BONE MASS, BONE TURNOVER AND BODY-COMPOSITION IN FORMER HYPOTHYROID PATIENTS RECEIVING REPLACEMENT THERAPY

The aim of the present cross-sectional study was to disclose whether l ong-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 th e 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 (FT4I) levels (p < 0.001), whereas serum triiodothyronine (T-3) and 4 FT3I levels were b oth reduced by 7% (p < 0.05). In the patients, serum TSH was reduced s ignificantly (p < 0.001). No significant differences were observed bet ween patients and normals in regional of total bone mineral content or bone mineral density levels, apart from 20% higher lumbar bone minera l content among the premenopausal patients (p < 0.05). Surprisingly, t he mean serum calcium level was slightly elevated (2.38 +/- 0.08 vs 2. 33 +/- 0.07 mmol/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 magn esium, intact parathyroid hormone or calcitriol. The biochemical marke rs of bone resorption (serum carboxyterminal telopeptide of type I col lagen, renal excretion of hydroxyproline, pyridinoline and deoxypyridi noline) and formation (serum levels of carboxyterminal propeptide of t ype 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 negati ve effect on bone mass or alter bone turnover.