Effect of postoperative thyrotropin suppressive therapy on bone mineral density in patients with papillary thyroid carcinoma: A prospective controlled study.

Author(s): Sugitani I, Fujimoto Y

Affiliation(s): Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

Publication date & source: 2011-12, Surgery., 150(6):1250-7.

BACKGROUND: The influence of thyrotropin (thyroid-stimulating hormone [TSH]) suppressive therapy on bone mineral density (BMD) remains contentious. We have conducted a randomized controlled trial evaluating the effects of postoperative TSH suppressive therapy on disease-free survival for papillary thyroid carcinoma (PTC) since 1996, while prospectively verifying the effects of TSH suppression on BMD. METHODS: Lumbar spine BMD as expressed by T-score was examined annually in female patients randomly assigned to receive TSH suppressive therapy (group A; n = 144) or no therapy (group B; n = 127). RESULTS: The mean TSH level was 0.07 +/- 0.10 mU/L in group A and 3.14 +/- 1.69 mU/L in group B. Group B did not show any significant decrease in T-score until 5 years postoperatively, whereas group A had a significant deterioration from 1 year postoperatively. Among group A patients, significant decreases in T-score within 1 year were seen in patients >/=50 years of age, but not in those <50 years of age. After 5 years of TSH suppression, 20 patients had T-scores below -2.0 and 100 patients did not. These former patients were significantly older and had lower preoperative BMD measurements than the latter. CONCLUSION: This prospective controlled trial suggests that TSH suppression after surgery for PTC has adverse effects on BMD in women >/=50 years of age. Copyright (c) 2011 Mosby, Inc. All rights reserved.