Trabecular bone deterioration in differentiated thyroid cancer: Impact of long‐term TSH suppressive therapy

• Published in: Cancer medicine (Malden, MA) Vol. 9; no. 16; pp. 5746 - 5755
• Main Authors: Hawkins Carranza, Federico, Guadalix Iglesias, Sonsoles, Luisa De Mingo Domínguez, María, Martín‐Arriscado Arroba, Cristina, López Álvarez, Begoña, Allo Miguel, Gonzalo, Martínez Díaz‐Guerra, Guillermo
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-08-2020; John Wiley and Sons Inc; Wiley
• Subjects: Ablation; Bone density; Bone mineral density; Cancellous bone; Clinical Cancer Research; differentiated thyroid carcinoma; Disease; Dual energy X-ray absorptiometry; Fractures; Hyperthyroidism; Long-term effects; Metabolism; Original Research; Osteoporosis; Patients; Software; Studies; Surgery; Thyroid cancer; Thyroid-stimulating hormone; Thyroidectomy; thyrotropin suppressive therapy; Thyroxine; trabecular bone score; Womens health; bone mineral density; differentiated thyroid carcinoma; trabecular bone score; thyrotropin suppressive therapy
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3200

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.
There is a debate respect the effect of long‐term TSH suppression therapy in Thyroid Cancer. We have demonstrated according to the degree of suppression and duration (Group I, 5‐10 years; Group II, >10 years): TBS values were lower in Groups I (1.29 ± 0.12) and II (1.26 ± 0.13) compared with baseline values while decreases in L‐BMD and FN‐BMD were seen in patients after >10 years. 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. We described for the first time 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. Therefore we support Trabecular Bone Score as a useful technique for identifying thyroid cancer patients with risk of bone fracture.