | - Erin Le Blanc
- Center for Health Research NW, Kaiser Permanente, Portland, Oregon 97277
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Fernando Rivadeneira
- Departments of Internal Medicine and Epidemiology, Erasmus University Rotterdam, 3062 Rotterdam, The Netherlands
| | - André G Uitterlinden
- Departments of Internal Medicine and Epidemiology, Erasmus University Rotterdam, 3062 Rotterdam, The Netherlands
| | - Kay-Tee Khaw
- School of Population Health, University of Western Australia, Crawley, Perth, Western Australia 6009, Australia
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, United Kingdom
| | - Rudi G J Westendorp
- Department of Public Health, Center for Health Aging, University of Copenhagen, 1004 Copenhagen, Denmark
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224
| | - Graham R Williams
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, South Yorkshire S10 2TN, United Kingdom
| | - Jacobijn Gussekloo
- Leiden University Medical Center, Department of Clinical Chemistry and Laboratory Medicine, 2300 RC Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Perth, Western Australia 6009, Australia
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin), University of Bern, 3012 Bern, Switzerland
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Kinai E, Gatanaga H, Mizushima D, Nishijima T, Aoki T, Genka I, Teruya K, Tsukada K, Kikuchi Y, Oka S. Protease inhibitor-associated bone mineral density loss is related to hypothyroidism and related bone turnover acceleration. J Infect Chemother 2017; 23:259-264. [DOI: 10.1016/j.jiac.2016.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/30/2016] [Accepted: 10/31/2016] [Indexed: 01/07/2023]
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Choi EM, Suh KS, Rhee SY, Oh S, Woo JT, Kim SW, Kim YS, Pak YK, Chon S. Perfluorooctanoic acid induces mitochondrial dysfunction in MC3T3-E1 osteoblast cells. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2017; 52:281-289. [PMID: 27901621 DOI: 10.1080/10934529.2016.1253402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Perfluorooctanoic acid (PFOA), a stable organic perfluorinated compound, is an emerging persistent organic pollutant, found widely in human and wildlife populations. Recent evidence suggests that exposure to environmental toxicants can be associated with higher risks of osteoporosis and fractures. We studied the cellular toxicology of PFOA in MC3T3-E1osteoblast cells. To examine the effect of PFOA, we measured cell viability, reactive oxygen species (ROS), mitochondrial superoxide, and mitochondrial parameters including adenosine triphosphate (ATP) level, mitochondrial membrane potential (MMP), cardiolipin content, and cytochrome c release in MC3T3-E1 cells. Incubating MC3T3-E1 cells in different concentrations of PFOA for 48 h resulted in a concentration-dependent decrease in cell viability and significant inductions of ROS and mitochondrial superoxide. Moreover, PFOA induced MMP collapse, cardiolipin peroxidation, cytochrome c release, and decreased ATP levels, which in turn induced apoptosis or necrosis. When osteoblast differentiation markers were assessed, PFOA treatment caused a significant reduction in alkaline phosphatase activity, collagen synthesis, and mineralization in the cells. In summary, we found an ROS- and mitochondria-mediated pathway for the induction of cell damage by PFOA in MC3T3-E1 cells. Together, our results indicate that mitochondrial toxicity could be a plausible mechanism for the toxic effects of PFOA on osteoblast function.
