Altered mineral bone tissue density in patients with thyrotoxicosis

Quantitative computed tomography (QCT) was used to examine 57females with diffuse toxic goiter (DTG) who were found to have its recurrence (n = 27), euthyrosis (n = 19), and postoperative hypothyroidism (n = 11) at the moment ofexamination. Double-energy X-ray absorptiometry (DEXA) of antebrachial bones was performed in 38 patients. Mineral bone tissue density (MBTD) was studied on an Xvision, Toshiba (CCT) apparatus and on DTX-200, Osteometer. The findings point to the similar rate ofdecreases in MBTD by the Z index in patients with DTG when measuring the trabecular substance ofvertebrae (22.8%) and the ultradistalpart (GDP) ofthe forearm (23.7%). In the distalpart (DP), osteopenia and osteoporosis were more prevalent (31.6%). However, no significant differences were found in the rate of decreases in MBTD in the GDP and DP (t - 0. 76, p > 0.05), as well as in the vertebrae and DP (t = 0.93, p > 0.05). The data of a comparative analysis (a decrease in the TSH in patients with decreased MBTD in the antebrachial GDP (t = 2.56, p < 0.05) and particularly those ofa correlation analysis (a negative correlation of serum free T4 levels with vertebral MBTD and antebrachial GDP and DP (r = -0.30, p < 0.05 and r = -0.48, r = -0.43, p < 0.01, respectively) and a positive correlation of MBTD in the GDP with TSH levels (r = 0.40, p < 0.05) suggest that thyrotoxicosis adversely affects both the trabecular and cortical bone tissue. Significant differences between patients with lower and normal vertebral MBTD and antebrachial GDP were revealed by age at the onset ofthe disease (t = 2.11 and t = 2.01, p < 0.05), which are supported by a negative correlation of MBTD of vertebrae and antebrachial bones with DTG debut (r = -0.39, p < 0.05). A widerprevalence ofosteopenia and osteoporosis in patients with DTG (70.2%) by the T index in the vertebrae (70.2%) and antebrachial bones (39.47and 44. 74%) was due to postmenopausal and age-related changes. There was a significant difference between DTG patients with normal and decreased vertebral MBTD in the duration ofa menopause (t = 2.53, p < 0.01) and in their age at the onset ofthe disease (t = 3.22, p < 0.01). Moreover, there was a negative correlation ofMBTD ofthe vertebral trabecular substance and the integral values ofMBTD ofantebrachial GDP with the duration ofa menopause (r = -0.66, p < 0.001; r = -0.35, p < 0.05) and with their age: the highest correlation with the values of vertebral trabecular substance (r = -0.72, p < 0.001) and the least correlation with the values ofantebrachial DP(r •-0.41,p< 0.05). Thus, thyrotoxicosis negatively affects the metabolism of two types of bone tissue and it is mainly associated with decompensation ofhyperthyroidism. And though in DTG patients, the extent ofosteopenia is rather uniformly, calcium loss mainly by vertebral trabecularsubstance is dramatized bypostmenopausal and age-related changes.

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