Osteoporosis International

, Volume 23, Issue 9, pp 2277–2282 | Cite as

Normalization of cortical bone density in children and adolescents with hyperthyroidism treated with antithyroid medication

  • N. Numbenjapon
  • G. Costin
  • P. PitukcheewanontEmail author
Original Article



We assessed bone size and bone density (BD) measurements using computed tomography (CT) in children and adolescents with hyperthyroidism treated with antithyroid medication. We found that cortical BD appeared to improve at 1 year and normalize at 2 years in all tested patients.


Our previous study demonstrated that cortical BD in children and adolescents with untreated hyperthyroidism was significantly decreased as compared to age-, sex- and ethnicity-matched healthy controls. The present report evaluated whether attainment of euthyroidism by medical antithyroid treatment was able to improve or normalize cortical BD in these patients.


Anthropometrics and three-dimensional CT bone measurements including cross-sectional area (CSA), cortical bone area (CBA) and cortical BD at midshaft of the femur (cortical bone), and CSA and BD of L1 to L3 vertebrae (cancellous bone) in 15 children and adolescents after 1- and 2-year treatments with antithyroid medication were reviewed and compared to their pretreatment results.


All patients were euthyroid at 1 and 2 years after medical antithyroid treatment. After adjusting for age, height, weight and Tanner stage, a significant increase in cortical BD in all patients (15/15) was found after 1 year of treatment (P < 0.001). Normalization of cortical BD was demonstrated in all tested patients (10/15) after 2 years. There were no significant changes in the other cancellous or cortical bone parameters.


Cortical BD was improved at 1 year and normalized at 2 years in hyperthyroid patients rendered euthyroid with antithyroid medication.


Antithyroid treatment Bone density Children Computed tomography Cortical bone Hyperthyroidism 



The authors would like to thank Frederick Dorey, Ph.D., for his support in statistical analysis and Norma Castaneda for her assistance in data collection.

Conflicts of interest

N.N., G.C. and P.P. have no conflicts of interest to declare.


