Effects of thyroid-stimulating hormone suppression after thyroidectomy for thyroid cancer on bone mineral density in postmenopausal women: a systematic review and meta-analysis

• Published in: BMJ open 2021-05, Vol.11 (5), p.e043007-e043007
• Main Authors: Kwak, Donghee, Ha, Jane, Won, Yousun, Kwon, Yeongkeun, Park, Sungsoo
• Format: Article
• Language: English
• Subjects: Bibliographic literature; Body mass index; Bone density; calcium & bone; Diabetes; diabetes & endocrinology; Diabetes and Endocrinology; Ethnicity; Fractures; Hyperthyroidism; Meta-analysis; Osteoporosis; Patients; Systematic review; Thyroid cancer; thyroid disease; Thyroidectomy; Womens health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-043007

ObjectivesWe assessed thyroid-stimulating hormone (TSH) suppression effects on bone mineral density (BMD) in postmenopausal women who underwent thyroidectomy.Data sourcesPubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched from inception to 24 February 2021.Study selectionCase-control studies were included.Data extraction and synthesisTwo authors independently reviewed the studies, extracted the data and performed meta-analysis of eligible studies.Research design and methodsStudies evaluating BMD in postmenopausal women with thyroid cancer who had thyroidectomy and levothyroxine therapy were included. Differences in BMD were presented as standardised mean differences (SMDs). Meta-analyses were conducted using a random-effects model.ResultsAnalysis of 16 case-control studies (426 patients and 701 controls without thyroid cancer) showed that stringent TSH suppression (TSH 10 years of follow-up (SMD −0.32; 95% CI −0.50 to −0.14). Subgroup analysis of the femoral neck showed that total thyroidectomy was related to detrimental effects on the BMD of the femoral neck (SMD −0.60; 95% CI −0.89 to −0.31; I2=90.4%), but near-total thyroidectomy was not (SMD 0.00; 95% CI −0.30 to 0.30; I2=55.6%).ConclusionsStringent TSH suppression had deleterious effects on the BMD of the lumbar spine after thyroidectomy in postmenopausal women. Further studies are needed to determine whether stringent TSH suppression after thyroidectomy increases the fracture risk.