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Affiliation(s)
- Eun Mi Choi
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
| | - Kwang Sik Suh
- b Research Institute of Endocrinology, Kyung Hee University Hospital , Seoul , Republic of Korea
| | - Sang Youl Rhee
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
| | - Seungjoon Oh
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
| | - Jeong-Taek Woo
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
| | - Sung Woon Kim
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
| | - Young Seol Kim
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
- c Department of Internal Medicine , Chung Hospital , Seongnam-si , Gyeonggi-do , Republic of Korea
| | - Youngmi Kim Pak
- d Department of Physiology , Kyung Hee University, College of Medicine , Seoul , Republic of Korea
| | - Suk Chon
- a Department of Endocrinology and Metabolism , School of Medicine, Kyung Hee University , Seoul , Republic of Korea
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Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343-1421. [PMID: 27521067 DOI: 10.1089/thy.2016.0229] [Citation(s) in RCA: 1345] [Impact Index Per Article: 168.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. CONCLUSIONS One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
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Affiliation(s)
- Douglas S Ross
- 1 Massachusetts General Hospital , Boston, Massachusetts
| | - Henry B Burch
- 2 Endocrinology - Metabolic Service, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David S Cooper
- 3 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Peter Laurberg
- 5 Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital , Aalborg, Denmark
| | - Ana Luiza Maia
- 6 Thyroid Section, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Scott A Rivkees
- 7 Pediatrics - Chairman's Office, University of Florida College of Medicine , Gainesville, Florida
| | - Mary Samuels
- 8 Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University , Portland, Oregon
| | - Julie Ann Sosa
- 9 Section of Endocrine Surgery, Duke University School of Medicine , Durham, North Carolina
| | - Marius N Stan
- 10 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Martin A Walter
- 11 Institute of Nuclear Medicine, University Hospital Bern , Switzerland
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Boruah P, Baruah AJ, Hajong R, Nath CK, Barman B, Chutia H, Sarma K. A Study to Assess the Validity of Estimation of Serum Ostase Level in Hyperthyroid and Hypothyroid Cases. J Clin Diagn Res 2016; 10:BC08-BC11. [PMID: 27790421 PMCID: PMC5071921 DOI: 10.7860/jcdr/2016/19750.8441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/15/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION One of the more specific assessments of the metabolic status of bone in normal and in disease conditions is the measurement of bone specific alkaline phosphatase or ostase. The measurement of serum ostase has several advantages over the measurements of other bone parameter. Because of its relatively long half-life, in-vivo (1 to 3days), it is relatively unaffected by diurnal variation. AIM To find the correlation of serum ostase level in hyper and hypothyroid cases and also to study the validity of routine estimation of serum ostase in hyper and hypothyroid cases so as to monitor the base level bone health on presentation. MATERIALS AND METHODS Serum ostase level was studied in 74 patients with disorder of thyroid function. Serum ostase level, Thyroid Stimulating Hormone (TSH), FT3, FT4 levels were estimated by chemiluminescent technique. The instrument used was Beckman- coulter Access 2. A total of 39 patients were hypothyroid, 31 were hyperthyroid and 4 patients had subclinical hyperthyroidism. RESULTS The serum ostase level was found to be elevated above 40 μg/L in 26 of the cases and above 16 μg/L but below 40μg/L in 5 cases of hyperthyroidism along with decrease in Bone Mineral Density (BMD). Serum ostase level was found to be directly proportional to the serum FT3 level (Normal range of serum ostase is 8-16 μg/L). CONCLUSION From this study, an inference can be drawn that a routine estimation of serum ostase level in hyperthyroid cases will help in proper monitoring of decrease bone turnover as indicated by increase serum ostase level. Besides, the estimation of serum ostase level in hyperthyroid cases it is found to be valid in this study, which can turn to be an important guiding parameter to the treating physician to formulate necessary protocols and guidelines for prophylaxis, treatment and to monitor the response to therapy in cases of reduced bone turnover related to hyperthyroid state.
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Affiliation(s)
| | - Arup Jyoti Baruah
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Ranendra Hajong
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Chandan Kumar Nath
- Assistant Professor, Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | - Bhupen Barman
- Assistant Professor, Department of General Medicine, NEIGRIHMS, Shillong, Meghalaya, India
| | - Happy Chutia
- Assistant Professor, Department of Biochemistry, NEIGRIHMS, Shillong, Meghalaya, India
| | - Kalyan Sarma
- PGT, Department of Radiology, NEIGRIHMS, Shillong, Meghalaya, India
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Pizzorno L. Bariatric Surgery: Bad to the Bone, Part 2. Integr Med (Encinitas) 2016; 15:35-46. [PMID: 27330488 PMCID: PMC4898280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As discussed in Part 1, obesity is now a global epidemic affecting a significant and rapidly increasing number of adults, adolescents, and children. As the incidence of obesity has increased, so has the use of bariatric surgery to treat it. A growing number of recently published studies have reported that, despite calcium and vitamin D supplementation, the most frequently performed types of bariatric surgery, the Roux-en-Y gastric bypass (RYGB) and the sleeve gastrectomy (SG), cause significant, ongoing bone loss. Recent studies investigating nutrient malabsorption and changes in a wide range of hormones that are induced by bariatric surgery have indicated that calcium malabsorption is just the tip of a formidable iceberg. Part 1 reviewed the latest research findings confirming that the prevalence of obesity is, in fact, skyrocketing and that bariatric surgery causes ongoing accelerated bone loss. Part 1 also discussed the mechanisms through which the malabsorption of key nutrients induced by bariatric surgery adversely affects bone. The current article, Part 2, reviews the specific changes seen in bone metabolism after bariatric surgery and the current data on the underlying mechanisms, in addition to nutrient malabsorption, that may contribute to bariatric surgery-induced bone loss. These mechanisms include mechanical unloading, calcium malabsorption despite maintenance of vitamin D levels of ≥30 ng/mL, and changes in a number of hormones, including leptin, adiponectin, testosterone, estradiol, serotonin, ghrelin, glucagon-like peptide 1 (GLP-1), and gastric inhibitory peptide (GIP). Research discussing the use of nutritional supplements to help ameliorate bariatric surgery-induced bone loss is summarized. The adverse effects of bariatric surgery on bone must be widely recognized, and protocols must be developed to prevent early onset osteoporosis in recipients of this increasingly utilized and otherwise potentially life-saving surgery.
