BONE HEALTH IN WOMEN UNDERGOING THYROID STIMULATING HORMONE SUPPRESSIVE THERAPY AFTER THYROIDECTOMY FOR CANCER

초록

Objective: The appropriate treatment of postoperative osteoporosis is critical for the successful management for women undergoing TSH suppressive therapy after thyroidectomy for cancer. However, previous studies showed differential effects of TSH suppressive therapy on postoperative bone density. We conducted a systematic review and meta-analysis of existing studies (1) to identify the effect of thyroidectomy with TSH suppression therapy on postoperative bone density and (2) differentiate the effect of extent and duration of TSH suppressive therapy on bone density in women undergoing thyroidectomy for cancer. Methods: Relevant studies published before April 2019 were selected by searching Medline, EMBASE, and Cochrane Library. We included studies which provided the data for bone density in women undergoing thyroidectomy with TSH suppressive therapy. Of 145 potentially relevant studies, 32 met the inclusion criteria. Data were combined by means of a random-effects model. Results: TSH suppressive therapy showed detrimental effect for postoperative bone density in postmenopausal women (SMD, -0.34; 95%CI, 0.58 to -0.11, I2 =76.4%), while no significant effect in premenopausal women. The subgroup with long term follow-up (>10 y) presented significant decrease of bone density in both premenopausal and postmenopausal women. In subgroup analyses considering two factors simultaneously [TSH level (<0.1 mlU/L or 0.1-0.44 mlU/L or ≥ 0.45 mlU/L), and follow-up time (<10 y or ≥10 y)], detrimental effect for bone density was identified in 2 subgroups; 1) postmenopausal women with TSH level 0.1-0.44 mlU/L and <10 y follow-up after thyroidectomy, 2) ≥10 y follow-up studies after thyroidectomy regardless of TSH suppression. Conclusion: These findings do not support the detrimental effect of TSH suppressive therapy after thyroidectomy in premenopausal women, and postmenopausal women except for the subgroups above mentioned. The risk and benefit of TSH suppressive therapy for postoperative bone health should be newly assessed by healthcare professionals based on the results of current meta-analyses.