Does Standard Low Thyroid Treatment Actually Lead to Bone Loss?

December 18, 2024 TruthUSA

A recent investigation indicating that Levothyroxine may heighten the chance of bone loss has sparked debate among experts.

A recent study conducted by the Johns Hopkins University (JHU) School of Medicine has associated one of the most frequently prescribed medications for older adults—levothyroxine, used for treating low thyroid levels—with an increased risk of bone loss. Hypothyroidism, characterized by insufficient hormone production by the thyroid gland, occurs when the thyroid is underactive.

Nonetheless, Dr. Jacob Teitelbaum, a board-certified internist and a recognized expert in chronic fatigue syndrome, contests these findings, informing The Epoch Times via email that the results constitute misinformation that could endanger lives.

He emphasized that individuals who have undergone thyroid gland removal due to cancer or other reasons must rely on prescription thyroid hormone for life. Conversely, he mentioned that natural methods to enhance thyroid hormone levels are reasonable for many individuals.

Are the Findings Misleading?

Results from the study linking levothyroxine to bone loss were concerning, considering that approximately 7 percent of Americans take it daily, according to a press release. Teitelbaum asserts there is no reason to panic, as he categorically disputes the study’s conclusions.

“The reporting I’ve seen in the brief summary is, I suspect, dangerously misleading for both doctors and the public,” he stated. He fears that the study may lead to inadequate treatment for those who genuinely need it.

Dr. Shadpour Demehri, a professor of radiology at Johns Hopkins, acknowledged to The Epoch Times via email that misinterpretation of the findings could indeed occur.

“I completely concur with the possible risk of misinterpretation of our presentation among the general population, especially for patients who evidently require thyroid hormone replacement, such as those with clear hypothyroidism or prior thyroid gland removal,” Demehri noted.

According to Demehri, the study’s findings are based on observational data, indicating an association rather than establishing causation. He clarified that the data were solely related to older adults, noting that aging increases the likelihood of subclinical hypothyroidism, and untreated subclinical hypothyroidism often resolves spontaneously in older individuals. Due to these dynamics, he suggested that rigorous thyroid screening among this demographic, particularly those experiencing weakness and fatigue, could lead to unnecessary treatment.

Is the Reasoning Flawed?

“The JHU study summary asserts that tracking individuals on thyroid hormones correlates with greater risk of bone density loss,” explained Teitelbaum. “This is, in fact, anticipated, as the primary cause of low thyroid function, an autoimmune disorder known as Hashimoto’s disease, is linked to bone loss independent of thyroid treatment.” He references a study featured in Reviews in Endocrine & Metabolic Disorder to substantiate his claims.

To illustrate what he perceives as erroneous reasoning, Teitelbaum provides this analogy: Individuals with hypertension are more prone to heart attacks. If researchers observe that patients on blood pressure medications experience a higher incidence of heart attacks, concluding that the medications are the cause would be a misinterpretation, disregarding the impact of hypertension itself. Similarly, he contends that since the JHU study overlooked the fact that the underlying cause of hypothyroidism can also cause bone loss, its findings are largely inconsequential.

Demehri commented on Teitelbaum’s analogy regarding blood pressure and heart attacks, noting the potential confounding variables that can complicate the interpretation of observational data. Confounding variables in research refer to factors distinct from the outcomes being studied that could influence the results.

“His assertion is generally valid, and that is why we accounted for these variables in our findings,” he stated. “However, the observational nature of our study does not eliminate the possibility that unknown confounding variables might affect the outcomes.”

He concluded that this uncertainty is why the researchers could not ascertain causality and why additional investigation is necessary.

Does Dosage Matter?

Moreover, Teitelbaum emphasized that the variations in dosage were not considered in the study. He questioned whether standard dosages of thyroid hormone significantly contribute to bone density loss.

“The study confirms a long-held belief that I have discussed for years,” he stated. “Maintaining free thyroxine levels in the upper 15 percent of the normal range, which is excessive for most individuals, can lead to bone density loss. Conversely, preserving levels within the normal range but beneath the upper 15 percent does not. Consequently, the study’s conclusions are vastly misleading.”

Datis Kharrazian, a clinical research scientist and recognized functional medicine healthcare provider, concurred that dosage is a crucial factor in determining whether levothyroxine contributes to bone loss.

“When levothyroxine is appropriately dosed to maintain thyroid-stimulating hormone (TSH) within the reference range, the chances of adverse effects, including bone density loss, are minimized,” he noted in an email to The Epoch Times.

He added that excessive levothyroxine treatment has been linked to diminished bone density, particularly among postmenopausal women who may also lack essential sex hormones required for maintaining bone health.

“The JHU study also highlighted the importance of addressing the underlying issue, Hashimoto’s disease. This can alleviate the need for increasing doses due to ongoing thyroid tissue loss from autoimmune activity,” Kharrazian elaborated.

Who Requires Levothyroxine?

Maintaining normal thyroid hormone levels is vital, as they influence nearly every organ in the body, according to the National Institute of Health (NIH). Hypothyroidism can slow bodily functions, and critically low thyroid levels can lead to severe and potentially life-threatening complications if left untreated.