  1. 1.
    Vestergaard P, Mosekilde L (2002) Fractures in patients with hyperthyroidism: a nationwide follow-up study in 16,249 patients. Thyroid 12:411–419PubMedCrossRefGoogle Scholar
  2. 2.
    Tsai KS, Lai SM, Huang KM, Chieng PU, Su CT, Chen FW (1991) Decreased bone mineral density in patients with prolonged thyrotoxicosis before and after treatment. J Formos Med Assoc 90:250–255PubMedGoogle Scholar
  3. 3.
    Karga H, Papapetrou PD, Korakovouni A, Papandroulaki F, Polymeris A, Pampouras G (2004) Bone mineral density in hyperthyroidism. Clin Endocrinol 61:466–472CrossRefGoogle Scholar
  4. 4.
    Numbenjapon N, Costin G, Gilsanz V, Pitukcheewanont P (2007) Low cortical bone density measured by computed tomography in children and adolescents with untreated hyperthyroidism. J Pediatr 150:527–530PubMedCrossRefGoogle Scholar
  5. 5.
    Wagasuki M, Wakao R, Tawata M, Gan N, Inoue M, Onaya T (1994) Change in bone mineral density in patients with hyperthyroidism after attainment of euthyroidism by dual energy x-ray absorptiometry. Thyroid 4:179–182CrossRefGoogle Scholar
  6. 6.
    Siddiqi A, Burrin M, Noonan K, James I, Wood DF, Price CP, Monsan JP (1997) A longitudinal study of markers of bone turnover in Graves' disease and their value in predicting bone mineral density. J Clin Endocrinol Metab 82:753–759PubMedCrossRefGoogle Scholar
  7. 7.
    Nagasaka S, Sugimoto H, Nakamura T et al (1997) Antithyroid therapy improves bony manifestations and bone metabolic markers in patients with graves' thyrotoxicosis. Clin Endocrinol (Oxf) 47:215–221CrossRefGoogle Scholar
  8. 8.
    Rosen CJ, Adler RA (1992) Longitudinal changes in lumbar bone density among thyrotoxic patients after attainment of euthyroidism. J Clin Endocrinol Metab 75:1531–1534PubMedCrossRefGoogle Scholar
  9. 9.
    Mora S, Weber G, Marenzi K, Signorini E, Rovelli R, Proverbic MC, Chiumello G (1999) Longitudinal changes of bone density and bone resorption in hyperthyroid girls during treatment. J Bone Miner Res 14:1971–1977PubMedCrossRefGoogle Scholar
  10. 10.
    Lucidarme N, Ruiz JC, Czernidrow P, Leger J (2000) Reduced bone mineral density at diagnosis and bone mineral recovery during treatment in children with Graves' disease. J Pediatr 137:56–62PubMedCrossRefGoogle Scholar
  11. 11.
    Gafni RI, Baron J (2004) Overdiagnosis of osteoporosis in children due to misinterpretation of dual-energy x-ray absorptiometry (DEXA). J Pediatr 144:253–257PubMedCrossRefGoogle Scholar
  12. 12.
    Pitukcheewanont P, Chen P (2005) Bone density measurements in children and adolescents: quantitative computed tomography versus dual-energy x-ray absorptiometry. Endocrinologist 15:232–239CrossRefGoogle Scholar
  13. 13.
    Hangartner TN, Johnston CC (1990) Influence of fat on bone measurements with dual-energy absorptiometry. Bone Miner 9:71–81PubMedCrossRefGoogle Scholar
  14. 14.
    Wren TA, Liu X, Pitukcheewanont P, Gilsanz V (2005) Bone densitometry in pediatric populations: discrepancies in the diagnosis of osteoporosis by DXA and CT. J Pediatr 146:776–779PubMedCrossRefGoogle Scholar
  15. 15.
    Tanner JM (1978) Physical growth and development. In: Forfar JO, Arnell CC (eds) Textbook of Pediatrics, 2nd edn. Churchill Livingstone, Edinburgh, pp 249–303Google Scholar
  16. 16.
    Kuczmarski RJ, Ogden CL, Grummer-Strawn LM et al (2000) CDC growth charts: United States. Adv Data 314:1–27PubMedGoogle Scholar
  17. 17.
    Gilsanz V, Skaggs DL, Kovanlikaya A et al (1998) Differential effect of race on the axial and appendicular skeletons of children. J Clin Endocrinol Metab 83:1420–1427PubMedCrossRefGoogle Scholar
  18. 18.
    Gilsanz V, Nelson DA (2003) Childhood and adolescence. In: Favus MJ (ed) Primer on the metabolic bone diseases and disorders of mineral metabolism, 5th edn. American Society for Bone and Mineral Research, Washington, D.C., pp 71–80Google Scholar
  19. 19.
    Pitukcheewanont P, Safani D, Church J, Gilsanz V (2005) Bone measures in HIV-1 infected children and adolescents: disparity between quantitative computed tomography and dual-energy x-ray absorptiometry measurements. Osteoporos Int 16:1393–1396PubMedCrossRefGoogle Scholar
  20. 20.
    Mosekilde L, Melsen F (1978) Effect of antithyroid treatment on calcium–phosphorus metabolism in hyperthyroidism. II: bone histomorphometry. Acta Endocrinol 87:751–758PubMedGoogle Scholar
  21. 21.
    Vestergaard P, Rejnmark L, Mosekilde L (2005) Influence of hyper- and hypothyroidism, and the effects of treatment with antithyroid drugs and levothyroxine on fracture risk. Calcif Tissue Int 77:139–144PubMedCrossRefGoogle Scholar
  22. 22.
    Langdahl BL, Loft AG, Eriksen EF, Mosekilde L, Charles P (1996) Bone mass, bone turnover, body composition, and calcium homeostasis in former hyperthyroid patients treated by combined medical therapy. Thyroid 6:161–168PubMedGoogle Scholar
  23. 23.
    Grant DJ, McMurdo ME, Mole PA, Paterson CR (1995) Is previous hyperthyroidism still a risk factor for osteoporosis in post-menopausal women? Clin Endocrinol 43:339–345CrossRefGoogle Scholar
  24. 24.
    Pantazi H, Papapetrou PD (2000) Changes in parameters of bone and mineral metabolism during therapy for hyperthyroidism. J Clin Endocrinol Metab 85:1099–1106PubMedCrossRefGoogle Scholar
  25. 25.
    Brockstedt H, Kassem M, Eriksen EF, Mosekilde L, Melsen F (1993) Age- and sex-related changes in iliac cortical bone mass and remodeling. Bone 14:681–691PubMedCrossRefGoogle Scholar
  26. 26.
    Parfitt AM, Travers R, Rauch F, Glorieux FH (2000) Structural and cellular changes during bone growth in healthy children. Bone 27:487–494PubMedCrossRefGoogle Scholar
  27. 27.
    Wong GW, Lai J, Cheng PS (1999) Growth in childhood thyrotoxicosis. Eur J Pediatr 158:776–779PubMedCrossRefGoogle Scholar
  28. 28.
    Schlesinger S, MacGillivray MH, Munschauer RW (1973) Acceleration of growth and bone maturation in childhood thyrotoxicosis. J Pediatr 83:233–236PubMedCrossRefGoogle Scholar
  29. 29.
    Lazar L, Kalter-Leibovici O, Pertzelan A, Weintrob N, Josefsberg Z, Phillip M (2000) Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab 85:3678–3682PubMedCrossRefGoogle Scholar
  30. 30.
    Jaruratanasirikul S, Sriplung H (2006) Growth pattern of childhood thyrotoxicosis: longitudinal follow-up to final height. J Med Assoc Thai 89:1396–1399PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • N. Numbenjapon
    • 1
    • 2
  • G. Costin
    • 1
  • P. Pitukcheewanont
    • 1
    Email author
  1. 1.Center for Endocrinology, Diabetes and Metabolism, Department of PediatricsChildren’s Hospital Los Angeles, Keck School of Medicine, University of Southern CaliforniaLos AngelesUSA
  2. 2.Division of Endocrinology, Diabetes and Metabolism, Department of PediatricsPhramongkutklao HospitalBangkokThailand

Personalised recommendations