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Trabecular bone score in women with differentiated thyroid cancer on long-term TSH-suppressive therapy

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Abstract

Introduction

Thyrotropin stimulating hormone (TSH) suppression in patients with differentiated thyroid cancer (DTC) aims to decrease the growth and proliferation of thyroid cancer cells. However, the effect of TSH-suppressive therapy on bone microarchitecture remains undefined.

Methods

Cross-sectional study including 43 women with DTC undergoing TSH-suppressive therapy (sTSH) compared to 20 women also on levothyroxine (LT4) therapy but with TSH in the low-normal range (nTSH) since the thyroid surgery. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA), and trabecular bone score (TBS) was evaluated using the TBS iNsigth software. Fracture risk assessed by FRAX, with and without TBS, was calculated. The relationship between suppressive therapy-related parameters and bone parameters was investigated.

Results

The TBS mean values were not significantly different in the sTSH and nTSH groups (1.273 ± 0.12 vs 1.307 ± 0.14, p = 0.7197). In both groups, postmenopausal women had degraded microarchitecture (TBS 1.216 ± 0.11 vs 1.213 ± 0.09, p = 0.9333), while premenopausal women had normal microarchitecture (1.328 ± 0.11 vs 1.401 ± 0.12, p = 0.195). The percentage of all postmenopausal women with degraded TBS was 54.7%, while the percentage of osteoporosis diagnoses was 16.1%. The TBS-adjusted FRAX-probability of fracture was similar in sTSH and nTSH groups. Body mass index (BMI) and menopausal status were the only variables associated with TBS and BMD.

Conclusion

Trabecular microarchitecture assessed by TBS was similar between women on long-term suppressive therapy in DTC and those on LT4 replacement therapy aiming at a TSH level within the low-normal reference range. Low TBS values were observed in postmenopausal women of both groups, suggesting that not only suppressed TSH levels but also a low-normal TSH is associated with deteriorated bone microarchitecture in postmenopausal women following total thyroidectomy.

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Acknowledgements

We thank the densitometry service of the Jenny Faria de Andrade Institute, especially the doctors Olívio Brito Mallheiros and Carlyle Marques Barral and the assistants Maria do Socorro de Souza and Elizabeth Aparecida de Souza.

Funding

This research did not receive any specific grant from any funding agency.

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Authors and Affiliations

  1. Graduate Program in Sciences Applied To Adult Health Care, Federal University of Minas Gerais - UFMG, Belo Horizonte, Minas Gerais State, Brazil

    B. É. C. A. Sousa, M. M. S. Soares & A. M. Kakehasi

  2. School of Medicine, University Center of Belo Horizonte - UNI-BH, Belo Horizonte, Brazil

    B. C. Silva

  3. Division of Endocrinology, Felício Rocho Hospital, Belo Horizonte, Brazil

    B. C. Silva & M. M. S. Soares

  4. Division of Endocrinology, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil

    B. C. Silva

  5. Physiotherapy Academic, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil

    T. de Oliveira Guidotti

  6. Statistics Department, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil

    M. C. Pires

  7. Department of Internal Medicine and Endocrinology, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil

    M. M. S. Soares

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  1. B. É. C. A. Sousa
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Sousa, B.É.C.A., Silva, B.C., de Oliveira Guidotti, T. et al. Trabecular bone score in women with differentiated thyroid cancer on long-term TSH-suppressive therapy. J Endocrinol Invest 44, 2295–2305 (2021). https://doi.org/10.1007/s40618-021-01537-0

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