BibTex RIS Kaynak Göster

The effect of levothyroxine suppression therapy for benign thyroid nodules on bone metabolism in premenopausal women

Yıl 2008, Cilt: 18 Sayı: 4, 232 - 237, 30.08.2008

Öz

Objectives: This prospective study was designed to investigate the effect of levothyroxine suppression therapy for benign thyroid nodules on markers of bone turnover in premenopausal women. Patients and Methods: The study included 28 premenopausal women who received levothyroxine suppression therapy for benign thyroid nodules for one year. The size of the thyroid gland and nodules, biochemical markers of bone turnover and urinary calcium excretion were measured before and after levothyroxine suppression therapy. Results: No significant adverse effects were seen during levothyroxine treatment. Decreases in total thyroid volume and the size of the nodules were not significant at the end of treatment. Although levothyroxine suppression therapy did not result in changes in serum levels of calcium and phosphor, and urinary calcium excretion, bone turnover markers, namely serum osteocalcin and urinary deoxypyridinoline levels, increased significantly. Serum intact parathyroid hormone levels showed a minimal decrease, which was not statistically significant. Conclusion: Data from our study suggest that levothyroxine suppression therapy is associated with increased osteoblastic and osteoclastic activity in premenopausal women with benign thyroid nodules.

Kaynakça

  • Mazzaferri EL. Management of a solitary thyroid nod- ule. N Engl J Med 1993;328:553-9.
  • Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab 2002;87:4154-9.
  • Wemeau JL, Caron P, Schvartz C, Schlienger JL, Orgiazzi J, Cousty C, et al. Effects of thyroid-stim- ulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular nonpalpable changes: a ran- domized, double-blind, placebo-controlled trial by the French Thyroid Research Group. J Clin Endocrinol Metab 2002;87:4928-34.
  • Koc M, Ersoz HO, Akpinar I, Gogas-Yavuz D, Deyneli O, Akalin S. Effect of low- and high-dose levothyrox- ine on thyroid nodule volume: a crossover placebo- controlled trial. Clin Endocrinol 2002;57:621-8.
  • Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thy- roid cancer. Thyroid 2006;16:109-42.
  • Murphy E, Williams GR. The thyroid and the skeleton. Clin Endocrinol 2004;61:285-98.
  • Vestergaard P, Mosekilde L. Hyperthyroidism, bone mineral, and fracture risk - a meta-analysis. Thyroid 2003;13:585-93.
  • Bauer DC, Ettinger B, Nevitt MC, Stone KL; Study of Osteoporotic Fractures Research Group. Risk for fracture in women with low serum levels of thyroid- stimulating hormone. Ann Intern Med 2001;134:561-8.
  • Nuzzo V, Lupoli G, Esposito Del Puente A, Rampone E, Carpinelli A, Del Puente AE, et al. Bone mineral den- sity in premenopausal women receiving levothyroxine suppressive therapy. Gynecol Endocrinol 1998;12:333-7.
  • Larijani B, Gharibdoost F, Pajouhi M, Sadjadi A, Aghakhani S, Eshraghian R, et al. Effects of levothy- roxine suppressive therapy on bone mineral density in premenopausal women. J Clin Pharm Ther 2004;29:1-5.
  • Oberhofer R, Ober A, Oberkofler F, Amor H. Thyroid gland volumes of healthy adults in an area with endem- ic goiter. Acta Med Austriaca 1989;16:38-41. [Abstract]
  • Knudsen N, Bols B, Bulow I, Jorgensen T, Perrild H, Ovesen L, et al. Validation of ultrasonography of the thyroid gland for epidemiological purposes. Thyroid 1999;9:1069-74.
  • Schneider R, Reiners C. The effect of levothyrox- ine therapy on bone mineral density: a systematic review of the literature. Exp Clin Endocrinol Diabetes 2003;111:455-70.
  • Sajjinanont T, Rajchadara S, Sriassawaamorn N, Panichkul S. The comparative study of bone mineral density between premenopausal women receiving long term suppressive doses of levothyroxine for well-dif- ferentiated thyroid cancer with healthy premenopausal women. J Med Assoc Thai 2005;88 Suppl 3:S71-6.
  • Chen CH, Chen JF, Yang BY, Liu RT, Tung SC, Chien WY, et al. Bone mineral density in women receiving thyroxine suppressive therapy for differentiated thy- roid carcinoma. J Formos Med Assoc 2004;103:442-7.
  • Mazokopakis EE, Starakis IK, Papadomanolaki MG, Batistakis AG, Papadakis JA. Changes of bone mineral density in pre-menopausal women with differenti- ated thyroid cancer receiving L-thyroxine suppressive therapy. Curr Med Res Opin 2006;22:1369-73.
  • Reverter JL, Holgado S, Alonso N, Salinas I, Granada ML, Sanmarti A. Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma. Endocr Relat Cancer 2005;12:973-81.
  • Toivonen J, Tahtela R, Laitinen K, Risteli J, Valimaki MJ. Markers of bone turnover in patients with differ- entiated thyroid cancer with and following withdraw- al of thyroxine suppressive thera py. Eur J Endocrinol 1998;138:667-73.
  • Mikosch P, Obermayer-Pietsch B, Jost R, Jauk B, Gallowitsch HJ, Kresnik E, et al. Bone metabolism in patients with differentiated thyroid carcinoma receiv- ing suppressive levothyroxine treatment. Thyroid 2003;13:347-56.
  • Jodar E, Begona Lopez M, Garcia L, Rigopoulou D, Martinez G, Hawkins F. Bone changes in pre- and postmenopausal women with thyroid cancer on levothyroxine therapy: evolution of axial and appen- dicular bone mass. Osteoporos Int 1998;8:311-6.
  • Bauer M, Fairbanks L, Berghofer A, Hierholzer J, Bschor T, Baethge C, et al. Bone mineral density dur- ing maintenance treatment with supraphysiological doses of levothyroxine in affective disorders: a longi- tudinal study. J Affect Disord 2004;83:183-90.
  • Lecomte P, Lecureuil N, Osorio-Salazar C, Lecureuil M, Valat C. Effects of suppressive doses of levothyrox- ine treatment on sex-hormone-binding globulin and bone metabolism. Thyroid 1995;5:19-23.

Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi

Yıl 2008, Cilt: 18 Sayı: 4, 232 - 237, 30.08.2008

Öz

Amaç: Bu prospektif çalışmada, menopoz öncesi kadınlarda selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik döngüsü belirteçleri üzerine etkisi incelendi.Hastalar ve Yöntemler: Çalışmaya, selim tiroid nodülü nedeniyle bir yıl boyunca levotiroksin supresyon tedavisi uygulanan, menopoz öncesi 28 kadın hasta alındı. Levotiroksin supresyon tedavisi öncesi ve sonrasında tiroid bezi ve nodül boyutları, kemik döngüsünün biyokimyasal göstergeleri ve üriner kalsiyum atılımları ölçüldü.Bulgular: Takip süresince tedaviyle ilgili ciddi bir yan etki gözlenmedi. Tedavi sonucunda toplam tiroid hacminde ve nodül büyüklüğündeki azalmalar anlamlı değildi. Levotiroksin supresyon tedavisi ile serum kalsiyum, fosfor düzeyleri ve üriner kalsiyum atılımında farklılık görülmemesine karşın, kemik döngüsü göstergeleri olan serum osteokalsin ve üriner deoksipiridinolin düzeyleri anlamlı artış gösterdi. Serum intakt paratiroid hormon düzeylerinde hafif bir azalma gözlenmekle birlikte, bu farklılık anlamlı bulunmadı.Sonuç: Çalışmamızdan elde edilen veriler, selim tiroid nodülü nedeniyle menopoz öncesi kadınlarda uygulanan levotiroksin supresyon tedavisinin hem osteoblastik hem de osteoklastik aktiviteyi artırdığını göstermektedir

