Do Premenopausal Hypothyroid Women on Levothyroxine Therapy Need Bone Status Monitoring?
Open accessAbstract
Background: Suppressive doses of levothyroxine therapy are reported to reduce bone mineral density (BMD) in women. Data on bone changes in premenopausal hypothyroid women with replacement therapy are limited. Hence, this study was undertaken to evaluate bone changes in this group using bone markers and BMD. Materials and Methods: A hospital-based case–control study including 75 premenopausal women aged 30–45 years was conducted. The subjects were categorized based on their thyroid function and history into three groups of 25 euthyroid, 25 newly diagnosed hypothyroid, and 25 hypothyroid women on 100–200 μg of levothyroxine for a minimum of 5 years. The bone changes were evaluated and compared among the groups biochemically by estimating their plasma osteocalcin and serum calcium and phosphorus and radiologically by measuring their BMD by quantitative ultrasonography. Statistical analysis was conducted by using analysis of variance, Tukey's test, and Pearson's correlation using IBM SPSS Statistics 20. Results: Levels of plasma osteocalcin, serum calcium, and serum phosphorus in patients on long-term levothyroxine therapy were significantly higher than those in newly diagnosed hypothyroid women and in the euthyroid group. BMD showed definite features of osteopenia ( T-score: −2.26 ± 0.5) among the women in the treatment group, while it was well within the normal range in the newly diagnosed and euthyroid women. A significant correlation was found between the osteocalcin levels and T-score. Conclusion: Hypothyroid women on long-term levothyroxine therapy showed signs of increased bone turnover and increased resorptive changes, though not frank osteoporosis. Hence, it may be important to evaluate the bone status of patients on levothyroxine for >5 years.
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Bone turnover markers such as ALP, CTX, and OC significantly increased in patients with SCH or OH after restoring euthyroid through LT4 treatment compared with controls.
“Several studies have illustrated that bone turnover markers, such as bone alkaline phosphatase (ALP), C-telopeptide of type I collagen (CTX) and osteocalcin (OC), significantly increased in patients of SCH or OH after restoring euthyroid through LT4 treatment compared with controls [17–19].”
From Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis (2025) · cites this paper as [18]
The Results report significantly higher osteocalcin in premenopausal hypothyroid women on long-term levothyroxine than in newly diagnosed hypothyroid women and euthyroid controls; the Discussion says the treated group had TSH levels in the normal range. The Methods list osteocalcin, calcium, phosphorus and BMD as the measured outcomes, not ALP or CTX, and do not distinguish subclinical from overt hypothyroidism. Thus the source supports the osteocalcin comparison, but not the claim for all three markers or both named conditions. (LLM, conf=0.89)
Experimental — accuracy not yet measuredThe reduction in lumbar spinal BMD observed in overt hypothyroidism may be due to the higher serum T4 concentrations achieved with LT4 replacement.
“Therefore, the reduction in lumbar spinal BMD observed in our study may be due to the higher serum T4 concentrations achieved with LT4 replacement [18].”
From Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis (2025) · cites this paper as [18]
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.”
From Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis (2025) · cites this paper as [18]
BMD may be affected by LT4 treatment.
“These are consistent with previous research indicating that BMD may be affected by LT4 treatment [18, 25].”
From Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis (2025) · cites this paper as [18]
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“These are consistent with previous research indicating that BMD may be affected by LT4 treatment [18, 25].”
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“11,12 The observed benefit in our data could be mediated by the relatively young age of the participants (36.6 years), vitamin D sufficiency, and participants belonging to both genders.”
Influential
- Authors
- Babu, R. P., Christy, A., Hegde, A., Manjrekar, P., & D'Souza, V.
- Affiliations
- NeoGen Labs, Bangalore, India.
- Clinical Chemistry & Immunoassays, Thyrocare Technologies Limited, Navi Mumbai, India.
- Kasturba Medical College, Mangalore (IN)
- Department of Biochemistry, Kasturba Medical College, Mangalore, India.
- Corresponding author
- Hegde, Anupama
- Venue
- Clinical Medicine Insights: Women's Health
- Publisher
- SAGE Publications
- Published
- 2015-01
- Volume
- 8
- Pages
- CMWH.S22114
- ISSN
- 1178-2196 (ISSN-L)
- 1179-562X
- PMC
- PMC4362625
- OpenAlex
- W2117646071
- Cited by
- 4
- References
- 47
- Citations by year
- 2025: 1 · 2020: 3
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Clinical Medicine Insights Women s Health (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- 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, premenopausal women, bone mineral density, osteocalcin, bone turnover, osteopenia, thyroid hormone replacement, serum calcium and phosphorus
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