info regarding levothyroxine and bone loss

@laura1970 I have been on levo for about 30 years. currently 75 micrograms, but had been on 88mcg for the first 10 years. A different doc switched me from 88 to 75, since my TSH was very low (.5) on the 88. What one doctor feels is ok, another may not agree with. I recently found out I have osteoporosis and wondering what being on an unnecessarily high dose for 10 years might have done. We need to be our own best advocate. I am at 1.4 now and still feel I can go lower. Seing a new endo tomorrow. However, I am 68, the damage has been done . Feeling very angry and disappointed in my health care professionals.

@zygote most of this over my head.

@blueberre After my last child was born I was diagnosed with hypothyroidism with a goiter being present. So, I’ve been on differing dosages of levothroxine for over 45 years. Since my mother had severe osteoporosis I’ve always asked the question about the correlation between thyroid medication and bone loss. Any doctor I’ve asked has answered there was no connection between the two. My dosages have gone up and down over the years but recently diagnosed with osteopenia.

Extract from https://www.medicalnewstoday.com/articles/common-thyroid-drug-levothyroxine-linked-to-bone-mass-loss

"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."

@dcanada54 there certainly is a connection, if the dosage is too high,which in my mind is pretty subjective. There are a lot of studies out on that, especially with older patients. I have my appointment with a new female endocrinologist today. I will update on her view.

@zygote I think it is easy to to confuse what is meant by T3 and T4. If one takes liothyronine, it is a pill form of the body’s naturally produced T3. Levothyroxine is a pill form of the bodies naturally produced T4. The body is able to convert T4 to T3, whether produced naturally or given in a pill form.

From my reading of the 2024 John’s Hopkins study, yes there is a slight but statistically significant decrease in bone mass in those taking levothyroxine despite normal TSH in those over 65. However, it does not break it down into brackets of TSH. What I mean is, it doesn’t break it down into TSH for example 0.4-1, 1-2, 2-3, 3-4 or variations on this theme. The body finely tunes T4 and T3 levels on a daily and probably even hour by hour and possibly minute to minute basis to keep T4 and T3 levels “just right”. Of course if you are taking a pill form of levothyroxine this cannot occur. So there may be moments when your T4 and/or T3 are too high or too low. At the present time, the best we can hope for is that we manage the overall average correctly.

This is a groundbreaking study as it alerts practitioners that, yes, even a normal TSH carries risks. I suspect when further studies are done, it will be found that lower TSH carries more risk than higher. If I were still practicing today, I would change how I practice because of this study. I would not discontinue therapy even if one had osteoporosis or high risk of getting it, but I would aim for a TSH more in the 3-4 range.

What I took from the article is in those over 65, it should periodically be reassessed to be sure patients still require thyroid replacement therapy. Of course, most people who need thyroid replacement need it for life. Doctors don’t prescribe levothyroxine without good lab evidence that it is needed. Hypothyroidism is a hormone disorder, meaning it effects most every cell in the body. untreated it causes a plethora of problems including high cholesterol, low metabolism and weight gain, fatigue, mood and cognitive changes, slow heart rate, constipation, muscle weakness, heavy, prolonged periods, fertility issues… the list goes on.

So, as is true for many things in medicine, treatment requires careful and thoughtful analysis with an eye toward risks and benefits, which this latest study has helped elucidate.

I hope some find this helpful

An up date on my Synthroid dosage. The new endocrinologist told me that my TSH was a bit higher than she liked it to be with someone having osteoporosis. Thankfully she did decrease the dosage. My TSH was 1.4. She told me it that it should be in the mid range, closer to 2.5, for my age.

I also have been on thyroid meds for about 30 years. At 68, my Dexa went from bad to worse. I wish I had gone a more natural approach with Armour thyroid medicine, but I did not and the damage is done. I was able to get my meds lowered once. Around age 52, went from 88 to 75 and was put on brand name Synthroid. I had gotten a bad batch of generic presumably from Pakistan. Terrible side effects, hair loss, anxiety, bursting out in tears for no reason! . My suspicion went to the Levo, when my drug supplier started to send brand name Synthroid without any change from my doctor. When Express scripts, started to send generic again, thankfully my Dr stepped in and wrote a script that indicated I was to get only Synthroid for the next 90 years. I encourage anyone who is on generic to talk to their doctors about prescribing only brand name Synthroid. The dosage is more consistent compared to generic. I don't think this will save anyone from osteoporosis, but at least your dose probably won't fluctuate.

Apparently it is true but to what degree I can't say. I have taken Synthroid for over 35 years. Never worried about osteoporosis as I have been a lifelong athlete. However, I do have a small frame. Back in 2012 my DEXA scan showed osteopenia but I shrugged it off and my doctors (gyn, endochronologist, pcp) never commented on that. Now I have full blown osteoporosis in my forearms and wrists. Oddly, my spine is fine. Hips were replaced back in 2018 but I was a marathon runner and ran long distance for 40 years. That likely accounts for the bad hips, but certainly helped my spine. I think regular weight workouts are a key element to prevention and possibly treatment (in addition to meds). I started that a month ago. I suggest light weight workouts and vitamins D3, Calcium, Magnesium and several others, if your current health permits.

@blueberre yes I would argue that a TSH in the 3-4 range would be best for your bones