Table 3.

TSH suppressive therapy and bone health: practical indication.

• TSH suppressive therapy should be used only when indicated • Treatment should be individualized in order to use the lowest effective dose of LT4 • TSH suppressive therapy should be carefully monitored (yearly) by measurements of serum FT4 and TSH • In premenopausal women and men chronically treated with TSH suppressive therapy or planning to be treated for several years (more than 3-5), there is no need to assess/monitor bone health, unless other risk factors are present • In postmenopausal women already treated with TSH suppressive therapy or planning to be treated for several years (more than 3-5) bone health should be evaluated/monitored using BMD and/or TBS (preferably) • Antiresorptive therapy could be considered in patients at increased risk of fracture or showing with a significant decline of BMD/TBS during TSH suppressive therapy

BMD, bone mineral density; LT4, levothyroxine; TBS, trabecular bone score.