title: Rapid restoration of bone mass after surgical management of hyperthyroidism: A prospective case control study in Southern India.
abstract: BACKGROUND
  The rate and the extent of bone remineralization at cancellous versus cortical sites after treatment of hyperthyroidism is unclear. Few studies have examined the effect of operative management of hyperthyroidism on recovery of bone mass.
  
  
  OBJECTIVE
  To evaluate prospectively the bone mineral density (BMD), bone mineral content (BMC), and bone areal size at the spine, hip, and forearm before and after total thyroidectomy.
  
  
  METHODS
  A prospective case control observational study from August 2011 to July 2014 in a single center.
  
  
  METHODS
  This study evaluated 40 overt hyperthyroid patients and 31 age-matched euthyroid controls who were operative candidates.
  
  
  METHODS
  Bone indices were measured at baseline and 6-month postoperatively using dual energy x-ray absorptiometry. Serum levels of alkaline phosphatase and 25-hydroxy vitamin D3 (25OHD) were assessed.
  
  
  RESULTS
  Baseline BMD of hyperthyroid subjects at the spine, hip, and forearm were less than euthyroid controls (P = .001) with concomitant increases in serum alkaline phosphatase (mean ± SD, 143 ± 72 vs 72 ± 23 IU/L control; P < .001). The 25OHD level was 24.3 ± 10.6 and 26.1 ± 14.6 ng/mL in patients and controls, respectively. Among hyperthyroid patients, posttreatment BMD expressed as g/cm(2) were 0.97 ± 0.12 (vs pretreatment 0.91 ± 0.14; P = .001) at the spine, 0.87 ± 0.12 (vs pretreatment 0.80 ± 0.13; P = .001) at the hip, and 0.67 ± 0.09 (vs pretreatment 0.64 ± 0.11; P = .191) at the forearm. The percent change in BMD was greatest at spine (8.3%) followed by the hip (7.6%) and forearm (3.0%).
  
  
  CONCLUSIONS
  Operative management with total thyroidectomy improved the bone loss associated with hyperthyroidism as early as 6 months postoperatively at the hip and spine despite concomitant vitamin D deficiency. Delayed recovery of bone indices at the forearm, a cortical bone, requires further long-term evaluation.
authors.affiliation: Department of Endocrine surgery, Madras Medical College, Chennai, India; Department of General surgery, Government Mohankumaramangalam Medical College and Hospital, Salem, India. Electronic address: poongkodithesurgeon@gmail.com.
authors.forename: Poongkodi
authors.initials: P
authors.lastname: Karunakaran
authors.affiliation: Department of Endocrine surgery, Madras Medical College, Chennai, India.
authors.forename: Chandrasekaran
authors.initials: C
authors.lastname: Maharajan
authors.affiliation: Department of Endocrine surgery, Madras Medical College, Chennai, India.
authors.forename: Kamaludeen N
authors.initials: KN
authors.lastname: Mohamed
authors.affiliation: Department of Endocrine surgery, Madras Medical College, Chennai, India.
authors.forename: Suresh V
authors.initials: SV
authors.lastname: Rachamadugu
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods*; D000328:Adult; D000704:Analysis of Variance; D015519:Bone Density / Q000502:physiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000502:physiology; D002118:Calcium / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000601:surgery*; D007194:India; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D013960:Thyroid Function Tests; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D002118:Calcium