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Cited by 10Thyroid Disorders and TreatmentsBone health and osteoporosis researchThyroid and Parathyroid Surgery

Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis

Open access
Li, Xiaotao, Zhang, Taotao, Zhang, Hongling, Liu, Shanshan, Tian, Limin·2025·BMC Endocrine Disorders
DOI 10.1186/s12902-024-01819-7PMC PMC11730139
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Abstract

Thyroid hormone plays an important role in accumulating bone development and regulating bone metabolism. It is established that hypothyroidism is linked to increased risk of osteoporosis and fracture. However, the effects of levothyroxine (LT4) treatment on bone for hypothyroid patients remain controversial. A systematical search was conducted of several databases, from inception until December 9, 2022, and updated the search using the same search strategy on October 30, 2024, for studies evaluating the effects of LT4 treatment on bone in hypothyroidism including subclinical hypothyroidism (SCH) and overt hypothyroidism (OH). The data were reported using a random-effects model with a standardized mean difference (SMD) and 95% conference interval (CI). Thirteen of the 5996 published articles were included in this meta-analysis. No significance was found in bone mineral density (BMD) at the lumbar spine between SCH patients treated with LT4 and control group either at baseline or after intervention. For OH, BMD at the lumbar spine was statistically lower in LT4 treatment group compared with healthy controls (HCs) (SMD: -0.28, 95%CI: -0.55, -0.02, P = 0.040, I 2 = 52%). There were no differences in BMD at the femoral neck, trochanter, and Ward’s triangle between OH patients treated with LT4 and HCs. In addition, BMD at the lumbar spine was significantly lower in males with OH undergoing LT4 treatment for a duration of less than five years compared to those treated over five years. Nevertheless, no significant differences were found in bone metabolism biomarkers between OH patients treated with LT4 and HCs. This systematic review and meta-analysis demonstrated that there is a slight adverse effect of LT4 replacement therapy on bone and mineral metabolism in patients with OH, while no observed effect was found in SCH patients.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis found that levothyroxine (LT4) replacement therapy had a slight adverse association with bone mineral density (BMD) in overt hypothyroidism (OH), especially at the lumbar spine, but no observed effect in subclinical hypothyroidism (SCH). Bone metabolism biomarkers did not differ significantly between LT4-treated OH patients and healthy controls.

Key findings

  • Among 13 included studies and 1135 participants, SCH showed no significant difference in lumbar spine BMD between LT4-treated and control groups at baseline (SMD 0.11, 95% CI -0.14 to 0.36, P = 0.370, I² = 2%) or after intervention (SMD 0.04, 95% CI -0.25 to 0.34, P = 0.780, I² = 0%).
  • In OH, lumbar spine BMD was significantly lower in LT4-treated patients than healthy controls (SMD -0.28, 95% CI -0.55 to -0.02, P = 0.040, I² = 52%), while no significant differences were found at the femoral neck (SMD -0.26, 95% CI -0.62 to 0.10, P = 0.150, I² = 74%), trochanter (SMD -0.58, 95% CI -1.33 to 0.16, P = 0.120, I² = 93%), or Ward’s triangle (SMD -0.46, 95% CI -1.05 to 0.13, P = 0.130, I² = 89%).
  • Bone metabolism biomarkers in OH showed no significant differences versus healthy controls, though there were non-significant trends toward higher osteocalcin (SMD 0.51, 95% CI -0.03 to 1.06, P = 0.070, I² = 76%) and alkaline phosphatase (SMD 0.38, 95% CI -0.02 to 0.78, P = 0.060, I² = 44%).
  • Subgroup analysis found significantly lower lumbar spine BMD when LT4 intervention was less than 5 years (SMD -0.56, 95% CI -1.06 to -0.06, P = 0.030, I² = 48%) but not at 5 years or more (SMD -0.12, 95% CI -0.31 to 0.08, P = 0.240, I² = 0%).

Methods

  • Systematic review and meta-analysis reported per PRISMA and registered in PROSPERO (CRD42023390228); eight databases were searched from inception to December 9, 2022, with an updated search on October 30, 2024.
  • Included studies evaluated LT4 treatment in SCH or OH, with controls receiving placebo, no treatment, or being euthyroid/healthy controls; exclusions included congenital or central hypothyroidism, pregnancy, age under 18, thyroid cancer/goiter suppression therapy, bone-affecting drugs, and no control group.
  • Thirteen studies were included: five RCTs in SCH and eight observational studies in OH; total 1135 participants, mean ages 32.8 to 74.3 years, and LT4 duration 4 months to 12.5 years. Random-effects models estimated standardized mean differences (SMDs) with 95% CIs; heterogeneity was assessed with I², sensitivity analyses excluded high-risk studies, and Egger’s test assessed publication bias using RevMan 5.4 and Stata 17.0.

