Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar;44(3):431-442.
doi: 10.1007/s40618-020-01359-6. Epub 2020 Jul 21.

Skeletal health in patients with differentiated thyroid carcinoma

M Cellini  1 , M Rotondi  2   3 , M L Tanda  4 , E Piantanida  4 , L Chiovato  2   3 , P Beck-Peccoz  5 , Andrea Lania  6   7 , G Mazziotti  1   8
Affiliations
Review

Skeletal health in patients with differentiated thyroid carcinoma

M Cellini et al. J Endocrinol Invest. 2021 Mar.

Abstract

Osteoporosis and fractures are important comorbidities in patients with differentiated thyroid cancer (DTC), with potential negative impact on quality of life and survival. The main determinant of skeletal fragility in DTC is the thyrotropin (TSH)-suppressive therapy, which is commonly recommended to prevent disease's recurrence, especially in patients with structural incomplete response after thyroid surgery and radio-iodine therapy. TSH-suppressive therapy can stimulate bone resorption with consequent bone loss, deterioration of bone microstructure and high risk of fragility fractures. The skeletal effects of TSH-suppressive therapy may be amplified when thyroid cancer cells localize to the skeleton inducing alterations in bone remodelling, impairment of bone structure and further increase in risk of fractures. The management of skeletal fragility in DTC may be challenging, since prediction of fractures is a matter of uncertainty and data on effectiveness and safety of bone-active agents in this clinical setting are still scanty. This review deals with pathophysiological, clinical and therapeutic aspects of skeletal fragility of patients with DTC.

Keywords: Bone metastases; Bone mineral density; Differentiated thyroid carcinoma; Fractures; Levothyroxine; TSH suppression.

PubMed Disclaimer

References

    1. Cabanillas ME, McFadden DG, Durante C (2016) Thyroid cancer. Lancet 388(10061):2783–2795. https://doi.org/10.1016/s0140-6736(16)30172-6 - DOI - PubMed
    1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133. https://doi.org/10.1089/thy.2015.0020 - DOI - PubMed - PMC
    1. Somwaru LL, Arnold AM, Joshi N, Fried LP, Cappola AR (2009) High frequency of and factors associated with thyroid hormone over-replacement and under-replacement in men and women aged 65 and over. J Clin Endocrinol Metab 94(4):1342–1345. https://doi.org/10.1210/jc.2008-1696 - DOI - PubMed - PMC
    1. Biondi B, Cooper DS (2019) Thyroid hormone suppression therapy. Endocrinol Metab Clin North Am 48(1):227–237. https://doi.org/10.1016/j.ecl.2018.10.008 - DOI - PubMed
    1. Pacini F, Basolo F, Bellantone R, Boni G, Cannizzaro MA, De Palma M, Durante C, Elisei R, Fadda G, Frasoldati A, Fugazzola L, Guglielmi R, Lombardi CP, Miccoli P, Papini E, Pellegriti G, Pezzullo L, Pontecorvi A, Salvatori M, Seregni E, Vitti P (2018) Italian consensus on diagnosis and treatment of differentiated thyroid cancer joint statements of six Italian societies. J Endocrinol Invest 41(7):849–876. https://doi.org/10.1007/s40618-018-0884-2 - DOI - PubMed

LinkOut - more resources