[The influence of hyperthyroidism and glucocorticosteroid treatment on bone metabolism in patients with Graves' disease and ophthalmopathy].
The aim of the study was to assess influence of hyperthyroidism and glucocorticosteroid treatment on changes of bone turnover markers in patients with Graves' disease and thyroid ophthalmopathy (TO).


METHODS
Three groups of patients were included in the study. Group I was composed of 26 euthyroid Graves' disease patients with TO suitable for steroid treatment. Group II included 14 hyperthyroid Graves' patients without TO treated medically with anti-thyroid drugs. Group III (control group) included 20 healthy volunteers. Levels of the bone formation marker, i.e. bone-specific alkaline phosphatase (BALP) and the bone resorption marker, i.e. deoxypyridinoline (DPD) were measured in the group I before steroid treatment administration, after 3 methylprednisolone i.v. pulses and after completing the oral prednisone treatment. In the group II levels of BALP and DPD were assessed twice: before treatment of hyperthyroidism and after 6 months since euthyroid state had been achieved. In the group III levels of BALP and DPD were measured once in the basal conditions.


RESULTS
Mean initial levels of BALP in groups I and II did not differ significantly and were increased when compared to healthy volunteers. In the group I a transient significant decrease in BALP levels after 3 i.v. pulses of methylprednisolone was observed, followed by a significant increase in BALP after completing the oral prednisone therapy. The achievement of euthyroid state in Graves' patients (II) did not influence significantly BALP values. In the group I initial DPD levels were significantly lower than those in group II and higher than those in the control group (III). During steroid treatment of TO (group I) no dynamic changes of DPD levels were observed. The achievement of euthyroid state in group II was accompanied by a significant decrease in DPD levels, which were however than those in the control group.


CONCLUSIONS
1. In hyperthyroid state is associated with the profound stimulation of bone resorption, and to a lesser extent of bone formation. 2. The achievement of euthyroid state causes a rapid inhibition of bone resorption and maintains a compensatory stimulation of bone formation. 3. Glucocorticosteroid treatment with methylprednisolone i.v. pulses and orally administered prednisone do not influence significantly the processes of bone formation and bone resorption.
Kaźmierczyk-Puchalska
Agnieszka
A
Department of Endocrinology, Hypertension and Metabolic Diseases, Pomeranian Medical University, Szczecin.
Kulig
Grzegorz
G
Krzyzanowska-Swiniarska
Barbara
B
Pilarska
Krystyna
K
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000097:blood; D013956:Antithyroid Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D001862:Bone Resorption; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006111:Graves Disease / Q000188:drug therapy* / Q000378:metabolism*; D049970:Graves Ophthalmopathy / Q000188:drug therapy / Q000378:metabolism; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy / Q000378:metabolism; D008297:Male; D008713:Methimazole / Q000008:administration & dosage; D008875:Middle Aged
D000596:Amino Acids; D013956:Antithyroid Agents; D015415:Biomarkers; D005938:Glucocorticoids; D008713:Methimazole; C036020:deoxypyridinoline; D000469:Alkaline Phosphatase