Limitations

  • The authors state that the limited number of included studies prevented further exploration of high heterogeneity, that SCH data mainly involved older adults with little evidence for adults under 60, that SCH menopausal subgroup analysis was not possible, that most participants were female with only one male study in the sex subgroup analysis, and that SCH studies mostly had approximately one-year intervention durations.
  • The paper itself makes evident that several OH pooled estimates had substantial heterogeneity, including femoral neck, trochanter, Ward’s triangle, and some biomarkers (I² 74–93% and 76–92%, respectively).
  • The OH evidence came from observational studies rather than RCTs, and the male subgroup finding was based on a single study, limiting causal inference and generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12902-024-01819-7

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

33 of 51 cited sources checked · 19 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    BMD may be affected by LT4 treatment.

    “These are consistent with previous research indicating that BMD may be affected by LT4 treatment [18, 25].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [18] Babu RP, Christy A, Hegde A, et al. Do premenopausal hypothyroid women on levothyroxine therapy need bone status monitoring? Clin Med Insights Womens Health. 2015;8:1–6. https://doi.org/10.4137/cmwh.S22114. source
    • cites [25] Christy AL, D’Souza V, Babu RP, et al. Utility of C-terminal telopeptide in evaluating levothyroxine replacement therapy-induced bone loss. Biomark Insights. 2014;9:1–6. https://doi.org/10.4137/BMI.S13965. source
  • Premisecitation

    The duration of intervention may influence BMD.

    “These findings are consistent with some studies [38, 45], suggesting that the duration of intervention may influence BMD.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [38] Karimifar M, Esmaili F, Salari A, et al. Effects of Levothyroxine and thyroid stimulating hormone on bone loss in patients with primary hypothyroidism. J Res Pharm Pract. 2014;3(3):83–7. https://doi.org/10.4103/2279-042x.141099. source
    • cites [45] Delitala AP, Scuteri A. Thyroid hormone diseases and osteoporosis. J Clin Med. 2020;9(4). https://doi.org/10.3390/jcm9041034. source
  • Interpretationcitation

    The effects of long-term LT4 treatment on bone loss may be attributed to the cumulative impact of hyperthyroidism and the control level of TSH during treatment, rather than the thyroid hormone itself.

    “These effects may be attributed to the cumulative impact of hyperthyroidism and the control level of TSH during treatment, rather than the thyroid hormone itself [9].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [9] Abrahamsen B, Jørgensen HL, Laulund AS, et al. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Min Res. 2015;30(5):898–905. https://doi.org/10.1002/jbmr.2416. source

      The Discussion (page unavailable) links long-term fracture risk in women to the cumulative duration of low TSH, likely from excessive thyroid-hormone replacement. The paper studies fractures, not bone loss, and does not establish that thyroid hormone itself has no effect on bone; the Introduction says thyroid hormones can decrease bone mass. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    The effects of LT4 treatment on bone for hypothyroid patients remain controversial.

    “However, the effects of levothyroxine (LT4) treatment on bone for hypothyroid patients remain controversial.”
    Quote in the paperSubstantial claim3 of 6 sources checked
    • cites [17] Meier C, Beat M, Guglielmetti M, et al. Restoration of euthyroidism accelerates bone turnover in patients with subclinical hypothyroidism: a randomized controlled trial. Osteoporos Int. 2004;15(3):209–16. https://doi.org/10.1007/s00198-003-1527-8. source
    • cites [18] Babu RP, Christy A, Hegde A, et al. Do premenopausal hypothyroid women on levothyroxine therapy need bone status monitoring? Clin Med Insights Womens Health. 2015;8:1–6. https://doi.org/10.4137/cmwh.S22114. source
    • cites [19] Chai R, Ye Z, Zhan Z, et al. The effects of levothyroxine replacement therapy on bone and mineral metabolism in patients with hypothyroidism. Zhonghua Nei Ke Za Zhi. 1999;38(1):18–21.
    • cites [20] Pedrera-Zamorano JD, Roncero-Martin R, Calderon-Garcia JF, et al. Treatment of subclinical hypothyroidism does not affect bone mass as determined by dual-energy X-ray absorptiometry, peripheral quantitative computed tomography and quantitative bone ultrasound in Spanish women. Arch Med Sci. 2015;11(5):1008–14. https://doi.org/10.5114/aoms.2015.54855. source
    • cites [21] Gonzalez Rodriguez E, Stuber M, Del Giovane C, et al. Skeletal effects of Levothyroxine for subclinical hypothyroidism in older adults: a TRUST Randomized Trial Nested Study. J Clin Endocrinol Metab. 2020;105(1). https://doi.org/10.1210/clinem/dgz058. source

