Effects of therapy on subclinical hyperthyroidism and bone mineral density

Au, Minnie, Berkman, Kathryn, Raidoo, Priyanka, Huynh, Aimee, Fernandes, Andrea, and Sangla, Kunwarjit (2015) Effects of therapy on subclinical hyperthyroidism and bone mineral density. Annals of the Australasian College of Tropical Medicine, 17 (1). p. 18.

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Background/Aims: Subclinical hyperthyroidism is known to increase fracture risk, however there is limited evidence to determine whether treatment leads to a significant benefit. Bone mineral density is a reliable predictor of fracture risk, whereby for a decrease in bone mineral density of one standard deviation below the age adjusted mean, the relative risk of a fracture is 1.5 in all sites apart from the hip and spine. The aim of this study is to determine whether treatment of subclinical hyperthyroidism leads to any improvement in bone mineral density.

Methods: A systematic review was performed using Pubmed, Cochrane Library and Embase from inception to July 2015 without language restrictions. Search terms used included: "subclinical hyperthyroidism", "treatment", "therapy" and "bone mineral density".

Results: Five studies were identified, including one randomized controlled trial, three intervention studies and one prospective case-control study. Four studies that evaluated elderly patients, postmenopausal women or those who have a multinodular goiter with subclinical hyperthyroidism demonstrated a significant increase in bone mineral density after treatment. Treatment options studied were methimazole, radioactive iodine or thyroidectomy. A small scale randomized controlled trial involving 40 participants showed no benefit in treating pre-menopausal women with subclinical hyperthyroidism.

Conclusion: Small scale clinical studies show that treatment of subclinical hyperthyroidism improves bone mineral density in postmenopausal women, the elderly and those with a multinodular goitre. However, large scale randomized controlled trials directly evaluating whether treating subclinical hyperthyroidism reduces fracture risk with stratification for confounding factors are needed to confirm this benefit.

Item ID: 40570
Item Type: Article (Abstract)
ISSN: 1448-4706
Keywords: subclinical hyperthyroidism; bone mineral density
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Date Deposited: 17 Nov 2015 02:43
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110306 Endocrinology @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920106 Endocrine Organs and Diseases (excl. Diabetes) @ 50%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920116 Skeletal System and Disorders (incl. Arthritis) @ 50%
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