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Affiliation(s)
- Lara Pizzorno
- Corresponding author: Lara Pizzorno, mdiv, ma, lmt, E-mail address:
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Abstract
The skeleton is an exquisitely sensitive and archetypal T3-target tissue that demonstrates the critical role for thyroid hormones during development, linear growth, and adult bone turnover and maintenance. Thyrotoxicosis is an established cause of secondary osteoporosis, and abnormal thyroid hormone signaling has recently been identified as a novel risk factor for osteoarthritis. Skeletal phenotypes in genetically modified mice have faithfully reproduced genetic disorders in humans, revealing the complex physiological relationship between centrally regulated thyroid status and the peripheral actions of thyroid hormones. Studies in mutant mice also established the paradigm that T3 exerts anabolic actions during growth and catabolic effects on adult bone. Thus, the skeleton represents an ideal physiological system in which to characterize thyroid hormone transport, metabolism, and action during development and adulthood and in response to injury. Future analysis of T3 action in individual skeletal cell lineages will provide new insights into cell-specific molecular mechanisms and may ultimately identify novel therapeutic targets for chronic degenerative diseases such as osteoporosis and osteoarthritis. This review provides a comprehensive analysis of the current state of the art.
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Affiliation(s)
- J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, United Kingdom
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Javed Z, Sathyapalan T. Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits. Ther Adv Endocrinol Metab 2016; 7:12-23. [PMID: 26885359 PMCID: PMC4740939 DOI: 10.1177/2042018815616543] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Subclinical hypothyroidism (SCH) is defined as elevated thyroid stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). SCH is further classified into a milder condition with TSH levels between 4.0 and 10.0 milli-international units (mIU)/l (mild-SCH) and a severe form with TSH >10.0 mIU/l (severe-SCH). SCH is a common problem (prevalence is greater in women than men), which increases further with increasing age and TSH levels. Even though the risk of progression to overt hypothyroidism is higher in patients with severe-SCH, the risk is also significant in patients having mild-SCH; it has been suggested that every twofold rise in serum TSH would increase the risk from 1 to 4%, which further increases to 38% if thyroid antibodies are positive. Current data have shown increased cardiovascular risk in patients with mild-SCH and have demonstrated some benefits of levothyroxine treatment in reducing these events. However, evidence on the association of mild-SCH and musculoskeletal system, cognitive dysfunction, mood disorders, dyslipidaemia, diabetes and goitre is conflicting. Similarly, the discussion regarding the exact upper limit of normal for serum TSH remains controversial. The data have also shown increased risk of adverse pregnancy outcomes in patient with mild-SCH, with some benefits of thyroxine treatment. The recent available guidelines related to management of patients with serum TSH <10 mIU/l have suggested decisions should be made taking into account the age of the patient, associated risk factors and comorbid conditions. This chronicle review assesses current evidence regarding the risks associated and the recommendations related to benefits of levothyroxine treatment in patients having mild-SCH.
