ECE2023 Oral Communications Oral Communications 8: Calcium and Bone (6 abstracts)
Bone mineral density and fracture status of differentiated thyroid cancer patients under TSH suppression treatment
Dilek Gogas Yavuz 1 , Ceyda Dinçer Yazan 1 , Zeliha Hekimsoy 2 , Kadriye Aydin 3 , Naile Gokkaya 3 , Canan Ersoy 4 , Berna I mge Aydogan 5 , Aysen Akalin 6 , Ömercan Topaloğlu 7 , Esra Nur Ademoglu Dilekci 8 , Guven Baris Cansu 9 , Bulent Can 10 , Kagan Gungor 10 , Mehtap Evran 11 , Lezzan Keskin 12 , Ziynet Alphan Uc 13 , Ozlem Iyidir 14 , Levent Ozsari 15 , Tayfun Garip 16 , Gulsah Elbuken 17 , Meral Mert 18 , Zafer Pekkolay 19 , Zeynep Canturk 20 , Can Ilgin 21 , Nilufer Ozdemir Kutbay 2 , Goknur Yorulmaz 6 , Ahmet Toygar Kalkan 6 , Yasemin Aydoğan Ünsal 4 , Adnan Yay 15 , Barış Karagün 11 & Evin Bozkur 18
1Marmara University Faulty of Medicine, Endocrinology and Metabolism, Turkey; 2Celal Bayar University Faculty of Medicine, Endocrinology and Metabolism, Turkey; 3Lutfi Kirdar Research and Training Hospital, Endocrinology and Metabolism, Turkey; 4Uludag University Faculty of Medicine, Endocrinology and Metabolism, Turkey; 5Batman Research and Training Hospital, Endocrinology and Metabolism, Turkey; 6Osmangazi University School of Medicine, Endocrinology and Metabolism, Turkey; 7Kocaeli Derince Research and Training Hospital, Endocrinology and Metabolism, Turkey; 8Bolu Abant Izzet Baysal University School of Medicine, Endocrinology and Metabolism, Turkey; 9Kutahya Health Sciences University, Endocrinology and Metabolism, Turkey; 10Medeniyet University School of Medicine, Endocrinology and Metabolism, Turkey; 11Cukurova University School of Medicine, Endocrinology and Metabolism, Turkey; 12Malatya Research and Training Hospital, Endocrinology and Metabolism, Turkey; 13Usak Research and Training Hospital, Endocrinology and Metabolism, Turkey; 14Baskent University School of Medicine, Endocrinology and Metabolism, Turkey; 15Sultan Abdulhamid Han Research and Training Hospital, Endocrinology and Metabolism, Turkey; 16Medical Park Pendik Hospital, Endocrinology and Metabolism, Turkey; 17Namik Kemal University, School of Medicine, Endocrinology and Metabolism, Turkey; 18Bakirkoy Sadi Konuk Research and Training Hospital, Endocrinology and Metabolism, Turkey; 19Dicle University School of Medicine, , Endocrinology and Metabolism, Turkey; 20Kocaeli University Faculty of Medicine, Endocrinology and Metabolism; 21Marmara University Faculty of Medicine, Radiation Oncology, Turkey
Aim: Thyroid Stimulating Hormone (TSH) suppression treatment may have a detrimental effect on bone tissue in differentiated thyroid cancer (DTC) patients. The current study aimed to investigate vertebral fracture, bone mineral density measurements, and TSH levels in DTC patients under levothyroxine (LT4) suppression treatment after total thyroidectomy and/or radioiodine ablation therapy in a multicentric setting.
Material and Method: This multicentric cross-sectional study was conducted at 21 medical centers from 12 cities in Turkey. Clinical data, serum TSH, free thyroxine (FT4), Thyroglobulin (Tg), and antithyroglobulin (Anti-Tg) levels were all recorded during the most recent visit. TSH serum concentrations were classified as TSH<0.1 mU/l, TSH 0.1-0.5 mU/l and TSH>0.5 mU/l according to TSH suppression recommendation of American Thyroid Association guidelines. Systolic and diastolic blood pressure and pulse rate were measured. Mineral densities were measured with a GE Lunar DXA scanner. Lateral vertebral X-rays were reviewed blindly. The vertebral fractures were defined according to Genant’s semi-quantitative method as grade 1-4.
Results: A group of 990 DTC patients (F/M:829/161,51.4±11.5 years) were enrolled. The mean disease duration was 5.2±4.4 years. LT4 daily dosage was 131.1±37.5 mg/day. The patient’s femur neck BMD (P=0.65) and L1-L4 BMD (P=0.86) levels were similar according to TSH suppression levels. Serum calcium, phosphor, parathormone, and 25-OHD3 levels were similar between groups. Four hundred sixty-eight lateral vertebral x-ray evaluations revealed that 200 patients had fractures. Mean vertebral fracture number was 5.43. The patients with vertebral fractures were older (P<0.001), The daily dosage (P<0.001) and dose per kg (P=0.015) were lower in the fracture group compared to the nonfracture group. The fracture group’s femur neck BMD (P=0.001) and L1-L4 BMD (P=0.003) were lower. The TSH levels of the patients with fractures were higher (P=0.0082).
Conclusion: The femur and L1-L4 BMD levels of patients in this study group were similar according to TSH suppression levels. Studies to date have also yielded conflicting results. Frequent monitoring and avoiding unnecessary TSH suppression especially in older patients is essential to prevent detrimental effects.
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