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Metabolism and mineral one density in thyrotoxicosis (literature review)

Vasyl Shymon, Vasil Stojka


Objective: based on information analyze research bone tissue in terms of hyperthyroidism — pathological conditions caused by increased blood levels of thyroid hormones. In physiological concentrations thyroid hormones (thyroxine (T4) and triyodtiro­nin (T3)) play important role in the development of the skeleton, achieving peak bone mass and maintaining it in adulthood. It is proved effect of thyroid hormones on bone cells is carried out with hormonreceptor interaction. Receptors for them and thyroid stimulating hormone (TSH) revealed in osteoblasts and osteoclasts. The presence of calcium in the skeleton, mainly de­fines the bone mineral density. In the case of hyperthyroidism negative calcium balance and lowered bone density observed in 10–20 % of patients regardless of age. This is due to disorders of bone remodeling with a disproportionate increase in bone re­sorption compared to bone, it’s activation does not compensate the loss of bone mass. In patients with hyperthyroidism recorded reduced blood serum concentrations of vitamin D, negatively impacts the metabolism of bone tissue and results in to low bone mineral density. With hyperthyroidism progression increases the concentration of alkaline phosphatase in blood serum, os­teocalcin, and osteoproteherin and fibroblastiv 23 growth factor, that testifies bone resorption. Women in pre and postmenopausal hyperthyroidism are at risk for osteoporosis and fracture. The likelihood of fractures in postmenopausal women increased by 2.2 times compared to women without hyperthyroidism.


hyperthyroidism; osteoporosis; thyroid hormones; fractures


Schegoleva OA. Faktoryi riska i prognozirovanie osteoporoza u zhenschin s tireotoksikozom: Metodicheskie rekomendatsii. Irkutsk, 2005. 16 р. (in Russian)

Tretyak SI, Hryischanovich VYa. Sovremennyie metodyi lecheniya gipotireoza: monografiya. Minsk: BGMU, 2011. 150 р. (in Russian)

Bassett JH, Williams GR. The molecular actions of the thyroid hormone in bone. Trends Endocrinol. Metab. 2003;14(8):356–64. doi: 10.1016/S1043-2760(03)00144-9.

Feigerlova E, Klein M, Angelousi A, Groza L, Weryha G, Leheup B. Thyroid disorders and bone mineral homeostasis. Thyroid hormone. Ed. NK Agrawal. InTech, 2012. doi: 10.5772/46207. Available from:

Bassett JH. Williams GR. Role of thyroid hormones in skeletal development and bone maintenance. Endocr Rev. 2016;37(2):135–87. doi: 10.1210/er.2015-1106.

Ashukina NO, Dedukh NV, Gopkalova IV. Influence of increased thyroid hormones on the bone. Problemi tndokrinnoy patologii. 2009;(2):107–13. (in Ukrainian)

Gorka J, Taylor-Gjevre RM, Arnason T. Metabolic and clinical consequences of hyperthyroidism on bonedensity. Int J Endocrinol. 2013;2013:638727. doi: 10.1155/2013/638727.

Abe E, Marians RC, Yu W, Wu XB, Ando T, Li Y, Iqbal J, Eldeiry L, Rajendren G, Blair HC, Davies TF, Zaidi M. TSH is a negative regulator of skeletal remodeling. Cell. 2003;115(2):151–62. doi: 10.1016/S0092-8674(03)00771-2.

Huang BK, Golden LA, Tarjan G, Madison LD, Stern PH. Insulin-like growth factor 1 production is essential for anabolic effects of thyroid hormone in osteoblasts. J Bone Miner. Res. 2000;15(2);188–97.

Nicholls JJ, Brassill MJ, Williams GR, Bassett JH. The skeletal consequences of thyrotoxicosis. J Endocrinol. 2012;213(3):209–21. doi: 10.1530/JOE-12-0059.

Murphy E, Williams GR. The thyroid and the skeleton. Clin. Endocrin. 2004;61(3);285–98. doi: 10.1111/j.1365-2265.2004.02053.x.

Mosekilde L, Eriksen EF, Charles P. Effects of thyroid hormones on bone and mineral metabolism. Endocrinol Metab Clin North Am. 1990;19:35–63.

Meunier PJ, Bianchi GGS, Edouard CM. Bony manifestations of thyrotoxicosis. Orthop Clin North Am. 1972;3:745–74.