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Affiliation(s)
- Zeeshan Javed
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS Trust, Brocklehurst Building, Hull Royal Infirmary, Hull, HU3 2RW, UK
| | - Thozhukat Sathyapalan
- Department of Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS Trust, Hull, UK
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Khalil N, Chen A, Lee M, Czerwinski SA, Ebert JR, DeWitt JC, Kannan K. Association of Perfluoroalkyl Substances, Bone Mineral Density, and Osteoporosis in the U.S. Population in NHANES 2009-2010. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:81-7. [PMID: 26058082 PMCID: PMC4710590 DOI: 10.1289/ehp.1307909] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 06/05/2015] [Indexed: 05/19/2023]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs), including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), are detectable in the serum of 95% of the U.S. OBJECTIVE Considering the role of PFASs as endocrine disruptors, we examined their relationships with bone health. METHODS The association between serum PFAS concentration and bone mineral density at total femur (TFBMD), femoral neck (FNBMD), lumbar spine (LSBMD), and physician-diagnosed osteoporosis was assessed in 1,914 participants using data from the National Health and Nutritional Examination Survey 2009-2010. RESULTS The mean age of the participants was 43 years. Men had higher serum PFAS concentrations than women (p < 0.001) except for PFNA. In both sexes, serum PFOS concentrations were inversely associated with FNBMD (p < 0.05). In women, significant negative associations were observed for natural log (ln)-transformed PFOS exposure with TFBMD and FNBMD, and for ln-transformed PFOA exposure with TFBMD (p < 0.05). In postmenopausal women, serum PFOS was negatively associated with TFBMD and FNBMD, and PFNA was negatively associated with TFBMD, FNBMD, and LSBMD (all p < 0.05). With one log unit increase in serum PFOA, PFHxS, and PFNA, osteoporosis prevalence in women increased as follows: [adjusted odds ratios (aORs)] 1.84 (95% CI: 1.17, 2.905), 1.64 (95% CI: 1.14, 2.38), and 1.45 (95% CI: 1.02, 2.05), respectively. In women, the prevalence of osteoporosis was significantly higher in the highest versus the lowest quartiles of PFOA, PFHxS, and PFNA, with aORs of 2.59 (95% CI: 1.01, 6.67), 13.20 (95% CI: 2.72, 64.15), and 3.23 (95% CI: 1.44, 7.21), respectively, based on 77 cases in the study sample. CONCLUSION In a representative sample of the U.S. adult population, serum PFAS concentrations were associated with lower bone mineral density, which varied according to the specific PFAS and bone site assessed. Most associations were limited to women. Osteoporosis in women was also associated with PFAS exposure, based on a small number of cases. CITATION Khalil N, Chen A, Lee M, Czerwinski SA, Ebert JR, DeWitt JC, Kannan K. 2016. Association of perfluoroalkyl substances, bone mineral density, and osteoporosis in the U.S. population in NHANES 2009-2010. Environ Health Perspect 124:81-87; http://dx.doi.org/10.1289/ehp.1307909.
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Affiliation(s)
- Naila Khalil
- Center for Global Health, Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
- Address correspondence to N. Khalil, 3123 Research Blvd., Suite #200, Center for Global Health, Department of Community Health, Boonshoft School of Medicine, Wright State University, Dayton, OH 45420-4006 USA. Telephone: (937) 258-5559. E-mail:
| | - Aimin Chen
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Miryoung Lee
- Lifespan Health Research Center, Department of Community Health, Wright State University, Dayton, Ohio, USA
| | - Stefan A. Czerwinski
- Lifespan Health Research Center, Department of Community Health, Wright State University, Dayton, Ohio, USA
| | - James R. Ebert
- The Pediatric Lipid Clinic, Dayton Children’s Hospital, Dayton, Ohio, USA
| | - Jamie C. DeWitt
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Kurunthachalam Kannan
- Wadsworth Center, New York State Department of Health and Department of Environmental Health Sciences, University at Albany, State University of New York, Albany, New York, USA
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Virgini VS, Rodondi N, Cawthon PM, Harrison SL, Hoffman AR, Orwoll ES, Ensrud KE, Bauer DC. Subclinical Thyroid Dysfunction and Frailty Among Older Men. J Clin Endocrinol Metab 2015; 100:4524-32. [PMID: 26495751 PMCID: PMC4667157 DOI: 10.1210/jc.2015-3191] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
