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 In particular, osteoporosis and bone fractures were much more likely
in patients who received thyroxine treatment for more than a year
after surgery, the study authors report in World Journal of Surgery.
“The incidence of thyroid cancer has been progressively increasing,
resulting in an increase in the number of thyroidectomy operations,”
said Dr. Ian Ganly of Memorial Sloan Kettering Cancer Center in New
York City, who wasn’t involved in the study.
“This means there will be a corresponding increase in patients with
osteoporosis and fracture,” Ganly said by email. “The findings from
this paper could be used as an argument to treat such patients with
observation (or delayed surgical intervention) rather than surgery.”
Researchers at four universities in Taiwan analyzed data in the
national health insurance database for 1,400 patients who had all or
part of their thyroid removed between 2000 and 2005 and 5,700
similar people who didn’t.
They considered age, sex and other health conditions such as
diabetes, hypertension, obesity, heart disease, kidney disease, lung
disease and cancers other than thyroid cancer. In particular, the
research team also looked for a new diagnosis of osteoporosis or
related bone fracture.
They found that 120 patients in the group that had thyroid surgery
and 368 in the group without surgery developed osteoporosis or
fractures. Overall, the risk was about 1.5 times higher for both the
partial and total thyroidectomy patients. The risk was also higher
in younger patients between ages 20 and 49 and women who had thyroid
surgery.
“We believe it is the degree of thyroid-stimulating hormone (TSH)
suppression which is the main cause for increased osteoporosis,”
Ganly said. “Reducing the degree of suppression, particularly in
low-risk thyroid cancer patients that account for the bulk of all
thyroid cancer patients, would seem the most obvious first remedy.”
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A limitation of the study is that it is a retrospective look at data
that can’t control for variables such as steroid use, alcohol use,
presence of rheumatoid arthritis, primary hyperparathyroidism and
other factors that lead to decreased bone density and osteoporosis,
said Dr. Maria Papaleontiou of the University of Michigan in Ann
Arbor, who wasn’t involved in the study.
Future studies should look more closely at thyroid-stimulating
hormone (or TSH) suppression therapy, which is currently the
standard of care for patients with intermediate-risk and high-risk
thyroid cancer, she said.
“TSH suppression therapy and overtreatment with thyroid hormone
(both of which induce a state of hyperthyroidism) may have played a
role in the development of adverse skeletal effects in these
patients,” Papaleontiou said in an email.
University of Michigan researchers are conducting several studies in
veterans to understand the possible links between thyroid
overtreatment or suppression therapy and osteoporosis, she noted.
They’re also surveying U.S. doctors to understand primary care
physicians and specialists’ beliefs about thyroid hormone
replacement therapy and bone density.
At the same time, she noted, current guidelines from national groups
don’t recommend regular bone density screenings or osteoporosis
treatments for patients who have undergone thyroid surgery.
“Decreased bone density may be multifactorial, physicians should use
their experience and discretion in screening for and treating
osteoporosis in these patients,” Papaleontiou said. “We should
advocate for providing evidence-based patient care but by first
doing no harm.”
SOURCE: https://bit.ly/2GmHtrD World Journal of Surgery, online
March 14, 2018.
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