[The effects of levothyroxine replacement therapy on bone and mineral metabolism in patients with hypothyroidism].

OBJECTIVE

To investigate the effects of short-term thyroid hormone replacement therapy on bone and mineral metabolism in patients with hypothyroidism.

METHODS

Enzyme linked immunosorbent assay (ELISA) was used to measure urinary deoxypyridinoline (DPD) and radioimmunoassay (RIA) to measure serum calcitonin (CT), parathyroid hormone (PTH-M), bone GLA protein (BGP), free T(3) (FT(3)), free T(4) (FT(4)) and thyroid-stimulating hormone (TSH) in 29 patients with hypothyroidism before and after treatment with levothyroxine for (11.5 +/- 2.5) months. Dual energy X-ray absorptiometry was used to measure bone mineral density (BMD) of their spine (L(2 - 4)) and femur neck, trochanter and Ward's triangle. The results were compared with those in 37 healthy controls.

RESULTS

In hypothyroidism patients before treatment, serum BGP level was significantly lower (P < 0.05) than but urinary DPD was similar with those of control. BMD was significantly lower in postmenopausal patients (P < 0.01 - 0.001) than that in control group, but there was no change in premenopausal patients. After replacement therapy serum BGP and urinary DPD elevated significantly (P < 0.05), whereas BMD decreased slightly both in the premenopausal and postmenopausal patients when compared with that before treatment, with no statistical significance (P > 0.05). BMD decreased by 0.7% and 1.7% - 5.1% in premenopausal and postmenopausal patients respectively, but there was no significant difference between these two groups (P > 0.05). FT(3) was positively correlated with BGP. FT(4) and FT(3) were positively correlated with DPD. BMD of femur neck and trochanter sites was negatively correlated with FT(4).

CONCLUSION

Short-term physiological dose levothyroxine replacement therapy causes increase of bone turnover and leads to bone mass loss to various extent on hypothyroidism patients.