CONTEXT Both subclinical thyroid dysfunction and frailty are common among older individuals, but data on the relationship between these 2 conditions are conflicting. OBJECTIVE The purpose of this study was to assess the cross-sectional and prospective associations between subclinical thyroid dysfunction and frailty and the 5 frailty subdomains (sarcopenia, weakness, slowness, exhaustion, and low activity). SETTING AND DESIGN The Osteoporotic Fractures in Men Study is a prospective cohort study. PARTICIPANTS Men older than 65 years (n = 1455) were classified into 3 groups of thyroid status: subclinical hyperthyroidism (n = 26, 1.8%), subclinical hypothyroidism (n = 102, 7.0%), and euthyroidism (n = 1327, 91.2%). MAIN OUTCOME MEASURES Frailty was defined using a slightly modified Cardiovascular Health Study Index: men with 3 or more criteria were considered frail, men with 1 to 2 criteria were considered intermediately frail, and men with no criteria were considered robust. We assessed the cross-sectional relationship between baseline thyroid function and the 3 categories of frailty status (robust/intermediate/frail) as well as the prospective association between baseline thyroid function and subsequent frailty status and mortality after a 5-year follow-up. RESULTS At baseline, compared with euthyroid participants, men with subclinical hyperthyroidism had an increased likelihood of greater frailty status (adjusted odds ratio, 2.48; 95% confidence interval, 1.15-5.34), particularly among men aged <74 years at baseline (odds ratio for frailty, 3.63; 95% confidence interval, 1.21-10.88). After 5 years of follow-up, baseline subclinical hypothyroidism and hyperthyroidism were not consistently associated with overall frailty status or frailty components. CONCLUSION Among community-dwelling older men, subclinical hyperthyroidism, but not subclinical hypothyroidism, is associated with increased odds of prevalent but not incident frailty.
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Affiliation(s)
- Vanessa S Virgini
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Nicolas Rodondi
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Peggy M Cawthon
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Stephanie Litwack Harrison
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Andrew R Hoffman
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Eric S Orwoll
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Kristine E Ensrud
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
| | - Douglas C Bauer
- Department of Internal Medicine (V.S.V.), University Hospital of Zürich, 8091 Zürich, Switzerland; Department of General Internal Medicine (N.R.), Inselspital, University Hospital of Bern, 3010 Bern, Switzerland; California Pacific Medical Center Research Institute (L.H.), San Francisco, California 94107; Stanford University Medical School (A.R.H.), Palo Alto, California 94305; Bone and Mineral Unit (E.S.O.), Oregon Health & Science University, Portland, Oregon 97239; Department of Medicine (K.E.E.) and Division of Epidemiology and Community Health (K.E.E.), University of Minnesota, Minneapolis, Minnesota 55455; Center for Chronic Disease Outcomes Research (K.E.E.), Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota 55417; and Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94143
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Biondi B, Bartalena L, Cooper DS, Hegedüs L, Laurberg P, Kahaly GJ. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J 2015; 4:149-63. [PMID: 26558232 PMCID: PMC4637513 DOI: 10.1159/000438750] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/16/2015] [Indexed: 12/12/2022] Open
Abstract
Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels <0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (<65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- *Bernadette Biondi, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via S. Pansini 5, IT-80131 Naples (Italy), E-Mail
| | - Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Varese, Italy
| | - David S. Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Md., USA
| | - Laszlo Hegedüs
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Peter Laurberg
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - George J. Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
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Secondary osteoporosis and metabolic bone disease in patients 50 years and older with osteoporosis or with a recent clinical fracture: a clinical perspective. Curr Opin Rheumatol 2015; 26:430-9. [PMID: 24841229 DOI: 10.1097/bor.0000000000000074] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide guidance to clinicians about which laboratory tests should be performed in patients with osteoporosis or with a recent fracture. RECENT FINDINGS Newly diagnosed secondary osteoporosis and other metabolic bone diseases (SECOB) have been found in 5-48% of patients with osteoporosis. In patients with a recent fracture, new SECOB is found in 10-47% of patients with osteoporosis, and in 26-51% if all patients with a fracture regardless of bone mineral density (BMD) are screened. More than one SECOB can be found in the same patient, even when they have already known SECOB. In primary hyperparathyroidism, hyperthyroidism, hypercortisolism, and multiple myeloma, both SECOB and its treatment have an impact on BMD and fractures. For other SECOBs, no treatment is available, or there are no data about the effect of treatment of the SECOB on BMD and fractures. SUMMARY We recommend performing the following tests in all patients with osteoporosis or a recent clinical fracture: calcium, phosphate, creatinine, albumin, erythrocyte sedimentation rate in all patients, 24 h urine calcium in men and serum testosterone in men less than 70 years. On indication, additional tests can be performed.
