학술논문
Effect of TSH Suppression Therapy on Bone Mineral Density in Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis
Meta-Analysis
Meta-Analysis
Document Type
Academic Journal
Author
Source
Journal of Clinical Endocrinology & Metabolism. December 2021, Vol. 106 Issue 12, p3655, 13 p.
Subject
Language
English
ISSN
0021-972X
Abstract
The primary purposes of the initial treatment of patients with differentiated thyroid cancer (DTC) are improving long-term survival and minimizing the risk of recurrence and metastasis (1). Specifically, appropriate surgery [...]
Context: Because subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of TSH suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC). Objective: We aimed to determine the effect ofTSH suppression therapy on bone mineral density (BMD) in DTC patients. Methods: We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies' characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women's and men's lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model.The weighted mean differences with 95% CIs are expressed for the differences in outcome measurements between groups. Results: Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared with the controls. Conclusion: Evidence from observational studies suggests that postmenopausal women treated withTSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors. Key Words: TSH suppression therapy, differentiated thyroid cancer, bone mineral density
Context: Because subclinical hyperthyroidism increases the risk of osteoporosis and fractures, concerns are growing about the long-term skeletal safety of TSH suppression therapy after total thyroidectomy in patients with differentiated thyroid cancer (DTC). Objective: We aimed to determine the effect ofTSH suppression therapy on bone mineral density (BMD) in DTC patients. Methods: We searched PubMed, Embase, the Cochrane library, and other sources. Eligible observational studies included DTC patients who underwent TSH suppression therapy and BMD measurement. Two independent reviewers extracted data on the studies' characteristics and outcomes and determined their risk of bias. Data were extracted from each study for postmenopausal/premenopausal women's and men's lumbar spine (LS), femoral neck (FN), and total hip (TH) BMD and summed using a random-effects meta-analysis model.The weighted mean differences with 95% CIs are expressed for the differences in outcome measurements between groups. Results: Seventeen studies (739 patients and 1085 controls) were included for quantitative analysis. In postmenopausal women, TSH suppression therapy showed a significant decrease in LS BMD (-0.03; -0.05, -0.02), and a similar trend was seen in TH. In premenopausal women, TSH suppression therapy significantly increased LS BMD (0.04; 0.02, 0.06) and FN BMD (0.02; 0.01, 0.04). In men, there was no significant association between TSH suppression therapy and BMD at any site compared with the controls. Conclusion: Evidence from observational studies suggests that postmenopausal women treated withTSH suppression therapy are at risk for lower BMD. Attention should be paid to long-term skeletal safety in DTC survivors. Key Words: TSH suppression therapy, differentiated thyroid cancer, bone mineral density