Evaluation of Bone Density, Serum Total and Ionized Calcium, Alkaline Phosphatase and 25-hydroxy Vitamin D in Papillary Thyroid Carcinoma, and their Relationship with TSH Suppression by Levothyroxine

Kachui, Ali; Tabatabaizadeh, Seyed Mashaallah; Iraj, Bijan; Rezvanian, Hasan; Feizi, Awat

Evaluation of Bone Density, Serum Total and Ionized Calcium, Alkaline Phosphatase and 25-hydroxy Vitamin D in Papillary Thyroid Carcinoma, and their Relationship with TSH Suppression by Levothyroxine

Document Type : Original Article

Authors

¹ Department of Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study aimed to evaluate the situation of Bone Mineral Density (BMD), Z score, T score, serum level of corrected and ionized calcium, alkaline phosphatase and 25-hydroxy vitamin D in percutaneous transhepatic cholangiography (PTC) patients and correlation of these variants with thyroid stimulating hormone (TSH) suppression level by levothyroxine. Materials and Methods: Among the patients referred to Esfahan's endocrinology research center, 34 PTC patients (aged 20– 50 years) with a history of thyroidectomy and conceived radioactive iodine and suppressive dose of levothyroxine were evaluated in this case– control study, and 38 healthy persons participated as the control group (matched by age and sex, body mass index). Bone density was evaluated with the DEXA method in four areas: Lumbar spine, femoral neck, and trochanter and distal of forearm. A reference laboratory assessed TSH, corrected and ionized calcium, Alkaline phosphatase (ALP) and 25OH vitamin D levels using fasting plasma and evaluated correlation of TSH level with variants by multivariate variance analysis. Results: There was no significant difference in bone density and laboratory data (unless TSH) between the groups. In the PTC group, there was no significant correlation between TSH and difference values of BMD, Z score or T score, corrected calcium (P value = 0.12), ionized calcium (P = 0.54), ALP (P = 0.22) and 25 OH vitamin D (P = 0.38). There was no significant correlation in the TSH subgroups with BMD. The TSH suppression level has no relation with the elevated prevalence of low BMD, hypocalcemia and vitamin D deficiency. Difference in odds ratio was not significant for osteopenia and osteoporosis between the TSH subgroups (TSH < 0.02, >0.02 and <0.1 and >0.1 mu/L). Conclusion: Suppressive therapy with levothyroxine cannot decrease BMD, Z score and T score in PTC patients.

Keywords

References

1.	Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams Textbook of Endocrinology. California: Saunders; 2011. p. 365, 453-7, 1315-7, 1323.
2.	Longe DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. New York: McGraw-Hill Professional; 2012. p. 2923, 3124-6.
3.	Frite MA, Speroff L. Climied Gynecologic Endocrinology and Infertility. 8^th ed. New York: Lippincott Williams & Wilkins; 2010. p. 895.
4.	DeGroot LJ, Jumeson JL, Burge HC. Endocrinology. 5^th ed. Philadelphia: Benjamin Cummings; 2008. p. 1190.
5.	Woolf AD, Dixon AS, Donitz M. Osteoporosis a Clinical Guide. 2^nd ed. London: Informa Healthcare; 1998. p. 188.
6.	Manolagas SC, Parfitt AM. For whom the bell tolls: Distress signals from long-lived osteocytes and the pathogenesis of metabolic bone diseases. Bone. 2012;pii: S8756-3282(12) 01246-X.
7.	Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR. Kelley's Textbook of Rheumatology. California: Saunders; 2013. p. 1662.
8.	Rosen HN, Moses AC, Garder J, Ross DS, Lee SL, Ferguson L, et al. Randomized trial of pamidronate in patients with thyroid cancer: Bone density is not reduced by suppressive doses of thyroxine, but is increased by cyclic intravenous pamidronate. J Clin Endocrinal Metab 1998;83:2324-30.
9.	Wei-Bo XI, Ling XU, Hua SU. Vitamin D deficiency and osteoporosis. Int J Rheum Dis 2008;11:366-73.
10.	Schneider R, Schneider M, Reiners C, Schneider P. Effect of levothyroxine on bone mineral density, muscle force, and bone turnover markers: A cohort study. J Clin Endocrinol Metab 2012;97:3926-34.
11.	Rosen HN, Moses AC, Garber J, Ross DS, Lee SL, Ferguson L, et al. Randomized trial of pamidronate in patients with thyroid cancer: Bone density is not reduced by suppressive doses of levothyroxine, but is increased by cyclic intravenous pamidronate. J Clin Endocrinol Metab 1998;83:2324-30.
12.	Sugitani I, Fujimot Y. Effect of postoperative thyrotropin suppressive therapy on bone mineral density in patients with papillary thyroid carcinoma. Surgery 2011;150:1250-7.
13.	Chen L, Lu H. Effects of lovothyroxin on bone metabolism I patients with differentiated thyroid cancer post operation and radioiodine ablation. J Nucl Med 2007;48(Suppl 2):271.
14.	Diamond T, Nery L, Hales I. A therapeutic dilemma: Suppressive doses of thyroxine significantly reduce bone mineral measurements in both premenopausal and postmenopausal women with thyroid carcinoma. J Clin Endocrinol Metab 1991;72:1184-8.
15.	Lee MY, Park YH, Bae KS, Jee YG, Ko AN, Han YJ, et al. Bone mineral density and bone turnover markers in patients on long-term suppressive levothyroxine therapy for differentiated thyroid cancer. Ann Surg Treat Res 2014;86:55-60.
16.	Reverter JL, Holgado S, Alonso N, Salinas I, Granada ML, Sanmartí A. Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma. Endocr Relat Cancer. 2005;12(4):973-81.
17.	Eftekhari M, Asadollahi A, Beiki D, Izadyar S, Gholamrezanezhad A, Assadi M, et al. The long term effect of levothyroxine on bone mineral density in patients with well differentiated thyroid carcinoma after treatment. Hell J Nucl Med 2008;11:160-3.
18.	Mazokopakis EE, Starakis IK, Papadomanolaki MG, Batistakis AG, Papadakis JA. Changes of bone mineral density in pre-menopausal women with differentiated thyroid cancers receiving L-thyroxin suppressive therapy. Curr Med Res Opin 2006;22:1369-73.
19.	Sajjinanont T, Rajchadara S, Sriassawaamorn N, Panichkul S. The comparative study of bone mineral density between premenopausal women receiving long term suppressive dose of levothyroxin for well-differentiated thyroid cancer with healthy premenopausal women. J Med Assoe Thai 2005;88(Suppl 3):S71-6.

Advanced Biomedical Research