title: Effect of Thyrotropin Suppression Therapy on Bone in Thyroid Cancer Patients.
abstract: BACKGROUND
  The thyroid cancer incidence is rising. Despite current guidelines, controversy exists regarding the degree and duration of thyrotropin suppression therapy. Also, its potential skeletal effects remain a concern to physicians caring for thyroid cancer patients. We conducted a review of published data to evaluate existing studies focusing on the skeletal effects of thyrotropin suppression therapy in thyroid cancer patients.
  
  
  METHODS
  A systematic search of the PubMed, Ovid/Medline, and Cochrane Central Register of Controlled Trials databases was conducted. The retained studies were evaluated for methodological quality, and the study populations were categorized into premenopausal women, postmenopausal women, and men.
  
  
  RESULTS
  Twenty-five pertinent studies were included. Seven studies were longitudinal and 18 were cross-sectional. Of the 25 included studies, 13 were assigned an excellent methodological quality score. Three of 5 longitudinal studies and 3 of 13 cross-sectional studies reported decreased bone mineral density (BMD) in premenopausal women; 2 of 4 longitudinal studies and 5 of 13 cross-sectional studies reported decreased BMD in postmenopausal women. The remaining studies showed no effect on BMD. The only longitudinal study of men showed bone mass loss; however, cross-sectional studies of men did not demonstrate a similar effect.
  
  
  CONCLUSIONS
  Studies to date have yielded conflicting results on the skeletal effects of thyrotropin suppression therapy and a knowledge gap remains, especially for older adults and men. Existing data should be cautiously interpreted because of the variable quality and heterogeneity. Identifying groups at risk of adverse effects from thyrotropin suppression therapy will be instrumental to providing focused and tailored thyroid cancer treatment.
  
  
  CONCLUSIONS
  The standard treatment for thyroid cancer includes total thyroidectomy with or without radioactive iodine ablation, often followed by thyrotropin suppression therapy. Despite current guidelines, controversy exists regarding the degree and duration of thyrotropin suppression therapy, and discordant results have been reported on its adverse effects on bone. The present review provides physicians with existing data on the skeletal effects of thyrotropin suppression therapy, highlighting the need for further research to identify the groups at risk of adverse skeletal effects. This knowledge will aid in developing tailored thyroid cancer treatment.
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA mpapaleo@med.umich.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Papaleontiou
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Hawley
authors.affiliation: Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects* / Q000473:pathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D013965:Thyroidectomy; D013972:Thyrotropin / Q000037:antagonists & inhibitors* / Q000378:metabolism; D013974:Thyroxine / Q000378:metabolism
chemical_list: D000970:Antineoplastic Agents; D013972:Thyrotropin; D013974:Thyroxine
keywords: Bone density; Risk; Thyroid neoplasms; Thyrotropin