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Effects of levothyroxine therapy on bone and mineral metabolism in hypothyroidism: a systematic review and meta-analysis.

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The First School of Clinical Medicine, Lanzhou University, No.199 Donggang West Road, Chengguan District, Lanzhou, Gansu Province, 730000, China.

Background: Thyroid hormone plays an important role in accumulating bone development and regulating bone metabolism. It is established that hypothyroidism is linked to increased risk of osteoporosis and fracture. However, the effects of levothyroxine (LT4) treatment on bone for hypothyroid patients remain controversial.

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Transthyretin is a thyroid hormone binding protein with a major role in the distribution of thyroid hormones to peripheral tissues. In preeclampsia, the failing placenta releases soluble endoglin into the maternal circulation causing systemic vascular dysfunction. Our group has previously shown that transthyretin binds to soluble endoglin and is taken up as a complex into hepatocytes.

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TSH-secreting pituitary adenoma (TSHoma) is the rarest functioning pituitary tumor, with an increasing incidence over the last decades. Diagnosis is often delayed, exposing patients to a high risk of developing chronic complications of long-standing hyperthyroidism. Although thyroid hormone excess is a recognized cause of secondary osteoporosis, very few studies have investigated skeletal damage in patients with TSHoma, with data limited to bone turnover markers (BTM) and a study on the prevalence of radiological vertebral fractures (VFs) incidentally detected on chest X-ray, whereas data on bone mineral density (BMD) are anecdotal.

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