Journal of Research in Pharmacy Practice

Effects of Levothyroxine and thyroid stimulating hormone on bone loss in patients with primary hypothyroidism

Document Type : Original Article

Authors

. Mansoor Karimifar 1
. Farah Esmaili 1
. Amirhossein Salari 2
. Ali Kachuei 3
. Ziba Faragzadegan 4
. Mozhgan Karimifar 3

1 Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Rheumatology, Baghiyatollah University of Medical Sciences, Tehran, Iran

3 Department of Endocrinology, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Community and Preventive Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract
Objective: Previous studies on bone mineral density (BMD) abnormalities associated with 
hypothyroidism are scarce and not conclusive. The effect of thyroid hormone therapy on 
BMD has shown mixed results. The aim of the present study was to determine the severities 
of osteoporosis in female patients with hypothyroidism in comparison to healthy women.
Methods: This cross‑sectional descriptive study was performed on 150 women aged 
over 50 years. Totally, 100 patients with primary hypothyroidism and 50 healthy subjects were 
enrolled in this study and divided into three groups. GroupA, which consisted the patients who had 
been recently diagnosed with primary hypothyroidism. The second group of patients diagnosed 
with primary hypothyroidism for at least 2 years and was treated with levothyroxine (Group B). 
The third group of healthy individuals was selected as a control group (Group C). Blood samples 
were taken for the measurements of thyroid stimulating hormone (TSH), and bone densitometry 
was performed to determine the BMD reported as T‑score in order to measure the severity 
of osteoporosis. T‑score of the lumbar vertebra (L2‑L4) and femoral neck were measured with 
dual energy X‑ray absorptiometry and were compared between the three groups. Data were 
analyzed by SPSS using regression analysis and Mann–Whitney, Kruskal–Wallis, or analysis of 
variances statistical tests. The statistical significance was set at a P < 0.05.
Findings: The average age of patients and baseline serum TSH levels in Group B was 
significantly different from the other two groups (P < 0.001). T‑score of the lumbar 
spine (L2‑L4) in Group B was significantly lower than the other groups (P = 0.01). The 
linear regression between serum TSH levels and BMD categories were not clearly associated. 
However, after removing the effect of the baseline TSH level in Group B, bone loss was 
significantly greater than the other two groups (P = 0.01).
Conclusion: According to the present study, it seems that the treatment of hypothyroidism 
with thyroid hormones reduces both serum levels of TSH and bone density. Hence, proper 
control of this risk factor can be an effective way in prevention of osteoporosis.

Keywords

Levothyroxine
osteoporosis
primary hypothyroidism
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Journal of Research in Pharmacy Practice
Volume 3, Issue 3
Summer 2014
Pages 83-87

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