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Bone loss density and T3

Postby Steve-H on Fri Jan 27, 2012 12:45 pm

Hi, My endo refused to do a Bone loss and density scan even though i am on T3 only replacement therapy. His reasoning were that because my dose is high 92mcg that i would 100% have bone loss so it is therefore pointless. I dont understand his answer. Could you give some explantion ?

Steve
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Re: Bone loss density and T3

Postby ipman on Fri Jan 27, 2012 1:14 pm

Steve-H wrote:Hi, My endo refused to do a Bone loss and density scan even though i am on T3 only replacement therapy. His reasoning were that because my dose is high 92mcg that i would 100% have bone loss so it is therefore pointless. I dont understand his answer. Could you give some explantion ?

Steve


How ridiculous! You really need to establish a benchmark now for future comparisons. Given your dose of T3, potentially you provide a good opportunity for your endo to investigate the issue of bone loss/density vs T3. I thought endos were scientists. Quite apart from giving you the reassurance you need about possible bone loss/density problems, a real scientist would be only too pleased to be presented with someone like yourself who provides an ideal way of testing the T3/bone hypothesis.

Of course, you could get the test done privately - we had one done recently at a very reasonable cost (although you shouldn't really have to resort to going outside the NHS for something as important as this).

Incidentally if the endo is so sure that you are going to suffer 100% bone loss, has he/she given you any advice about how you might compensate for this other than reducing your T3 intake?

On a related point, I do wonder whether people on T3 ought, as a matter of routine, be asked to have heart scans in order that development/progression of any heart condition can be detected and monitored. My own view is that the medical profession prefer the whole subject of bone/heart problems vis-a-vis T3 to remain shrouded in uncertainty rather than do any research to show whether or not there is really any basis for the scare stories. My daughter saw an eminent endo about 12 months ago who regaled her with the usual scare stories about heart/bone problems but absolutely refused to provide any sort of risk evaluation. Life is full of risks and, when it comes to medical matters, risk has to balanced against quality of life. My daughter received absolutely no guidance on this and, even when she pressed the issue by way of subsequent correspondence, my daughter to this day has received no guidance on the level of risk. In contrast, her private consultant has simply told her that the risks if they exist are not at all significant when put in the context of quality of life and he talks from extensive experience of dealing with patients with thyroid-related disorders.

Hopefully you will get the answers you seek from one of the experts. Even if you don't, I think we have to acknowledge the invaluable service provided by Talkhealth in enabling these issues to be aired in a public forum.

ipman
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Re: Bone loss density and T3

Postby Steve-H on Fri Jan 27, 2012 2:10 pm

Hi Ipman,

"You really need to establish a benchmark now for future comparisons." - This was my arguement but of course not listened to.

"Incidentally if the endo is so sure that you are going to suffer 100% bone loss, has he/she given you any advice about how you might compensate for this other than reducing your T3 intake? " - No you gussed it, only you must reduce your T3. My dose that i am on is what makes me feel the best.

I have had an ECG the 30 minute one, no serious compliactions were found.

Thanks for your reply, its good? (i guess bad) that i am not the only one in this situtation, i would quite like to hear what there panel of experts have to offer on this.

Steve
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Re: Bone loss density and T3

Postby Dr Petros Perros on Tue Feb 21, 2012 11:49 am

THE QUESTION IS WHAT IS THE RISK OF OSTEOPOROSIS FOR PEOPLE WHO ARE TREATED WITH T3 ALONE AND WHAT IS THE ROLE OF A BONE DENSITY SCAN?

ONE OF THE STUDIES COPARING T4 WITH A COMBINATION OF T3 AND T3 IN HYPOTHYROIDISM FOUND THAT ONE OF THE MARKERS FOR OSTEROPOROSIS WAS INCREASED IN PATIENTS ON COMBINATION TREATMENT (Hormones (Athens). 2010 Jul-Sep;9(3):245-52. Combined therapy with L-thyroxine and L-triiodothyronine compared to L-thyroxine alone in the treatment of primary hypothyroidism. Fadeyev VV, Morgunova TB, Melnichenko GA, Dedov II).