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Blum MR, Bauer DC, Collet TH, Fink HA, Cappola AR, da Costa BR, Wirth CD, Peeters RP, Åsvold BO, den Elzen WPJ, Luben RN, Imaizumi M, Bremner AP, Gogakos A, Eastell R, Kearney PM, Strotmeyer ES, Wallace ER, Hoff M, Ceresini G, Rivadeneira F, Uitterlinden AG, Stott DJ, Westendorp RGJ, Khaw KT, Langhammer A, Ferrucci L, Gussekloo J, Williams GR, Walsh JP, Jüni P, Aujesky D, Rodondi N. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA 2015; 313:2055-65. [PMID: 26010634 PMCID: PMC4729304 DOI: 10.1001/jama.2015.5161] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.
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Affiliation(s)
- Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, Lausanne, Switzerland
| | - Howard A Fink
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis5Geriatric Research Education and Clinical Center, VA Medical Center, Minneapolis, Minnesota
| | - Anne R Cappola
- University of Pennsylvania School of Medicine, Philadelphia7Associate Editor, JAMA
| | - Bruno R da Costa
- Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami
| | - Christina D Wirth
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands10Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bjørn O Åsvold
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway12Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Misa Imaizumi
- Radiation Effects Research Foundation, Nagasaki, Japan
| | - Alexandra P Bremner
- School of Population Health, University of Western Australia, Crawley, WA, Australia
| | - Apostolos Gogakos
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erin R Wallace
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | - Mari Hoff
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway22Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands10Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands10Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | | | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Arnuf Langhammer
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Graham R Williams
- Department of Medicine, Imperial College London, London, United Kingdom
| | - John P Walsh
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia28Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Peter Jüni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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Abrahamsen B, Jørgensen HL, Laulund AS, Nybo M, Bauer DC, Brix TH, Hegedüs L. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Miner Res 2015; 30:898-905. [PMID: 25431028 DOI: 10.1002/jbmr.2416] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 11/11/2014] [Accepted: 11/27/2014] [Indexed: 11/10/2022]
Abstract
The long-term relationship between hypothyroidism and fracture risk is challenging to dissect because of the modifying influence of subsequent thyroxine replacement with the potential for excessive replacement doses. We studied changes in serum thyrotropin concentration (TSH) over time and association with fracture risk in real-world patients presenting with elevated TSH. All TSH determinations were done in the same laboratory, which served all hospitals and general practices. The study population consisted of all adults with a first measurement of TSH >4.0 mIU/L (n = 8414) or normal TSH (n = 222,138; comparator). We used a Cox proportional hazards analysis incorporating additional time-dependent covariates to represent initiation of thyroxine replacement and cumulative number of periods with high versus low TSH after index date with a mean follow-up of 7.2 years. Elevated baseline TSH was not associated with an increased risk of hip fracture (HR 0.90; 95% CI, 0.80 to 1.02) or major osteoporotic fractures (HR 0.97; 95% CI, 0.90 to 1.05), nor was subsequent thyroxine prescription predictive of increased risk of fractures. The number of subsequent 6-month periods with low TSH-suggesting excessive thyroxine dosing-was significantly associated with increased risk of both hip fracture (HR 1.09; 95% CI, 1.04 to 1.15) and major osteoporotic fracture (HR 1.10; 95% CI, 1.06 to 1.14). When gender- and age-stratified analyses for major osteoporotic fractures were undertaken, hyperthyroid time was identified as a predictor of fracture risk in postmenopausal women whereas hypothyroid time predicted increased fracture risk in men below age 75 years. In conclusion, among patients who present with an elevated TSH, the long-term risk of hip and other osteoporotic fractures is strongly related to the cumulative duration of periods with low TSH-likely from excessive replacement. An independent effect of elevated TSH could only be observed in young and middle-aged men, suggesting gender-discrepant consequences on risk.
