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Rapid restoration of bone mass after surgical management of hyperthyroidism: A prospective case control study in Southern India.

Abstract：

CONTEXT: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. DESIGN AND SETTING:A prospective case control observational study from August 2011 to July 2014 in a single center. PARTICIPANTS:This study evaluated 40 overt hyperthyroid patients and 31 age-matched euthyroid controls who were operative candidates. MAIN OUTCOME MEASURES: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%). CONCLUSION: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.

journal_name

Surgery

journal_title

Surgery

authors

Karunakaran P,Maharajan C,Mohamed KN,Rachamadugu SV

doi

10.1016/j.surg.2015.10.002

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

771-6

issue

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(15)00829-6

journal_volume

159

pub_type

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Rapid restoration of bone mass after surgical management of hyperthyroidism: A prospective case control study in Southern India.