Radyoaktif İyot Tedavisi Uygulanan Hipertiroidili Hastalarda Kemik Mineral Yoğunluğunun DEXA ile Değerlendirilmesi

Amaç: Bu çalışmada hipertiroidili hastalarda kemik mineral yoğunluğu (KMY) ve radyoaktifiyot (RAI) tedavisinin araştırılması ve RAI tedavisinin KMY üzerine etkilerinin değerlendirilmesi amaçlanmıştır. Sonuçlar güncel literatürle gözden geçirildi. Materyal ve Metot: Hipertiroidi nedeniyle RAİ uygulanan hastaların tedavi öncesi ve sonrası, tiroid sintigrafileri, tiroid fonksiyonları ve kemik dansitometresi sonuçları değerlendirildi. Bulgular: Yaş ortalaması 58,4±11,1 olan 46 hasta (31 kadın, 15 erkek) incelendi. Hastaların 3’ü (%7) Graves’ hastalığı (GH), 24’ü (%52) toksik adenom (TA), 19’u (%41) toksik multi nodüler guatr (TMNG) idi. RAİ öncesi ortalama değerler; TSH 0.005 IU/mL, sT3 12.33 pmol/L, sT4 17.38 pmol/L, vertebra T skoru (-)1.15, Z skoru 0.33, KMY 0.99g/cm2, femur T Skoru (-)1.30, Z Skoru 0, KMY 0.83g/cm2 idi. RAİ tedavisinden bir yıl sonra ortalama değerler; TSH 1.19 IU/mL, sT3 3.44 pmol/L, sT4 11.33 pmol/mL, vertebra T skoru (-) 0.85, Z skoru 0.04, KMY 1.03g/cm2, femur T Skoru (-)1.0, Z Skoru 0.30, KMY 0.87 g/cm2 idi. Sonuç: Seçilmiş hipertiroidili hastalarda RAİ başarı ile uygulanabilir. Hipertiroidi sırasında oluşan KMY’deki azalma RAİ sonrası düzelmektedir. Sonuçlar güncel literatürle uyumludur.

Anahtar Kelimeler:

Hipertiroidi, kemik mineral yoğunluğu, radyoaktif iyot

Evaluation of Bone Mineral Density with DEXA in Hyperthyroid Patients Treated with Radioactive Iodine Treatment

Objective: In this study, it was aimed to investigate bone mineral density (BMD) and radioactive iodine (RAI) treatment in patients with hyperthyroidism and to evaluate the effects of RAI treatment on BMD. The results were reviewed with current literature. Materials and Methods: Thyroid scintigraphy, thyroid functions, DEXA results of patients were evaluated before and after RAI. Results: Forty-six patients (31 female, 15 male) with a mean age of 58.4±11.1 were studied. Three (7%) patients had Graves' disease (GH), 24 (52%) toxic adenomas (TA), 19 (41%) toxic multinodular goiters (TMNG). Mean values before RAI; TSH 0.005 IU/mL, fT3 12.33 pmol/L, fT4 17.38 pmol/L, vertebral T score (-)1.15, Z score 0.33, BMD 0.99g/cm2, femur T-Score (-)1.30, Z-Score 0, BMD 0.83 was g/cm2. Mean values after RAI; TSH 1.19 IU/mL, fT3 3.44 pmol/L, fT4 11.33 pmol/mL, vertebral T score (-) 0.85, Z score 0.04, BMD 1.03g/cm2, femur T-Score (-)1.0, Z-Score 0.30, BMD 0.87 was g/cm2. Conclusion: RAI can be successfully used in selected patients with hyperthyroidism. The decrease in BMD improves after RAI. The results are consistent with current literature.

Keywords:

Bone mineral density, hyperthyroidism, radioactive iodine,

PDF

___

Braverman LE UR. Introduction to thyrotoxicosis. In: Braverman LE, Utiger RD (Eds) Werner and Ingbar’s the Thyroid. 7th ed. Philadelphia: Lippincott –Raven Publisher; . 1996:522-524.
Rivkees SA, Sklar C, Freemark M. The Management of Graves’ Disease in Children, with Special Emphasis on Radioiodine Treatment. The Journal of Clinical Endocrinology & Metabolism. 1998;83(11):3767-3776.
Tavintharan S, Sundram F, Chew L. Radioiodine (I-131) therapy and the incidence of hypothyroidism. Annals of the Academy of Medicine, Singapore. 1997;26(1):128-131.
Huysmans D, Hermus A, Corstens F, Kloppenborg P. Long-term results of two schedules of radioiodine treatment for toxic multinodular goitre. Eur J Nucl Med. 1993;20(11):1056-1062.
Biberoğlu S. Sekonder Osteoporoz. Editör: Gökçe Kutsal Y O, Güneş Kitabevi, Ankara; 2005:61-80.
Łacka K, Fraczek MM. Podział i etiopatogeneza nadczynności tarczycy [Classification and etiology of hyperthyroidism]. Pol Merkur Lekarski. 2014;36(213):206-211.
Delitala AP, Scuteri A, Doria C. Thyroid Hormone Diseases and Osteoporosis. J Clin Med. 2020;9(4):1034. doi:10.3390/jcm9041034
Seibel MJ. Biochemical markers of bone turnover: part I: Biochemistry and variability. Clin Biochem Rev. 2005;26(4):97-122.
Von Recklinghausen F. Die fibröse und deformierende Ostitis dOudOC, in ihren gegenseitigen Beziehungen. In: Festschrift für Rudolf Virchow. Berlin: Georg Reimer; 1891:1-89.
Vestergaard P, Mosekilde L. Hyperthyroidism, bone mineral, and fracture risk--a meta-analysis. Thyroid. 2003;13(6):585-93. doi:10.1089/105072503322238854
Ilić J, Kovacev B, Todorović-Dilas L. [Effects of hyperthyroidism on bone mass in women of reproductive age]. Med Pregl. 2004;57(3-4):111-115.
Guo CY, Weetman AP, Eastell R. Longitudinal changes of bone mineral density and bone turnover in postmenopausal women on thyroxine. Clin Endocrinol (Oxf). 1997;46(3):301-307.
Mosekilde L, Eriksen EF, Charles P. Effects of thyroid hormones on bone and mineral metabolism. Endocrinol Metab Clin North Am. 1990;19(1):35-63.
Safi S, Hassikou H, Hadri L, Sbihi A, Kadiri A. [Evaluation of bone mineral density in hyperthyroid patients before and after medical therapy]. Annales D'endocrinologie. 2006;67(1):27-31.
Majima T, Komatsu Y, Doi K, et al. Negative correlation between bone mineral density and TSH receptor antibodies in male patients with untreated Graves' disease. Osteoporosis International. 2006. doi:10.1007/s00198-006-0091-4
Doubleday AR, Sippel RS. Hyperthyroidism. Gland surgery. Feb 2020;9(1):124-135.
Arata N, Momotani N, Maruyama H, et al. Bone mineral density after surgical treatment for Graves' disease. Thyroid. 1997;7(4):547-554.
Majima T, Komatsu Y, Doi K, et al. Clinical significance of risedronate for osteoporosis in the initial treatment of male patients with Graves' disease. J Bone Miner Metab. 2006;24(2):105-113.
Horst-Sikorska W, Ignaszak-Szczepaniak M, Marcinkowska M, Kaczmarek M, Stajgis M, Slomski R. Association analysis of vitamin D receptor gene polymorphisms with bone mineral density in young women with Graves' disease. Acta Biochim Pol. 2008;55(2):371-380.
Lee WY, Oh KW, Rhee EJ, et al. Relationship between subclinical thyroid dysfunction and femoral neck bone mineral density in women. Arch Med Res. 2006;37(4):511-516.
Belaya ZE, Melnichenko GA, Rozhinskaya LY, et al. Subclinical hyperthyroidism of variable etiology and its influence on bone in postmenopausal women. Hormones (Athens, Greece). 2007;6(1):62-70.
Baldini M, Gallazzi M, Orsatti A, Fossati S, Leonardi P, Cantalamessa L. Treatment of benign nodular goitre with mildly suppressive doses of L-thyroxine: effects on bone mineral density and on nodule size. Journal of Internal Medicine. 2002;251(5):407-414.
Ock SY, Chung YS, Choi YJ. Changes in bone mineral density and trabecular bone score in Graves' disease patients after anti-thyroid therapy. Osteoporosis and Sarcopenia. 2016;2(3):175-179.
Obermayer-Pietsch B, Dobnig H, Warnkross H, et al. Variable bone mass recovery in hyperthyroid bone disease after radioiodine therapy in postmenopausal patients. Maturitas. 2000;35(2):159-166.
Faber J, Jensen IW, Petersen L, Nygaard B, Hegedüs L, Siersbaek-Nielsen K. Normalization of serum thyrotrophin by means of radioiodine treatment in subclinical hyperthyroidism: effect on bone loss in postmenopausal women. Clinical Endocrinology. 1998;48(3):285-290.
Azizi F, Abdi H, Cheraghi L, Amouzegar A. Treatment of subclinical hyperthyroidism in the elderly: Comparison of radioiodine and long-term methimazole treatment. Thyroid. 2021;31(4):545-551.
Nicolaisen P, Obling ML, Winther KH, et al. Consequences of hyperthyroidism and its treatment for bone microarchitecture assessed by high-resolution peripheral quantitative computed tomography. Thyroid. 2021;31(2):208-216.
Apostu D, Lucaciu O, Oltean-Dan D, et al. The Influence of Thyroid Pathology on Osteoporosis and Fracture Risk: A Review. Diagnostics (Basel, Switzerland). 2020;10(3):149. doi:10.3390/diagnostics10030149
Rosario PW. Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to non-voluminous nodular goiter and its effect on bone metabolism. Arq Bras Endocrinol Metabol. 2013;57(2):144-147.
Kansara S, Kotwal N, Kumar KVSH, Singh Y, Upreti V, Nachankar A. Effect of antithyroid therapies on bone and body composition: A prospective, randomized, clinical study comparing antithyroid drugs with radioiodine therapy. Indian J Endocrinol Metab. 2017;21(4):531-534. doi:10.4103/ijem.IJEM_103_17