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Skeletal health in patients with differentiated thyroid carcinoma

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Abstract

Osteoporosis and fractures are important comorbidities in patients with differentiated thyroid cancer (DTC), with potential negative impact on quality of life and survival. The main determinant of skeletal fragility in DTC is the thyrotropin (TSH)-suppressive therapy, which is commonly recommended to prevent disease’s recurrence, especially in patients with structural incomplete response after thyroid surgery and radio-iodine therapy. TSH-suppressive therapy can stimulate bone resorption with consequent bone loss, deterioration of bone microstructure and high risk of fragility fractures. The skeletal effects of TSH-suppressive therapy may be amplified when thyroid cancer cells localize to the skeleton inducing alterations in bone remodelling, impairment of bone structure and further increase in risk of fractures. The management of skeletal fragility in DTC may be challenging, since prediction of fractures is a matter of uncertainty and data on effectiveness and safety of bone-active agents in this clinical setting are still scanty. This review deals with pathophysiological, clinical and therapeutic aspects of skeletal fragility of patients with DTC.

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Authors and Affiliations

  1. Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy

    M. Cellini, Andrea Lania & G. Mazziotti

  2. Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100, Pavia, Italy

    M. Rotondi & L. Chiovato

  3. Department of Internal Medicine and Therapeutics, University of Pavia, 27100, Pavia, Italy

    M. Rotondi & L. Chiovato

  4. Department of Medicine and Surgery, Endocrine Unit, University of Insubria, ASST Dei Sette Laghi, Viale Borri, 57, 21100, Varese, Italy

    M. L. Tanda & E. Piantanida

  5. University of Milan, Via Pietro Custodi 16, 20136, Milan, Italy

    P. Beck-Peccoz

  6. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20090, Milan, Italy

    Andrea Lania & G. Mazziotti

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Cellini, M., Rotondi, M., Tanda, M.L. et al. Skeletal health in patients with differentiated thyroid carcinoma. J Endocrinol Invest 44, 431–442 (2021). https://doi.org/10.1007/s40618-020-01359-6

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