Kaynakça

  • Mazzaferri EL. Management of a solitary thyroid nod- ule. N Engl J Med 1993;328:553-9.
  • Castro MR, Caraballo PJ, Morris JC. Effectiveness of thyroid hormone suppressive therapy in benign solitary thyroid nodules: a meta-analysis. J Clin Endocrinol Metab 2002;87:4154-9.
  • Wemeau JL, Caron P, Schvartz C, Schlienger JL, Orgiazzi J, Cousty C, et al. Effects of thyroid-stim- ulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular nonpalpable changes: a ran- domized, double-blind, placebo-controlled trial by the French Thyroid Research Group. J Clin Endocrinol Metab 2002;87:4928-34.
  • Koc M, Ersoz HO, Akpinar I, Gogas-Yavuz D, Deyneli O, Akalin S. Effect of low- and high-dose levothyrox- ine on thyroid nodule volume: a crossover placebo- controlled trial. Clin Endocrinol 2002;57:621-8.
  • Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thy- roid cancer. Thyroid 2006;16:109-42.
  • Murphy E, Williams GR. The thyroid and the skeleton. Clin Endocrinol 2004;61:285-98.
  • Vestergaard P, Mosekilde L. Hyperthyroidism, bone mineral, and fracture risk - a meta-analysis. Thyroid 2003;13:585-93.
  • Bauer DC, Ettinger B, Nevitt MC, Stone KL; Study of Osteoporotic Fractures Research Group. Risk for fracture in women with low serum levels of thyroid- stimulating hormone. Ann Intern Med 2001;134:561-8.
  • Nuzzo V, Lupoli G, Esposito Del Puente A, Rampone E, Carpinelli A, Del Puente AE, et al. Bone mineral den- sity in premenopausal women receiving levothyroxine suppressive therapy. Gynecol Endocrinol 1998;12:333-7.
  • Larijani B, Gharibdoost F, Pajouhi M, Sadjadi A, Aghakhani S, Eshraghian R, et al. Effects of levothy- roxine suppressive therapy on bone mineral density in premenopausal women. J Clin Pharm Ther 2004;29:1-5.
  • Oberhofer R, Ober A, Oberkofler F, Amor H. Thyroid gland volumes of healthy adults in an area with endem- ic goiter. Acta Med Austriaca 1989;16:38-41. [Abstract]
  • Knudsen N, Bols B, Bulow I, Jorgensen T, Perrild H, Ovesen L, et al. Validation of ultrasonography of the thyroid gland for epidemiological purposes. Thyroid 1999;9:1069-74.
  • Schneider R, Reiners C. The effect of levothyrox- ine therapy on bone mineral density: a systematic review of the literature. Exp Clin Endocrinol Diabetes 2003;111:455-70.
  • Sajjinanont T, Rajchadara S, Sriassawaamorn N, Panichkul S. The comparative study of bone mineral density between premenopausal women receiving long term suppressive doses of levothyroxine for well-dif- ferentiated thyroid cancer with healthy premenopausal women. J Med Assoc Thai 2005;88 Suppl 3:S71-6.
  • Chen CH, Chen JF, Yang BY, Liu RT, Tung SC, Chien WY, et al. Bone mineral density in women receiving thyroxine suppressive therapy for differentiated thy- roid carcinoma. J Formos Med Assoc 2004;103:442-7.
  • Mazokopakis EE, Starakis IK, Papadomanolaki MG, Batistakis AG, Papadakis JA. Changes of bone mineral density in pre-menopausal women with differenti- ated thyroid cancer receiving L-thyroxine suppressive therapy. Curr Med Res Opin 2006;22:1369-73.
  • Reverter JL, Holgado S, Alonso N, Salinas I, Granada ML, Sanmarti A. Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma. Endocr Relat Cancer 2005;12:973-81.
  • Toivonen J, Tahtela R, Laitinen K, Risteli J, Valimaki MJ. Markers of bone turnover in patients with differ- entiated thyroid cancer with and following withdraw- al of thyroxine suppressive thera py. Eur J Endocrinol 1998;138:667-73.
  • Mikosch P, Obermayer-Pietsch B, Jost R, Jauk B, Gallowitsch HJ, Kresnik E, et al. Bone metabolism in patients with differentiated thyroid carcinoma receiv- ing suppressive levothyroxine treatment. Thyroid 2003;13:347-56.
  • Jodar E, Begona Lopez M, Garcia L, Rigopoulou D, Martinez G, Hawkins F. Bone changes in pre- and postmenopausal women with thyroid cancer on levothyroxine therapy: evolution of axial and appen- dicular bone mass. Osteoporos Int 1998;8:311-6.
  • Bauer M, Fairbanks L, Berghofer A, Hierholzer J, Bschor T, Baethge C, et al. Bone mineral density dur- ing maintenance treatment with supraphysiological doses of levothyroxine in affective disorders: a longi- tudinal study. J Affect Disord 2004;83:183-90.
  • Lecomte P, Lecureuil N, Osorio-Salazar C, Lecureuil M, Valat C. Effects of suppressive doses of levothyrox- ine treatment on sex-hormone-binding globulin and bone metabolism. Thyroid 1995;5:19-23.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Barış Akıncı Bu kişi benim

