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Cited by 123Thyroid Disorders and TreatmentsBone health and osteoporosis researchBone Metabolism and Diseases

Persistent Increase in Bone Turnover in Graves’ Patients with Subclinical Hyperthyroidism

Kumeda, Yasuro, Inaba, Masaaki, Tahara, Hideki, Kurioka, Yasuko, Ishikawa, Tetsuro, Morii, Hirotoshi, Nishizawa, Yoshiki·2000·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jcem.85.11.6979
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Abstract

Hyperthyroid patients exhibit accelerated bone loss by increased bone turnover, and normalization of thyroid function is associated with a significant attenuation of increased bone turnover, followed by an increase in bone mineral density. However, of patients with Graves’ disease (GD) maintained on antithyroid drug (ATD) treatment, some exhibit persistent suppression of TSH long after normalization of their serum free T3 (FT3) and free T4 (FT4) levels. The aim of this study was to examine whether bone metabolism is still enhanced in TSH-suppressed premenopausal GD patients with normal FT3 and FT4 levels after ATD therapy (n = 19) compared with that in TSH-normal premenopausal GD patients (n = 30), and to evaluate the relationship between serum TSH receptor antibody (TRAb), an indicator of disease activity of GD, and various biochemical markers of bone metabolism. No difference was found between the two groups in serum Ca, phosphorus, or intact PTH, or in urinary Ca excretion. Serum bone alkaline phosphatase (B-ALP), bone formation markers, and urinary excretions of pyridinoline (U-PYD) and deoxypyridinoline (U-DPD), which are bone resorption markers, were significantly higher in the TSH-suppression group than in the TSH-normal group (B-ALP, P < 0.05; U-PYD, P < 0.001; U-DPD, P < 0.001). For the group of all GD patients enrolled in this study, TSH, but neither FT3 nor FT4, exhibited a significant negative correlation with B-ALP (r = −0.300; P < 0.05), U-PYD (r= −0.389; P < 0.05), and U-DPD (r = −0.446; P < 0.05), whereas TRAb exhibited a highly positive and significant correlation with B-ALP (r = 0.566; P < 0.0001), U-PYD (r = 0.491; P < 0.001), and U-DPD (r = 0.549; P < 0.0001). Even in GD patients with normal TSH, serum TRAb was positively correlated with B-ALP (r = 0.638; P < 0.001), U-PYD (r = 0.638; P < 0.001), and U-DPD (r = 0.641; P < 0.001). In conclusion, it is important to achieve normal TSH levels during ATD therapy to normalize bone turnover. TRAb was not only a useful marker for GD activity, but was also a very sensitive marker for bone metabolism in GD patients during ATD treatment.

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Authors
Kumeda, Y., Inaba, M., Tahara, H., Kurioka, Y., Ishikawa, T., Morii, H., & Nishizawa, Y.
Affiliations
  • Osaka City University (JP)
  • Division of Metabolism, Endocrinology and Molecular Medicine, Department of Internal Medicine, and First Department of Surgery (T.I.), Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
ORCID
Inaba, Masaaki
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2000-11-01
Volume
85
Issue
11
Pages
4157-4161
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jcem.85.11.6979
OpenAlex
W2105853087
Cited by
123
References
26
Citations by year
2025: 3 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 5 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 1 · 2015: 3 · 2014: 6 · 2013: 2 · 2012: 9
FWCI
3.15
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
Keywords
Graves' disease, subclinical hyperthyroidism, bone turnover, TSH suppression, antithyroid drug therapy, TSH receptor antibodies, bone-specific alkaline phosphatase, pyridinoline, deoxypyridinoline, bone resorption markers, bone formation markers, bone mineral density, premenopausal women, thyroid function normalization, bone loss, parathyroid hormone
MeSH terms
Adult, Alkaline Phosphatase, Amino Acids, Autoantibodies, Bone and Bones, Bone Resorption, Calcium, Female, Graves Disease, Humans, Hyperthyroidism, Parathyroid Hormone, Phosphates, Receptors, Thyrotropin, Reference Values, Regression Analysis, Antithyroid Agents, Thyrotropin, Thyroxine, Triiodothyronine, Biomarkers, Premenopause

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