Common Thyroid Drug

Common thyroid drug
levothyroxine linked to
bone mass loss
• SLevothyroxine is a frequently prescribed drug in the United States,

particularly for older people, as lower thyroid function can be
associated with aging.
• Questions remain over how appropriately it is prescribed, however, as
side effects can cause problems.
• A recent abstract presented at the annual meeting of the Radiological
Society of North America suggested that levothyroxine use in people
with typical hormone ranges could lead to lower bone mass and
density in older people, over time.
Levothyroxine, a drug used to treat hypothyroidism, can lead to reduced bone
mass and density in older adults with normal thyroid levels, a small cohort study
has shown.
Researchers from Johns Hopkins University School of Medicine in Baltimore,
MD, showed that total body bone mass and density both decreased in adults
over the age of 65 who received levothyroxine over a 6-year follow-up period.
They presented the results at the Annual Meeting of the Radiological Society of
North America on November 25, 2024. These results are yet to appear in a peer-
reviewed journal.
The results came from a small study comprising 81 participants who had typical
thyrotropin levels, which are used to indicate thyroid function, and who were
taking levothyroxine.
The study authors point out that levothyroxine is one of the most commonly
prescribed drugs in the United States, particularly among older adults.
Sean Ormond, MD, of Atlas Pain Specialists, dual board-certified in

anesthesiology and interventional pain management, who was not involved in
this research, told Medical News Today that:
“Levothyroxine is a very common medication because thyroid problems become
more likely as we age. Older adults are more prone to hypothyroidism, where the
thyroid slows down and doesn’t make enough hormones to keep the body
running smoothly.“
“When the thyroid underperforms, people often feel tired, gain weight, get cold
easily, or even feel depressed. These symptoms can make life tough, so doctors
often prescribe levothyroxine to restore hormone levels and help people feel like
themselves again. It’s especially important in cases where untreated thyroid
issues could harm the heart or other organs,” he further explained.
Why is the thyroid gland important?
The thyroid is found in the neck, and is responsible for producing hormones that
in turn play a role in metabolism, growth and development in children,
temperature regulation and in the functioning of the heart and digestive system.
Thyroid stimulating hormone (TSH) is produced by the pituitary gland, another

hormone-producing organ in the head. This in turn causes the thyroid to produce
T3 and T4, which play a role in the aforementioned processes.
Low levels of thyroid hormones can lead to symptoms including fatigue, weight
gain, cold intolerance, dry, flakey skin, loss of hair and inability to concentrate.
Conversely, hyperthyroidism — where thyroid levels are too high — is associated
with weight loss and muscle weakness, high heart rate and blood pressure,
feeling anxious and irritable.
Levothyroxine: Can it raise
osteoporosis risk?
The team behind the recent study had previously shown that levothyroxine use,
particularly in people it is used in unnecessarily, can have an array of unwanted
side effects.
Previously, the authors had shown that the use of levothyroxine in people with
higher thyroid hormone levels had a negative effect on leg mass in older adults,
in a study whose results appeared in Frontiers in Aging.
That study included an analysis of the Baltimore Longitudinal Study of Aging, as

does their latest research.
To look at the impact of levothyroxine use on a similar cohort of adults, in their

latest research, the authors studied 32 males and 49 females who were aged 65
or over at the start of the study, with a mean age of 73.
They matched these participants to five other members of the cohort by
biological sex, body mass index (BMI), age, race, history of alcohol consumption,
history of smoking, other treatments they were undertaking, and TSH levels to
create a quasi-control group.
The analysis of this cohort occurred following two visits where they had their
bone mass and density measured using Dual-Energy X-ray Absorptiometry.
Researchers showed that over the course of the study, those who had
typical thyroid hormone levels and were on levothyroxine demonstrated a
lower bone mass and density.
The results suggest that bone loss could be an effect of levothyroxine use in
older adults, even when used at the appropriate dosage, which could be a
concern in terms of osteoporosis risk.
Is levothyroxine overprescribed?
Questions have been asked for sometime whether levothyroxine is

overprescribed for older adults, with a letter published in Clinical Chemistry in
2023 suggesting that hypothyroidism was overdiagnosed in many people.
It cited research showing that TSH levels vary significantly throughout the year,
peaking in the winter and dropping in the summer months.
Hypothyroidism is diagnosed by looking at the free thyroxine (T4) levels in people

with elevated TSH levels, and comparing the ratio between them.
People with high TSH and low T4 get a diagnosis of hypothyroidism. Those with
slightly elevated TSH and slightly low T4 get a diagnosis of subclinical

hypothyroidism, which might be treated with levothyroxine.
The letter proposed that by not taking normal seasonal variation in TSH levels
into account, many people were being prescribed drugs that might not help
them, and they may even experience negative, avoidable side effects.
Deprescribing is an option for patients who experience unpleasant side effects,

said Sue Clenton, MD, a consultant clinical oncologist at Weston Park Cancer
Centre in Sheffield, U.K.

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Common thyroid drug

bone mass loss

• SLevothyroxine is a frequently prescribed drug in the United States,

Researchers from Johns Hopkins University School of Medicine in Baltimore,

prescribed drugs in the United States, particularly among older adults.

Sean Ormond, MD, of Atlas Pain Specialists, dual board-certified in

Why is the thyroid gland important?

Thyroid stimulating hormone (TSH) is produced by the pituitary gland, another

Levothyroxine: Can it raise

That study included an analysis of the Baltimore Longitudinal Study of Aging, as

To look at the impact of levothyroxine use on a similar cohort of adults, in their

bone mass and density measured using Dual-Energy X-ray Absorptiometry.

Questions have been asked for sometime whether levothyroxine is

Hypothyroidism is diagnosed by looking at the free thyroxine (T4) levels in people

slightly elevated TSH and slightly low T4 get a diagnosis of subclinical

Deprescribing is an option for patients who experience unpleasant side effects,

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