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Related Experiment Videos

Persistent increase in bone turnover in Graves' patients with subclinical hyperthyroidism.

Y Kumeda1, M Inaba, H Tahara

  • 1Department of Internal Medicine, Osaka City University Graduate School of Medicine, Japan.

The Journal of Clinical Endocrinology and Metabolism
|November 30, 2000
PubMed
Summary

Persistent TSH suppression in Graves' disease patients on antithyroid drugs indicates ongoing bone loss. TSH receptor antibody (TRAb) levels strongly correlate with bone turnover markers, suggesting its utility in monitoring bone health during treatment.

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Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Graves' Disease

Background:

  • Hyperthyroidism accelerates bone loss due to increased bone turnover.
  • Normalization of thyroid function typically reduces bone turnover and increases bone mineral density.
  • Some Graves' disease patients on antithyroid drugs exhibit persistent TSH suppression despite normal FT3 and FT4 levels.

Purpose of the Study:

  • To investigate bone metabolism in premenopausal Graves' disease patients with persistent TSH suppression while on antithyroid drug therapy.
  • To compare bone metabolism markers between TSH-suppressed and TSH-normal Graves' disease patients.
  • To evaluate the relationship between TSH receptor antibody (TRAb) levels and bone metabolism markers.

Main Methods:

  • Compared bone metabolism markers (serum bone alkaline phosphatase, urinary pyridinoline, deoxypyridinoline) in TSH-suppressed (n=19) and TSH-normal (n=30) premenopausal Graves' disease patients on antithyroid drugs.

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  • Assessed serum calcium, phosphorus, intact PTH, and urinary calcium excretion.
  • Correlated TSH, FT3, FT4, and TRAb levels with bone metabolism markers in all patients.

    • Main Results:

    • TSH-suppressed patients showed significantly higher bone formation (B-ALP) and resorption (U-PYD, U-DPD) markers compared to TSH-normal patients.
    • TSH levels, but not FT3 or FT4, negatively correlated with bone metabolism markers across all patients.
    • TRAb levels demonstrated a strong positive correlation with bone formation and resorption markers, even in patients with normal TSH.

    Conclusions:

    • Achieving normal TSH levels is crucial for normalizing bone turnover in Graves' disease patients undergoing antithyroid drug therapy.
    • TSH receptor antibody (TRAb) is a sensitive indicator of disease activity and bone metabolism status in Graves' disease patients during treatment.
    • Persistent TSH suppression despite normal thyroid hormones indicates ongoing detrimental effects on bone metabolism.