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Thyroid problems are exceedingly common.
But it is still commonplace to do only the most basic investigation of thyroid function.
Doctors and even specialists will often only look at 1 or 2 labs.
And many professionals do not keep up to speed with the most recent science…
…which is often updating the “normal” range for thyroid related lab tests.
One of the issues that occurs here is the issue of “subclinical” thyroid issues.
These are a set of problems that occur when the storage form of the thyroid hormone is in the normal range, but the TSH is out of range.
Often, the active thyroid hormone T3 is completely ignored in this context.
Men who struggle with this (often ignored) problem are much more likely to suffer with bone metabolism problems.
This increases the risk of hip fractures.
The human research was carried out at the University of California. The paper was published in the Archives of Internal Medicine.
“Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported.”
Though thyroid hormones have profound effects on bones, researchers are still trying to get their heads around the issue.
“We sought to determine prospectively whether older men with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture.”
The researchers looked at 2 thyroid hormone labs.
TSH is a hormone which should react to blood levels of thyroid hormones.
It is an indirect marker for thyroid hormones – and it is not always correct.
FT4 is the storage form of thyroid hormone.
The researchers defined the subclinical thyroid problems as follows.
Subclinical hyperthyroidism (high) is when the TSH is too low, but the free T4 is in the normal range.
“Subclinical hyperthyroidism: A TSH level of less than 0.45 mIU/L with a FT4 level in the reference range.
Subclinical hypothyroidism (low) is when the TSH is high but again free T4 is in the normal range.
“Subclinical hypothyroidism: A TSH level of 4.5 to 20.0 mIU/L with an FT4 level in the reference range.”
Euthyroidism is a word which describes normal thyroid labs.
The researchers analyzed data from over 3,000 people.
They look at the relationship between the above categorizations of thyroid function and hip fractures over the next 13 years.
“Main outcome measures included incidence and hazard ratios of incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline.”
Men with subclinical hyperthyroidism were almost 3 times more likely to suffer from hip fractures compared with those who had normal thyroid labs.
“Hip fracture incidence (per 1000 men-years) was 13.5 in men with subclinical hyperthyroidism.”
Men with subclinical low thyroid were twice as likely to suffer a hip fracture than those with normal labs.
“Hip fracture incidence 10 in men with subclinical hypothyroidism. Both thyroid disorders were associated with greater risk of hip fractures compared to 5 in men with euthyroidism.”
When the researchers included other known risk factors for hip fractures into their models they found similar results.
Subclinical thyroid problems increase the risk of hip fractures by 2-3x.
“Men with subclinical hypothyroidism had a multivariable-adjusted hazard ratio of 2.3 and for those with subclinical hyperthyroidism it was 3.3.”
Thyroid hormones (T3 and T4) have a large role in bone metabolism – just as they have a large role in the health of the whole body.
It is no surprise that thyroid problems like this could cause bone problems.
The TSH is known to be inflammatory itself when elevated – and this could lead to degradation of bone tissue – increasing hip fractures.
What is more, this research did not even evaluate the most important thyroid lab – T3.
T3 is the actual thyroid hormone – the one that does the work!
The altered TSH levels seen in subclinical thyroid problems could be reflective of T3 levels – we do not know because they did not test.
And that is part of the problem – even somewhat useful studies like this do not take into account the totality of the most basic thyroid labs.
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