      The introduction says evidence on LT4’s effects on bone is scarce and conflicting, and the Discussion describes conflicting results from earlier trials. Those statements concern subclinical hypothyroidism; the cited paper does not establish the same uncertainty for hypothyroid patients generally. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [22] Franklyn J, Betteridge J, Holder R, et al. Bone mineral density in thyroxine treated females with or without a previous history of thyrotoxicosis. Clin Endocrinol (Oxf). 1994;41(4):425–32. https://doi.org/10.1111/j.1365-2265.1994.tb02572.x. source
    • Rests on an assumption: The effects of LT4 replacement, rather than suppression treatment, on bone remain unclear.
  • Interpretationcitation

    BMD assessment shortly after the initiation of LT4 treatment may not accurately reflect steady bone remodeling because many new remodeling units remained in the resorptive phase at that time.

    “BMD assessment shortly after the initiation of LT4 treatment may not accurately reflect the steady bone remodeling, because many new remodeling units remained in the resorptive phase at that time [44].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [44] Schneider R, Schneider M, Reiners C, et al. Effects of levothyroxine on bone mineral density, muscle force, and bone turnover markers: a cohort study. J Clin Endocrinol Metab. 2012;97(11):3926–34. https://doi.org/10.1210/jc.2012-2570. source
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 14

  • May combine two claims.

    Premisecitation

    Hypothyroidism is linked to increased risk of osteoporosis and fracture.

    “Previous studies have indicated that hypothyroidism can be accompanied by decrease of bone mineral density (BMD), osteoporosis, even fracture [7–9].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [7] Vestergaard P. Fractures in patients with hyperthyroidism and hypothyroidism: a nationwide follow-up study in 16,249 patients. Thyroid. 2002;12(5):411–9. https://doi.org/10.1089/105072502760043503. source
    • cites [8] Daya NR, Fretz A, Martin SS, et al. Association between subclinical thyroid dysfunction and fracture risk. JAMA Netw Open. 2022;5(11):e2240823. https://doi.org/10.1001/jamanetworkopen.2022.40823. source

      The Introduction says overt hypothyroidism is associated with normal or slightly increased bone mass, contrary to the claimed decrease in BMD. It discusses an apparent increased fracture risk in overt hypothyroidism, but the Results report no evidence of an association between subclinical hypothyroidism and fracture risk. The paper does not establish the claimed link to osteoporosis. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [9] Abrahamsen B, Jørgensen HL, Laulund AS, et al. The excess risk of major osteoporotic fractures in hypothyroidism is driven by cumulative hyperthyroid as opposed to hypothyroid time: an observational register-based time-resolved cohort analysis. J Bone Min Res. 2015;30(5):898–905. https://doi.org/10.1002/jbmr.2416. source

      The Fracture risk section reports increased major osteoporotic fracture risk with hypothyroid time in men under 75, supporting a qualified fracture association. But the Introduction says fracture risk in hypothyroidism is uncertain, and the Discussion attributes much of the excess risk to periods of thyroid-hormone excess during replacement treatment. The paper does not establish that hypothyroidism itself causes decreased BMD or osteoporosis; its discussion of decreased BMD concerns low-normal TSH, not hypothyroidism. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Thyroid hormones have profound effects on skeletal development and bone maintenance, affecting osteoclast and osteoblast function and participating in the regulation of bone metabolism.

    “Thyroid hormones have profound effects on the skeletal development and bone maintenance, affecting not only the function of osteoclasts and osteoblasts but also participating in the regulation of bone metabolism [3–5].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [3] Bassett JH. Role of thyroid hormones in skeletal development and bone maintenance. Endocr Rev. 2016;37(2):135–87. https://doi.org/10.1210/er.2015-1106. source
    • cites [4] Williams GR. Thyroid diseases and bone health. J Endocrinol Invest. 2018;41(1):99–109. https://doi.org/10.1007/s40618-017-0753-4. source
    • cites [5] Kim HY. Role and mechanisms of actions of thyroid hormone on the skeletal development. Bone Res. 2013;1(2):146–61. https://doi.org/10.4248/br201302004. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The results for subclinical hypothyroidism are in accordance with a previous meta-analysis.