Tevfik Demir Bu kişi benim

Abdurrahman Çömlekçi Bu kişi benim

Oğuzhan Karaoğlu Bu kişi benim

Mustafa Seçil Bu kişi benim

Sena Yeşil Bu kişi benim

Yayımlanma Tarihi 30 Ağustos 2008
Yayımlandığı Sayı Yıl 2008 Cilt: 18 Sayı: 4

Kaynak Göster

APA Akıncı, B., Demir, T., Çömlekçi, A., Karaoğlu, O., vd. (2008). Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi. The Turkish Journal of Ear Nose and Throat, 18(4), 232-237.
AMA Akıncı B, Demir T, Çömlekçi A, Karaoğlu O, Seçil M, Yeşil S. Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi. Tr-ENT. Ağustos 2008;18(4):232-237.
Chicago Akıncı, Barış, Tevfik Demir, Abdurrahman Çömlekçi, Oğuzhan Karaoğlu, Mustafa Seçil, ve Sena Yeşil. “Menopoz öncesinde Selim Tiroid nodülleri için Uygulanan Levotiroksin Supresyon Tedavisinin Kemik metabolizmasına Etkisi”. The Turkish Journal of Ear Nose and Throat 18, sy. 4 (Ağustos 2008): 232-37.
EndNote Akıncı B, Demir T, Çömlekçi A, Karaoğlu O, Seçil M, Yeşil S (01 Ağustos 2008) Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi. The Turkish Journal of Ear Nose and Throat 18 4 232–237.
IEEE B. Akıncı, T. Demir, A. Çömlekçi, O. Karaoğlu, M. Seçil, ve S. Yeşil, “Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi”, Tr-ENT, c. 18, sy. 4, ss. 232–237, 2008.
ISNAD Akıncı, Barış vd. “Menopoz öncesinde Selim Tiroid nodülleri için Uygulanan Levotiroksin Supresyon Tedavisinin Kemik metabolizmasına Etkisi”. The Turkish Journal of Ear Nose and Throat 18/4 (Ağustos 2008), 232-237.
JAMA Akıncı B, Demir T, Çömlekçi A, Karaoğlu O, Seçil M, Yeşil S. Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi. Tr-ENT. 2008;18:232–237.
MLA Akıncı, Barış vd. “Menopoz öncesinde Selim Tiroid nodülleri için Uygulanan Levotiroksin Supresyon Tedavisinin Kemik metabolizmasına Etkisi”. The Turkish Journal of Ear Nose and Throat, c. 18, sy. 4, 2008, ss. 232-7.
Vancouver Akıncı B, Demir T, Çömlekçi A, Karaoğlu O, Seçil M, Yeşil S. Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi. Tr-ENT. 2008;18(4):232-7.