Eriksen EF. Normal and pathological remodeling of human trabecular bone: Three dimensional reconstruction of the remodeling sequence in normals and in metabolic bone disease. Endocr Rev. 1986;7:379–408.

Park SE, Cho MA, Kim SH, Rhee Y, Kang ES, Ahn CW, Cha BS, Lee EJ, Kim KR, Lee HC, Lim SK. The adaptation and relationship of FGF-23 to changes in mineral metabolism in Graves disease. Clin Endocrinol (Oxf) 2007;66(6):854–8. doi: 10.1111/j.1365-2265.2007.02824.x.

Williams GR. Actions of thyroid hormones in bone. Endokrinol Pol. 2009;60(5):380–8.

Van de Ven AC, Erdtsieck RJ. Changes of bone mineral density, quantitative ultrasound parameters and markers of bone turnover during treatment of hyperthyroidism. Neth J Med. 2008;66(10):428–32.

Dhanwal DK. Thyroid disorders and bone mineral metabolism. Indian J Endocrinol Metab. 2011;15(2):S107–12. doi: 10.4103/2230-8210.83339.

Lakatos P, Foldes J, Horvath C. Serum interleukin-6 and bone metabolism in patients with thyroid function disorders. J Clin Endocrinol Metab. 1997;82:78–81.

Vadiveloo T, Donnan PT, Cochrane L, Leese GP. The thyroid epidemiology, audit, and research study (TEARS): morbidity in patients with endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011;96(5):1344–51. doi: 10.1210/jc.2010-2693.

Sarezky MD, Corwin DJ, Harrison VS, Jacobstein C. Hyperthyroidism presenting with pathologic fractures. Pediatrics. 2016;137(2):e20150169. doi: 10.1542/peds.2015-0169.

Bauer DC, Ettinger B, Nevitt MC, Stone KL. Risk for fracture in women with low serum levels of thyroid-stimulating hormone. Ann Intern Med. 2001;134(7):561–8.

Kravets YeB, Zavadovskaya VD, Nochevnaya LB. Osteopenic syndrome at diffuse-toxic goiter. Bulletin of Siberian Medicine. 2008;4:90–3. (in Russian)

Udayakumar N, Chandrasekaran M, Rasheed MH, Suresh RV, Sivaprakash S. Evaluation of bone mineral density in thyrotoxicosis. Singapore Med J. 2006;47(11):947–50.

Vestergaard P, Rejnmark L, Mosekilde L. Influence of hyper- and hypothyroidism, and the effects of treatment with anti-thyroid drugs and levothyroxine on fracture risk. Calcif Tissue Int. 2005;77:139–44. doi:10.1007/s00223-005-0068-x.

Ahmed LA, Schirmer H, Berntsen GK, Fønnebø V, Joakimsen RM. Self-reported diseases and the risk of non-vertebral fractures: the Tromsø study. Osteoporosis Int. 2006;17:46–53. doi:10.1007/s00198-005-1892-6.

Rosario PW. Radioiodine therapy in elderly patients with subclinical hyperthyroidism due to nonvoluminous nodular goiter and its effect on bone metabolism. Arq Bras Endocrinol Metab. 2013;57(2):144–7. doi: 10.1590/S0004-27302013000200008.

Boonya-Ussadorn T, Punkaew B., Sriassawaamorn N. A comparative study of bone mineral density between premenopausal women with hyperthyroidism and healthy premenopausal women. J Med Assoc Thai. 2010:93 Suppl 6:S1-5.

Rosario PW. Bone and heart abnormalities of subclinical hyperthyroidism in women below the age of 65 years. Arq. Bras. Endocrinol. Metab. 2008; 52(9):1448-51. doi: 10.1590/S0004-27302008000900007.

Shepelkevich AP, Leonova TA, Zhukovskaya OV, Suhodolova OI. Giperfunktsiya schitovidnoy zhelezyi i kostnyiy metabolism. Meditsinskiy zhurnal. 2011;1:116–23. (in Russian)

Anvarova ShS, Niyazova NF. K otsenke sostoyaniya kostnoy tkani u zhenschin, bolnyih tireotoksikozom, v usloviyah yodnogo defitsita. Doklady akademii nauk respubliki Tadzhikistan. 2010;53(11):889–902. (in Russian)



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