Bone mass, bone turnover and body composition in former hypothyroid patients receiving replacement therapy
Abstract
Langdahl BL, Loft AGR, Eriksen EF, Mosekilde L, Charles P. Bone mass, bone turnover and body composition in former hypothyroid patients receiving replacement therapy. Eur J Endocrinol 1996;134:702–9. ISSN 0804–4643 The aim of the present cross-sectional study was to disclose whether long-term thyroxine replacement therapy (TRT) in primary hypothyroidism causes osteopenia. We compared 36 adult biochemically and clinically euthyroid patients who had received TRT for more than 5 years (mean 13 years) for primary hypothyroidism with 80 sex- and age-matched normal controls. Height, body weight and lean body mass were similar, but the patients had 21% higher fat body mass (p < 0.01) than their controls. Furthermore, compared to controls the patients had 29% higher serum thyroxine (T 4) and 31% higher serum free T 4 index (FT 4 I) levels (p < 0.001), whereas serum triiodothyronine (T 3) and FT 3 I levels were both reduced by 7% (p < 0.05). In the patients, serum TSH was reduced significantly (p < 0.001). No significant differences were observed between patients and normals in regional or total bone mineral content or bone mineral density levels, apart from 20% higher lumbar bone mineral content among the premenopausal patients (p < 0.05). Surprisingly, the mean serum calcium level was slightly elevated (2.38 ± 0.08 vs 2.33 ± 0.07 nmol/l, p < 0.001), serum phosphate decreased (1.13 ± 0.19 vs 1.23 ± 0.16 mmol/l, p < 0.01) and 24-h renal calcium excretion was reduced by 19% (p < 0.05). No changes were observed in serum magnesium, intact parathyroid hormone or calcitriol. The biochemical markers of bone resorption (serum carboxyterminal telopeptide of type I collagen, renal excretion of hydroxyproline, pyridinoline and deoxypyridinoline) and formation (serum levels of carboxyterminal propeptide of type I procollagen, osteocalcin and total and bone alkaline phosphatase) were similar in the two groups. We conclude that long-term thyroxine replacement therapy in primary hypothyroidism does not exert a negative effect on bone mass or alter bone turnover. Bente L Langdahl, University Department of Endocrinology and Metabolism, Aarhus Amtssygehus, Tage Hansensgade 2, DK-8000, Aarhus C, Denmark
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
None of the studies examining body weight and composition in LT4-treated subjects have shown significant differences in these parameters compared to control subjects or when LT4 doses were altered to lower TSH within the reference range.
“None have shown significant differences in these parameters compared to control subjects (47,48) or when LT4 doses were altered to lower TSH within the reference range (14,41).”
From Effects of levothyroxine replacement or suppressive therapy on energy expenditure and body composition (2016) · cites this paper as [47]
Cited by
Sorted by citations
Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., et al. (2014) · Thyroid® · doi:10.1089/thy.2014.0028 · Cited by 1,928 · see citing works
Vestergaard, P., & Mosekilde, L. (2002) · Thyroid · doi:10.1089/105072502760043503 · Cited by 289 · see citing works
“Accordingly, BMD is usually normal in eu-thyroid patients treated for hypothyroidism (19–21) but may be decreased in the case of suppressed TSH after larger dosages of levothyroxine (22–24).”
Self-citationSamuels, M. H., Schuff, K. G., Carlson, N. E., Carello, P., & Janowsky, J. S. (2007) · Thyroid · doi:10.1089/thy.2006.0252 · Cited by 124 · see citing works
“However, earlier studies have suggested that treated hypo-thyroid subjects are, on average, heavier than euthyroid controls, with increased fat mass and decreased lean body mass (63,64).”
Oral Tori Are Associated With Local Mechanical and Systemic Factors: A Case-Control Study
Morrison, M. D., & Tamimi, F. (2012) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2012.08.005 · Cited by 96 · see citing works
“3) 47 Men 51 (41-61) 4 mokers 8 (3-13) ttrition 23 (15-31) 5 MD 14 (7-21) 4 eriodontal disease 43 (33-53) 3 ypertension 21 (13-29) 2 enicillin allergy 5 (1-9) espiratory problem 4 (0-8) ypothyroidism 3 (0-6) iabetes mellitus 8 (3-13) nxiety/depression 4 (0-8)”
Serum Cytokines in Thyrotoxicosis1
Siddiqi, A., Monson, J., Wood, D. F., BESSER, G. M., & Burrin, J. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.2.5436 · Cited by 98 · see citing works
Samuels, M. H., Kolobova, I., Smeraglio, A., Peters, D., Purnell, J. Q., & Schuff, K. G. (2016) · Thyroid · doi:10.1089/thy.2015.0345 · Cited by 87 · see citing works
“None have shown significant differences in these parameters compared to control subjects (47,48) or when LT4 doses were altered to lower TSH within the reference range (14,41).”
