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Abstract
Objectives We assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy.
Data sources PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched from inception to 24 February 2021.
Study selection Case-control studies were included.
Data extraction and synthesis Two authors independently reviewed the studies, extracted the data and performed meta-analysis of eligible studies.
Research design and methods Studies evaluating BMD in postmenopausal women with thyroid cancer who had thyroidectomy and levothyroxine therapy were included. Differences in BMD were presented as standardised mean differences (SMDs). Meta-analyses were conducted using a random-effects model.
Results Analysis of 16 case-control studies (426 patients and 701 controls without thyroid cancer) showed that stringent TSH suppression (TSH <0.10 mIU/L) after thyroidectomy had deleterious effects on the BMD of the lumbar spine in postmenopausal women compared with controls (SMD −0.55; 95% CI −0.99 to −0.10; I2=75.8%). There was no significant difference in patients with moderate TSH suppression (TSH 0.10–0.49 mIU/L). TSH suppression in postmenopausal women was not significantly associated with lower femoral neck BMD. Subgroup analysis of the lumbar spine showed that the association between stringent TSH suppression and lower BMD was consistent among studies with >10 years of follow-up (SMD −0.32; 95% CI −0.50 to −0.14). Subgroup analysis of the femoral neck showed that total thyroidectomy was related to detrimental effects on the BMD of the femoral neck (SMD −0.60; 95% CI −0.89 to −0.31; I2=90.4%), but near-total thyroidectomy was not (SMD 0.00; 95% CI −0.30 to 0.30; I2=55.6%).
Conclusions Stringent TSH suppression had deleterious effects on the BMD of the lumbar spine after thyroidectomy in postmenopausal women. Further studies are needed to determine whether stringent TSH suppression after thyroidectomy increases the fracture risk.
- diabetes & endocrinology
- calcium & bone
- thyroid disease
Data availability statement
Data are available on reasonable request. Data are available on request. The data are available on request from the corresponding author (kukwon@korea.ac.kr).
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available on reasonable request. Data are available on request. The data are available on request from the corresponding author (kukwon@korea.ac.kr).
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Footnotes
DK and JH contributed equally.
Contributors DK designed the study, collected, extracted, analysed the data and wrote the manuscript. JH extracted and analysed the data and wrote the manuscript. YW interpreted the results and critically revised the manuscript. YK designed the study, collected the data and wrote the manuscript. SP supervised the study and critically revised the manuscript.
Funding This work was supported by grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education ((2020R1I1A1A01070106) (for Y.K.), and the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 9991007295, KMDF_PR_202012D13-02) (for S.P.)
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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