    “These results are in accordance with a previous meta-analysis [33].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [33] Zhao C, Wang Y, Xiao L, et al. Effect of levothyroxine on older patients with subclinical hypothyroidism: a systematic review and Meta-analysis. Front Endocrinol (Lausanne). 2022;13:913749. https://doi.org/10.3389/fendo.2022.913749. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review and meta-analysis was reported according to PRISMA guidelines.

    “We reported this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [23] and registered the study protocol online in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023390228).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [23] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    TSH can promote the proliferation and differentiation of osteoblasts in rat primary osteoblasts.

    “Additionally, it has been found that TSH can promote the proliferation and differentiation of osteoblasts in rat primary osteoblasts [6].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Deng T, Zhang W, Zhang Y, et al. Thyroid-stimulating hormone decreases the risk of osteoporosis by regulating osteoblast proliferation and differentiation. BMC Endocr Disord. 2021;21(1):49. https://doi.org/10.1186/s12902-021-00715-8. source

  • May combine two claims.

    Premisecitation

    The lumbar spine is primarily composed of trabecular bone and is structurally more fragile compared to other skeletal sites.

    “the lumbar spine is primarily composed of trabecular bone and it is structurally more fragile compared to other skeletal sites [42].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [42] Kwak D, Ha J, Won Y, et al. Effects of thyroid-stimulating hormone suppression after thyroidectomy for thyroid cancer on bone mineral density in postmenopausal women: a systematic review and meta-analysis. BMJ Open. 2021;11(5):e043007. https://doi.org/10.1136/bmjopen-2020-043007. source

  • May combine two claims.

    Findingown data

    There was a trend towards increased serum OC in the LT4 treatment group compared with HCs, but the difference was not statistically significant.

    “However, there was a trend towards increased levels of serum OC and ALP in the LT4 treatment group, although the differences were not statistically significant (SMD for OC: 0.51, 95%CI: -0.03, 1.06, P = 0.070, I2 = 76%;”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Thirteen of the 5996 published articles were included in this meta-analysis.

    “Thirteen of the 5996 published articles were included in this meta-analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was a trend towards increased serum ALP in the LT4 treatment group compared with HCs, but the difference was not statistically significant.

    “SMD for ALP: 0.38, 95%CI: -0.02, 0.78, P = 0.060, I2 = 44%) (Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    BMD at skeletal sites other than the lumbar spine and bone metabolism biomarkers did not exhibit any significant difference between LT4-treated overt hypothyroidism patients and healthy controls.

    “BMD at other skeletal sites and bone metabolism biomarkers did not exhibit any significant difference between individuals with LT4-treated OH and HCs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of the 13 included studies, five were RCTs focusing on SCH, and eight were observational studies on OH.

    “Of the 13 studies, five were RCTs focusing on SCH, while the remaining eight were observational studies on OH.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 1135 participants were included in this study.

    “A total of 1135 participants were included in this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The LT4 treatment group exhibited increased levels of OC and ALP compared with controls, although there was no statistical difference.

    “the LT4 treatment group exhibited increased levels of OC and ALP, although there was no statistical difference.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The majority of participants in this study were female, which limits the generalizability of the findings to male patients.

    “Fourthly the majority of participants in this study were female, which limits the generalizability of the findings to male patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two investigators independently selected articles.

    “Two investigators (XL and TZ) independently selected articles using the following terms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Most included studies on subclinical hypothyroidism had intervention durations of approximately one year, and there is a paucity of research on the long-term effects of LT4 therapy on bone in patients with subclinical hypothyroidism.

    “most of the included studies on SCH had intervention durations of approximately one year in this review, and there is paucity of research on the long-term effects of LT4 therapy on bone in patients with SCH.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two investigators independently assessed risk of bias, with discrepancies resolved by a third author.

    “Two investigators (XL and TZ) assessed the risk of bias independently. Any discrepancies were addressed by re-evaluation of the original by the third author (HZ).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    LT4 replacement therapy has a slight detrimental effect on bone and mineral metabolism in patients with overt hypothyroidism, while it has no adverse effect on subclinical hypothyroidism.