BackgroundChanges in bone mineral density in survivors of childhood acute lymphoblastic leukemia
Kaste, S. C., Rai, S. N., Fleming, K., McCammon, E., Tylavsky, F. A., Danish, R. K., Rose, S. R., Sitter, C. D., Pui, C., & Hudson, M. M. (2005) · Pediatric Blood & Cancer · doi:10.1002/pbc.20553 · Cited by 85 · see citing works
“In these studies, osteopenia did not develop in children and adults with primary hypothyroidism who received longterm thyroxine therapy [104,105].”
BackgroundMetabolic and Clinical Consequences of Hyperthyroidism on Bone Density
Gorka, J., Taylor‐Gjevre, R. M., & Arnason, T. (2013) · International Journal of Endocrinology · doi:10.1155/2013/638727 · Cited by 80 · see citing works
“6 years of euthyroid state after successful antithyroid therapy [40, 55, 65, 69].”
BackgroundRelationship between Subclinical Thyroid Dysfunction and Femoral Neck Bone Mineral Density in Women
Lee, W., Oh, K. W., Rhee, E., Jung, C., Kim, S. W., Yun, E. J., Tae, H. J., Baek, K. H., Kang, M. I., Choi, M. G., et al. (2006) · Archives of Medical Research · doi:10.1016/j.arcmed.2005.09.009 · Cited by 78 · see citing works
Trace Element Status and Hypothyroidism: A Systematic Review and Meta-analysis
Talebi, S., Ghaedi, E., Sadeghi, E., Mohammadi, H., Hadi, A., Clark, C. C. T., & Askari, G. (2019) · Biological Trace Element Research · doi:10.1007/s12011-019-01963-5 · Cited by 73 · see citing works
Hypovitaminosis D in acutely injured pediatric burn patients
Gottschlich, M. M., Mayes, T., Khoury, J. C., & Warden, G. D. (2004) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2004.03.020 · Cited by 67 · see citing works
Wexler, J., & Sharretts, J. (2007) · Endocrinology and metabolism clinics of North America (Print) · doi:10.1016/j.ecl.2007.04.005 · Cited by 138 · see citing works
The multiple effects of thyroid disorders on bone and mineral metabolism
Cardoso, L. F., Maciel, L. M. Z., & de Paula, F. J. A. (2014) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/0004-2730000003311 · Cited by 60 · see citing works
Biochemical bone turnover markers in hormonal disorders in adults: a narrative review
Szulc, P. (2020) · Journal of Endocrinological Investigation · doi:10.1007/s40618-020-01269-7 · Cited by 28 · see citing works
Adverse Effects of Thyroid Hormones
Williams, J. (1997) · Drugs & Aging · doi:10.2165/00002512-199711060-00005 · Cited by 28 · see citing works
Sabuncu, T., Aksoy, N., Arıkan, E., et al. (2001) · Endocrine Research · doi:10.1081/erc-100107181 · Cited by 27 · see citing works
Lakatos, P. A., Bakos, B., Takács, I., & Stern, P. H. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814841-9.00038-5 · Cited by 19 · see citing works
Sánchez, A., Carretto, H., Ulla, M. R., & Capozza, R. F. (2004) · The Endocrinologist · doi:10.1097/01.ten.0000146570.51516.5b · Cited by 15 · see citing works
Kempers, M. J. E., Vulsma, Τ., Wiedijk, Β. Μ., de Vijlder, J. J. Μ., van Eck-Smit, B. L. F., & Verberne, H. J. (2006) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2006.19.12.1405 · Cited by 14 · see citing works
Correction of Hypothyroidism Seems to Have No Effect on Body Fat
Bakiner, O., Bozkirli, E., Ersozlu Bozkirli, E. D., & Ozsahin, K. (2013) · International Journal of Endocrinology · doi:10.1155/2013/576794 · Cited by 14 · see citing works
“Nevertheless, the expected decrease in body fat content is not observed with replacement therapy in a few studies [5, 6].”
BackgroundEffects of Thyroid Hormone on Bone
Stathatos, N., & Wartofsky, L. (2004) · Clinical Reviews in Bone and Mineral Metabolism · doi:10.1385/bmm:2:2:135 · Cited by 14 · see citing works
“Langdahl et al. ( 32 ) compared 36 patients with primary hypothyroidism on stable chronic thyroid hormone treatment to 80 matched controls.”
BackgroundBody Mass and Body Composition After Total Thyroidectomy for Benign Goiters
Kormas, N., Diamond, T., O’Sullivan, A., & Smerdely, P. (1998) · Thyroid · doi:10.1089/thy.1998.8.773 · Cited by 13 · see citing works
Pitukcheewanont, P., Safani, D., Gilsanz, V., Klein, M. L., Chongpison, Y., & Costin, G. (2004) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2004.17.6.889 · Cited by 13 · see citing works
Wölfel, E. M., Lademann, F., Hemmatian, H., Blouin, S., Messmer, P., Hofbauer, L. C., Busse, B., Rauner, M., Jähn, K., & Tsourdi, E. A. (2020) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.4736 · Cited by 10 · see citing works
“Additionally, bone loss induced by thyroid hormone excess was shown to be reversible with thyreostatic therapy.((29)) Although some authors detected normalized bone mineral density values after 3–6 years of treatment,((30)) others determined an incomplete reversibility at earlier time points.”
