تاثیر لووتیروکسین با دوز جایگزینی روی تراکم استخوان در زنان قبل از یائسگی با هیپوتیروئیدی اولیه

Background and Objective: Patients with hypothyroidism require thyroid hormone replacement. Many studies have shown that bone density reduction is caused by suppressive doses of levothyroxine, but there are contradictory results regarding the effect of levothyroxine replacement dose (non suppressive). The purpose of this study was to investigate the effect of replacement doses of levothyroxine on bone mineral density in premenopausal females with primary hypothyroidism. Materials and methods: In this analytic case - control study, 55 females aged 30 to 50 years with primary hypothyroidism who received levothyroxine for at least two years, with TSH of 0.1 to 4.5 over their follow ups underwent densitometry using DXA method in spine and hip and then were compared with 55 subjects in the control group. Results: The mean differences in bone mineral density and Z-score of total femur zone, neck of femur and lumbar spine zone were significant in control and case groups. There were no significant correlations between the duration and dose and bone density in femur zone (neck and total) and lumbar spine. Likewise, there was no significant correlation between TSH and bone density in total femur zone and lumbar spine however, the difference was significant in femur neck zone, but not at the level of osteoporosis and osteopenia. Conclusion: This study indicates that taking levothyroxine even with replacement dose (TSH within the normal range) can result in prominent changes in bone density, although it is not clinically significant. References 1- Hafezi R, Hamidi Z, Soltani A, Keshtkar AA. Correlation between DXL and DXA in assessment of bone structure in patients using levothyroxine. J Rep Infert. 2005 87-92. 2- Mary JS, William C. Is thyroid medication going to give you osteoporosis? experts evaluate the risks. Medical review board 2004. 3- Bagheri P, Haghdoost AA, Dortaj E, et al. Ultra analysis of prevalence of osteoporosis in iranian women a systematic review and meta-analysis. Iran J Endocrinol Metab. 2011 3. 4- Kanis K. Osteoporosis and its consequences. Osteoporosis Blackwell Science Ltd 1993. 5- Aminorroaya A, Janghorbani M, Amini M, Hovsepian S, Tabatabaei A, Fallah Z. The prevalence of thyroid dysfunction in an iodine-sufficient area in Iran. Arch Iran Med. 2009 12: 262-70. 6- Roberts CG, Ladenson PW. Hypothyroidism. Lancet. 2004 363: 793-803. 7- Bartalena L, Bogazzi F, Martino E. Adverse effects of thyroid hormone preparations and antithyroid drugs. Drug Saf. 1996 15: 53-63. 8- Thyroid disease and osteoporosis. National osteoprosis society 2012. 9- Mettler FA, Jr, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 2008 248: 254-63. 10- Vallejo R. Current management of osteoporotic spine fractures. Perspectives. 2003 2. 11- Florkowski CM, Brownlie BE, Elliot JR, Ayling EM, Turner JG: Bone mineral density in patients receiving suppressive doses of thyroxine for thyroid carcinoma. N Z Med J. 1993 106: 443-4. 12- Nuzzo V, Lupoli G, Esposito Del Puente A, et al. Bone mineral density in premenopausal women receiving levothyroxine suppressive therapy. Gynecol Endocrinol. 1998 12: 333-7. 13- Marcocci C, Golia F, Vignali E, Pinchera A: Skeletal integrity in men chronically treated with suppressive doses of L-thyroxine. J Bone Miner Res.1997 12: 72-7. 14- Franklyn JA, Betteridge J, Daykin J, et al. Long-term thyroxine treatment and bone mineral density. Lancet. 1992 340: 9-13. 15- Reverter JL, Holgado S, Alonso N, Salinas I, Granada ML, Sanmarti A: Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma. Endocr Relat Cancer. 2005 12: 973-81. 16- Giannini S, Nobile M, Sartori L, et al. Bone density and mineral metabolism in thyroidectomized patients treated with long-term L-thyroxine. Clin Sci (Lond). 1994 87: 593-7. 17- Gorres G, Kaim A, Otte A, Gotze M, Muller-Brand J: Bone mineral density in patients receiving suppressive doses of thyroxine for differentiated thyroid carcinoma. Eur J Nucl Med. 1996 23: 690-2. 18- Appetecchia M. Effects on bone mineral density by treatment of benign nodular goiter with mildly suppressive doses of L-thyroxine in a cohort women study. Horm Res. 2005 64: 293-8. 19- Affinito P, Sorrentino C, Farace MJ, et al. Effects of thyroxine therapy on bone metabolism in postmenopausal women with hypothyroidism. Acta Obstet Gynecol Scand. 1996 75: 843-8. 20- Salerno M, Lettiero T, Esposito-del PA, et al. Effect of long-term L-thyroxine treatment on bone mineral density in young adults with congenital hypothyroidism. Eur J Endocrinol. 2004 151: 689-94. 21- Ribot C, Tremollieres F, Pouilles JM, Louvet JP. Bone mineral density and thyroid hormone therapy. Clin Endocrinol (Oxf). 1990 33: 143-53. 22- Van Den Eeden SK, Barzilay JI, Ettinger B, Minkoff J. Thyroid hormone use and the risk of hip fracture in women > or = 65 years: a case-control study. J Womens Health (Larchmt). 2003 12: 27-31. 23- Hanna FW, Pettit RJ, Ammari F, Evans WD, Sandeman D, Lazarus JH: Effect of replacement doses of thyroxine on bone mineral density. Clin Endocrinol. 1998, 48: 229-34. 24- De Rosa G, Testa A, Maussier ML, Calla C, Astazi P, Albanese C. A slightly suppressive dose of L-thyroxine does not affect bone turnover and bone mineral density in pre- and postmenopausal women with nontoxic goitre. Horm Metab Res. 1995 27: 503-7. 25- Schneider R, Reiners C. The effect of levothyroxine therapy on bone mineral density: a systematic review of the literature. Exp Clin Endocrinol Diabetes. 2003 111: 455-70.