    “This systematic review and meta-analysis concluded that LT4 replacement therapy has a slight detrimental effect for patients with OH on bone and mineral metabolism, while no adverse effect on SCH.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The possibility of publication bias was evaluated using Egger's test.

    “Moreover, the possibility of publication bias was evaluated using Egger’s test.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The effects of LT4 on bone metabolism in subclinical hypothyroidism patients may be influenced by factors such as treatment dose, individual age, and follow-up time.

    “It is worth noting that the effects of LT4 on bone metabolism in SCH patients may be influenced by factors such as treatment dose, individual age, and follow-up time.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study protocol was registered online in PROSPERO (CRD42023390228).

    “We reported this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [23] and registered the study protocol online in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023390228).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Of the eight included observational studies on OH, most rated eight scores, one received nine, two received seven, and one received five.

    “Of the eight included observational studies on OH, most of them rated eight scores [18, 24–26], one studies received nine scores [19], two studies received seven scores [27, 28]and the rest one studies received five scores [29].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The included studies focused primarily on older adults with subclinical hypothyroidism, and there was a lack of comprehensive data on the association between LT4 replacement therapy and bone metabolism in adults under the age of 60.

    “Secondly, the focus of the included studies was primarily on older adults with SCH, and there was a lack of comprehensive data on the association between LT4 replacement therapy and bone metabolism in adults under the age of 60.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Risk of bias in observational studies was assessed using the Newcastle-Ottawa Scale.

    “The Newcastle-Ottawa Scale (NOS) was used to evaluate the risk of bias in observational studies included in this review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Risk of bias in randomized controlled trials was assessed using the Cochrane Collaboration Risk of bias assessment tool.

    “The bias risk assessment of randomized controlled trials (RCTs) was conducted according to the Cochrane Collaboration Risk of the bias assessment tool and every article will have an entry judgment of high, low, or unclear risk.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    A comprehensive search of eight databases was conducted from inception until December 9, 2022, and updated on October 30, 2024.

    “We conducted a comprehensive search of eight databases were systematically searched, including PubMed, Web of Science, Embase, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Wang Fang Database, China Science and Technology Journal Database, and China Biology Medicine Disc, from inception until December 9, 2022. And updated the search using the same search strategy on October 3”
    Quote in the paperNot a substantial claim
26 of 26

  • The paper relies on this without support.

    The effects of LT4 replacement, rather than suppression treatment, on bone remain unclear.

    “However, the effects of LT4 replacement, rather than suppression treatment on bone remain unclear.”
1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Male short-versus-long treatment comparison is unsupported

    Minor

    The abstract claims a significant comparison between men treated for less than five years and those treated longer. Table 4 lists the only male subgroup in study [28], while the less-than-five-year subgroup consists of studies [19] and [26]; Table 2 reports both of those studies as 100% female.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Franklyn J, Betteridge J, Holder R, et al. Bone mineral density in thyroxine treated females with or without a previous history of thyrotoxicosis. Clin Endocrinol. 1994;41(4):425–32. https://doi.org/10.1111/j.1365-2265.1994.tb02572.x. · DOI · Paper page

Cited by

Still being checked.

Related

Authors
Li, X., Zhang, T., Zhang, H., Liu, S., & Tian, L.
Affiliations
  • Gansu Provincial Hospital (CN)
  • Gansu University of Traditional Chinese Medicine (CN)
Corresponding author
Tian, Limin
ORCID
Venue
BMC Endocrine Disorders
Publisher
Springer Science and Business Media LLC
Published
2025-01-14
Volume
25
Issue
1
Pages
11-11
ISSN
1472-6823 (ISSN-L)
DOI
10.1186/s12902-024-01819-7
PMC
PMC11730139
OpenAlex
W4406352083
Semantic Scholar
9c954cddb9132badacf13d3449bf8accfea9845d
Cited by
10
References
47
Citations by year
2026: 9 · 2025: 1
FWCI
2.02
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Endocrine Disorders (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Natural Science Foundation of China (No. 82060152)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
levothyroxine, hypothyroidism, subclinical hypothyroidism, bone mineral density, bone metabolism, osteoporosis, fracture risk, thyroid hormone replacement, lumbar spine, femoral neck, treatment duration, bone turnover markers
MeSH terms
Bone and Bones, Humans, Hypothyroidism, Minerals, Thyroxine, Bone Density

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