BackgroundLi, X., Zhang, T., Zhang, H., Liu, S., & Tian, L. (2025) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01819-7 · Cited by 10 · see citing works
“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].”
Cañibano, C., Otamendi, F. J., & Solís, F. (2010) · Revista española de Documentación Científica · doi:10.3989/redc.2010.3.736 · Cited by 9 · see citing works
Paloyan, E., Walker, R. P., & Lawrence, A. M. (1998) · Surgical Oncology Clinics of North America · doi:10.1016/s1055-3207(18)30239-4 · Cited by 5 · see citing works
Vinther, C. J., Poulsen, L., Nicolaisen, P., Obling, M. L., Brix, T. H., Hermann, A. P., Hegedűs, L. D., Jørgensen, N. R., Hansen, S., & Bonnema, S. J. (2022) · Journal of Endocrinological Investigation · doi:10.1007/s40618-022-01907-2 · Cited by 3 · see citing works
Assessment of Metabolic Parameters in Female Triathletes with Hashimoto’s Thyroiditis in Poland
Gierach, M., & Junik, R. (2023) · Biomedicines · doi:10.3390/biomedicines11030769 · Cited by 4 · see citing works
“Nevertheless, in a few other studies, no significant reduction in body fat was observed with L-thyroxine therapy [30,31].”
ResultBudhalakoti, N., & Kulshrestha, K. (2015) · FOOD SCIENCE RESEARCH JOURNAL · doi:10.15740/has/fsrj/6.1/67-75 · Cited by 2 · see citing works
Vasamsetti, S. R., Guddeti, A., Sridharan, A., Shaikh, N. N., Kumar, S., Aleem, S., Mashetty, S., Alekya, L. A. V., & Kumar, K. H. H. (2026) · AACE endocrinology and diabetes · doi:10.1016/j.aed.2026.01.007 · Cited by 1 · see citing works
Bone metabolism during substitution therapy of primary hypothyroidism
Pejin, R., Ćurić, N., Kovačev-Zavišić, B., & Todorovic-Djilas, L. (2009) · Medicinski pregled · doi:10.2298/mpns0910407p · Cited by 1 · see citing works
Clinical thyroidology: beyond the 1970s’ TSH-T4 Paradigm
Lindner, H. H. (2025) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1529791 · Cited by 1 · see citing works
“They have a lower resting energy expenditure (190) and a 21% greater fat mass (189).”
Stern, P. H. (2002) · Elsevier eBooks · doi:10.1016/b978-012098652-1.50142-6 · Cited by 1 · see citing works
Stern, P. H. (2008) · Elsevier eBooks · doi:10.1016/b978-0-12-373884-4.00060-4 · Cited by 1 · see citing works
The Use of Bone Biopsies in the Diagnosis of Male Osteoporosis
Eriksen, E. F., & Halse, J. (2010) · Elsevier eBooks · doi:10.1016/b978-0-12-374602-3.00047-x
Self-citationEvaluation of Bone Strength in Women with Graves's Disease by Ultrasound Bone Densitometry
Ban, Y., Ban, Y., Taniyama, M., & Katagiri, T. (2000) · The Showa University Journal of Medical Sciences · doi:10.15369/sujms1989.12.139
Thyroid and Thyroid Hormone: Normal Function, Diseases, Disorders, Emerging Therapeutics
Stern, P. H. (2012) · Springer eBooks · doi:10.1007/978-1-4471-2745-1_4
Langdahl, B. L. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.65361-8
Self-citationBone manifestations of endocrine disease
Goltzman, D., & Kremer, R. B. (2000)
Thyroid Disorders and Bone Disease
Watts, L. M., Freudenthal, B., Bassett, J. H. D., & Williams, G. R. (2022) · doi:10.1093/med/9780198870197.003.0089
Langdahl, B. L., & Grove‐Laugesen, D. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-13825-6.00080-7
Self-citation
- Authors
- Langdahl, B. L., Loft, A. G. R., Eriksen, E. F., Mosekilde, L., & Charles, P.
- Affiliations
- Aarhus University (DK)
- Corresponding author
- Langdahl, Bente L
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-06
- Volume
- 134
- Issue
- 6
- Pages
- 702-709
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2146624680
- Cited by
- 42
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 2 · 2020: 2 · 2019: 2 · 2018: 1 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 1.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Endocrinology (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
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- primary hypothyroidism, thyroxine replacement, bone mineral density, bone turnover, osteopenia, body composition, fat mass, serum thyroid hormones, thyroid-stimulating hormone, serum calcium, serum phosphorus, urinary calcium excretion, bone resorption markers, bone formation markers
- MeSH terms
- Adult, Aged, Body Composition, Bone and Bones, Calcium, Female, Homeostasis, Humans, Hypothyroidism, Male, Middle Aged, Organ Size, Thyroid Gland, Thyroxine, Biomarkers, Bone Density
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
