Journal Article

Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis

Eun Kyung Lee, Hyun Kyung Chung, Hwa Young Ahn, Seung Hoon Woo, Jin-Woo Park, Won Sang Yoo, Jun Hwa Hong, Eu Jeong Ku

2021

Overview

Abstract Context Because subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of TSH suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC). Objective We aimed to determine the effect of TSH suppression therapy on bone mineral density (BMD) in DTC patients. Methods We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies’ characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women’s and men’s lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model. The weighted mean differences with 95% CIs are expressed for the differences in outcome measurements between groups. Results Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared with the controls. Conclusion Evidence from observational studies suggests that postmenopausal women treated with TSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors.

• Publisher: The Endocrine Society,Oxford University Press
• Subject: Adenocarcinoma / Adenocarcinoma - pathology / Adenocarcinoma - surgery / Bone cancer / Bone Density / Bone mineral density / Bones / Care and treatment / Density / Fractures / Health aspects / Humans / Hyperthyroidism / Hyperthyroidism - drug therapy / Hyperthyroidism - etiology / Hyperthyroidism - pathology / Medical research / Medicine, Experimental / Meta-analysis / Observational studies / Osteoporosis / Osteoporosis - etiology / Osteoporosis - metabolism / Osteoporosis - pathology / Post-menopause / Postmenopausal women / Prognosis / Spine (lumbar) / Thyroid cancer / Thyroid Neoplasms / Thyroid Neoplasms - pathology / Thyroid Neoplasms - surgery / Thyroid-stimulating hormone / Thyroidectomy / Thyroidectomy - adverse effects / Thyrotropin / Thyrotropin - adverse effects / Thyrotropin - deficiency