THERE ARE NO DIRECT DATA FROM STUDIES OF PEOPLE ON T3 ALONE. WE CAN EXTRAPOPLATE FROM SOME OTHER SITUATIONS. A STUDY OF ENDOGENOUS SUBCLINICAL HYPERTHYROIDISM (IE PATIETNS WERE NOT TAKING THYROID HORMONES BUT THEIR THYROID GLANDS WERE MAKING SOME EXCESS THYROXINE SO THAT THE FREE T3 AND FREE T4 WERE NORMAL BUT THE SERUM TSH SUPPRESSED. IN THESE PATIENTS THE RISK OF OSTEOPOROTIC FRACTURE WAS 1.25 TIMES GREATER THAN EXPECTED. THES RISK OF HEART PROBLEMS WAS 1.36 TIMES GREATER THAN EXPECTED AND THERE WAS ALSO AN INCREASED RISK OF DEMENTIA OF 1.79 TIMES ABOVE EXPECTED

INCIDENTALLY ONE OF THE QUESTIONS THAT HAS BEEN ASKED IN THE FORUM REPEATEDLY IS WHAT RESEARCH ON TEHSE TOPICS IS BEING CARRIED OUT IN THE UK. SOME OF THE LEADING RESEARCH ON THE EFFCTS OF THYROID HORMONES ON BONES IS BEING CONDUCTED IN THE UK (Molecular Endocrinology May 1, 2007 vol. 21 no. 5 1095-1107. ALSO THE RESEARCH I REFERRED TO ABOVE ABOUT SUBCLINICAL HYPERTHYROIDISM, CAME FROM THE UK ((JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2011, 96:1344).

TO GO BACK TO STEVE’S COMMENT:
I AM NOT SURE WHAT YOUR ENDOCRINOLOGIST MEANT BY SAYING THAT YOU WOULD HAVE 100% BONE LOSS, THIS IS NOT TERMINOLOGY THAT IS USED TO DESCRIBE RISKS OF OSTEOPOROSIS. THERE ARE NUMEROUS RISKS FOR OETEOPOROSIS. EVELATED SERUM T3 AND T4 LEVELS IS ONE. IF A TREATMENT PLACES SOMEONE AT RISK OF OSTEPOROSIS IT IS APPROPRIATE TO ASK “IS THAT TREATMENT NECESSARY AND CAN IT BE SUBSTITUTED BY SOMETHING SAFER?” IF THE ANSWER IS NOT, THEN IT IS RIGHT TO ENSURE THAT THE OTHER RISK FACTORS ARE ALSO ADDRESSED. I WOULD ALSO HIGHLIGHT THAT A BONE DENSITY SCAN IS NOT A PERFECT MEANS OF SCREENING FOR OSTEOPOROSIS. BONE DENSITY IS NOT THE ONLY DETERMINANT OF BONE STRENGTH AND THERE ARE EXAMPLES OF NORMAL BONE DENSITY YET OSTEOPOROTIC FRACTURES DO OCCUR. FURTHERMORE MANY PEOPLE WITH “WEAR AND TEAR” CHANGES IN THEIR BONES PRODUCE MISLEADINGLY NORMAL BONE DENSITOMETRY READINGS. MOST OF THE EXPERIENCE OF THE UTILITY OF BONE DENSITY SCANS COMES FROM POST-MENOPAUSAL OSTEOPOROSIS. A NORMAL BONE DENSITY READING FOR SOMEONE LIKE YOU STEVE, MAY INDICATE THAT YOU HAVE NO OSTEOPOROSIS AT THE MOMENT BUT DOES NOT PRECLUDE IT HAPPENING IN FUTURE.
Dr Petros Perros
Consultant Endcorinologist
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