Influence of Thyroid Functional Status on the Bone Mineral Density
Background. The studies carried our in recent years have found that thyroid hormones affect the metabolism of bone tissue, thereby causing occurrence of osteoporosis. Despite the researches conducted in the past, a clear explanation of the pathogenesis of metabolic osteopathy associated with thyroid disorders currently doesn’t exist. The objective of the study. To determine the influence of thyroid functional status on the characteristics of bone tissue according to ultrasound densitometry and laboratory research methods, to develop an algorithm for timely diagnosis of osteopenia and osteoporosis. Materials and methods. The study included 168 patients of reproductive age with diffuse nontoxic goiter, diffuse toxic goiter, postoperative hypothyroidism due to thyroidectomy for thyroid cancer and primary hypothyroidism. Thyroid functional status has been evaluated by determining the basal concentrations of thyroid stimulating hormone and free thyroxine in the blood serum. We assessed the level of osteocalcin, β-isomer of C-terminal telopeptide of type I collagen. To evaluate the structural and functional status of bone tissue, we have used ultrasound densitometry be means of quantitative bone ultrasonometer Sahara. Results. In people with thyroid pathology, changes of bone mineral density were found in 59 (39.9 %) cases, of them osteopenia — in 45 (30.4 %) and osteoporosis — in 14 (9.5 %). The incidemce of osteopenia and osteoporosis significantly increased in all groups of patients with disorders of thyroid functional status. The main factor that leads to reduced bone strength in patients with thyropathy is excessive or insufficient production of thyroid hormones, as well as treatment with suppressive doses of levothyroxine. The state of bone metabolism wasn’t affected by subclinical hypothyroidism and the duration and receiving low (less than 75 mg/day) doses of levothyroxine replacement therapy. The most significant changes in bone remodeling occur in patients with diffuse toxic goiter. Treatment with suppressive doses of levothyroxine promotes the activation of both bone resorption and formation, and substitute doses lead to increased resorption rate while maintaining the rate of bone formation. Conclusions. The complex approach to the assessment of bone metabolism in patients with thyroid disorders, which includes ultrasonic densitometry and laboratory methods, has been introduced for the first time. The factors (excessive and insufficient production of thyroid hormones, intake of thyroid hormones in suppressive dose) and the mechanisms of negative impact (stimulation of osteoclastic activity, reduced osteoblastic activity) on the state of bone strength in patients with different thyroid pathologies were established.
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