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Affiliation(s)
- Bo Abrahamsen
- Odense Patient data Explorative Network (OPEN), Institute of Clinical Research University of Southern Denmark, Odense, Denmark; Department of Medicine M, Research Centre for Ageing and Osteoporosis, Glostrup Hospital, Glostrup, Denmark
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Medici M, Visser WE, Visser TJ, Peeters RP. Genetic determination of the hypothalamic-pituitary-thyroid axis: where do we stand? Endocr Rev 2015; 36:214-44. [PMID: 25751422 DOI: 10.1210/er.2014-1081] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
For a long time it has been known that both hypo- and hyperthyroidism are associated with an increased risk of morbidity and mortality. In recent years, it has also become clear that minor variations in thyroid function, including subclinical dysfunction and variation in thyroid function within the reference range, can have important effects on clinical endpoints, such as bone mineral density, depression, metabolic syndrome, and cardiovascular mortality. Serum thyroid parameters show substantial interindividual variability, whereas the intraindividual variability lies within a narrow range. This suggests that every individual has a unique hypothalamus-pituitary-thyroid axis setpoint that is mainly determined by genetic factors, and this heritability has been estimated to be 40-60%. Various mutations in thyroid hormone pathway genes have been identified in persons with thyroid dysfunction or altered thyroid function tests. Because these causes are rare, many candidate gene and linkage studies have been performed over the years to identify more common variants (polymorphisms) associated with thyroid (dys)function, but only a limited number of consistent associations have been found. However, in the past 5 years, advances in genetic research have led to the identification of a large number of new candidate genes. In this review, we provide an overview of the current knowledge about the polygenic basis of thyroid (dys)function. This includes new candidate genes identified by genome-wide approaches, what insights these genes provide into the genetic basis of thyroid (dys)function, and which new techniques will help to further decipher the genetic basis of thyroid (dys)function in the near future.
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Affiliation(s)
- Marco Medici
- Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, 3015 GE Rotterdam, The Netherlands
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Barbosa AP, Rui Mascarenhas M, Silva CF, Távora I, Bicho M, do Carmo I, de Oliveira AG. Prevalence of silent vertebral fractures detected by vertebral fracture assessment in young Portuguese men with hyperthyroidism. Eur J Endocrinol 2015; 172:189-94. [PMID: 25576150 DOI: 10.1530/eje-14-0602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hyperthyroidism is a risk factor for reduced bone mineral density (BMD) and osteoporotic fractures. Vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) is a radiological method of visualization of the spine, which enables patient comfort and reduced radiation exposure. OBJECTIVES This study was carried out to evaluate BMD and the prevalence of silent vertebral fractures in young men with hyperthyroidism. DESIGN We conducted a cross-sectional study in a group of Portuguese men aged up to 50 years and matched in hyperthyroidism (n=24) and control (n=24) groups. MATERIALS AND METHODS A group of 48 Portuguese men aged up to 50 years was divided and matched in hyperthyroidism (n=24) and control (n=24) groups. BMD (g/cm(2)) at L1-L4, hip, radius 33%, and whole body as well as the total body masses (kg) were studied by DXA. VFA was used to detect fractures and those were classified by Genant's semiquantitative method. No patient had previously been treated for hyperthyroidism, osteoporosis, or low bone mass. Adequate statistical tests were used. RESULTS The mean age, height, and total fat mass were similar in both groups (P≥0.05). The total lean body mass and the mean BMD at lumbar spine, hip, and whole body were significantly decreased in the hyperthyroidism group. In this group, there was also a trend for an increased prevalence of reduced BMD/osteoporosis and osteoporotic vertebral fractures. CONCLUSIONS The results obtained using VFA technology (confirmed by X-ray) suggest that the BMD changes in young men with nontreated hyperthyroidism may lead to the development of osteoporosis and vertebral fractures. This supports the pertinence of using VFA in the routine of osteoporosis assessment to detect silent fractures precociously and consider early treatment.
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Affiliation(s)
- Ana Paula Barbosa
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
| | - Mário Rui Mascarenhas
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
| | - Carlos Francisco Silva
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
| | - Isabel Távora
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
| | - Manuel Bicho
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
| | - Isabel do Carmo
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
| | - António Gouveia de Oliveira
- Santa Maria University HospitalAvenida Professor Egas Moniz. 1649-028 Lisbon, PortugalImaging DepartmentSanta Maria University Hospital, Lisbon, PortugalGenetics LaboratoryLisbon University Medical School, Environmental Health Institute, Lisbon, PortugalEndocrinologyDiabetes and Metabolism Department, Lisbon University Medical School, Environmental Health Institute, Santa Maria University Hospital, Lisbon, PortugalPharmacy DepartmentHealth Sciencies Center, Federal University Rio Grande do Norte, Natal, Brazil
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