Teitelbaum asserts that individuals who have had their thyroid glands removed or possess critically low thyroid levels for various reasons should take levothyroxine or another form of prescription-strength thyroid hormone.

What about those with suboptimal, but not critically low levels? Teitelbaum believes that many fall into this category and maintaining a natural approach may be appropriate for them if desired. Those exploring natural alternatives should remain under medical supervision to ensure a thyroid hormone prescription if those methods do not yield results in a reasonable timeframe.

Challenges in Diagnosis

Teitelbaum contends that many individuals in need of the medication may not receive it due to unclear diagnostic criteria.

“There exists significant debate over who truly requires thyroid treatment,” he noted. “For many physicians, the criterion is an elevated TSH level. However, TSH testing is often very unreliable, and what constitutes ‘abnormal’ levels may not be accurate.”

He elaborated that these and other factors may prevent those suffering from hypothyroidism from obtaining a diagnosis or treatment, even if they display significant symptoms.

“To many endocrinologists, thyroid treatment in these cases is deemed unnecessary, even if it could transform a person’s life from being bedridden and in pain to fully functional,” he shared. “When treatment is warranted, it’s essential for doctors to prescribe the minimum effective dose while keeping thyroid levels safely in the mid-range.”

Conversely, Teitelbaum highlighted that some older adults might remain on levothyroxine for extended periods longer than necessary, as healthcare providers do not stop the medication when it is no longer essential.

“Many seniors take numerous medications, many of which may no longer be necessary. Due to Medicare’s limitations on compensating for time spent assessing the need to maintain a medication, along with the legal risks associated with discontinuing prescriptions, many unsuitable medications simply remain in use,” he noted.

Possible Alternatives

As noted by the NIH, consuming iodine supplements or foods rich in iodine can occasionally exacerbate hypothyroidism in individuals with Hashimoto’s disease. In contrast, insufficient iodine intake is more likely to contribute to or worsen hypothyroidism, Teitelbaum advised, suggesting individuals consult a holistic doctor to determine if they should avoid or increase iodine consumption.

Moreover, various natural strategies might help enhance thyroid function.

“Addressing hypothyroidism through natural approaches requires a comprehensive strategy tailored to support the body’s innate healing capabilities,” stated Jamie Bacharach, an acupuncture diplomate at Acupuncture Jerusalem, in an email to The Epoch Times. These methods can include:

Nutrition: Selenium plays a role in thyroid hormone metabolism, so including selenium-rich foods like Brazil nuts can be beneficial. For individuals with Hashimoto’s disease, adhering to a gluten-free diet may help reduce inflammation and enhance thyroid health.
Supplements: Regularly checking for deficiencies in vitamin D and B12 is essential, as supplementation may be necessary to support thyroid health.
Lifestyle Changes: Stress management is vital since chronic stress can hinder thyroid function. Engaging in moderate exercise can improve thyroid health by enhancing circulation and metabolic processes, while adequate sleep is crucial for hormonal equilibrium and overall wellness.
Gut Health: The emerging concept of the gut-thyroid connection suggests that improving gut health may positively influence thyroid function. Incorporating probiotics and a fiber-rich diet is recommended.

“While these strategies can assist in symptom management, they should not replace medications without consulting a healthcare provider,” emphasized Bacharach. “Ongoing monitoring of thyroid hormone levels and cooperation with the healthcare team will ensure a safe and effective treatment plan.”

Underlying Causes of Low Thyroid Function

The NIH identifies several causes of hypothyroidism:

Hashimoto’s Disease

Hashimoto’s is an autoimmune disorder in which the immune system attacks the thyroid gland, leading to inflammation and a reduced ability to generate thyroid hormones.

Thyroiditis

Thyroiditis refers to inflammation of the thyroid gland, which may cause thyroid hormones stored within the gland to leak into the bloodstream. This can initially result in high thyroid hormone levels (thyrotoxicosis), but prolonged inflammation can lead to permanent hypothyroidism.

Surgical Removal

A partial thyroidectomy can occasionally lead to hypothyroidism, while complete removal of the gland ensures the condition will develop. Surgeons may recommend removal for various issues, including hyperthyroidism or the presence of thyroid nodules, regardless of whether they are benign or malignant.

Congenital Conditions

Some infants may be born with underdeveloped or non-functioning thyroid glands, resulting in hypothyroidism. Without treatment, this condition can lead to cognitive disabilities, though early intervention can prevent this outcome.

Medication Effects

Certain medications can suppress the production of thyroid hormones, including those prescribed for bipolar disorder and cardiovascular conditions. In addition, some cancer treatments may adversely affect the thyroid directly or harm the pituitary gland, affecting thyroid function indirectly.

Radiation Therapy

Treatments for hyperthyroidism often employ radioactive iodine, which gradually destroys thyroid cells, leading to hypothyroidism. This outcome can also occur following radiation therapy for oncology conditions involving the head or neck.

Strategies for Reducing Bone Loss

Regardless of levothyroxine use or hypothyroidism status, engaging in healthful lifestyle habits can significantly enhance bone health.

For example, consistent physical activity can combat bone deterioration by boosting bone density and renewing old bone. Weight-bearing activities, such as brisk walking, impose stress on bones and enhance their function, while resistance training with weights strengthens both muscles and bones. Health professionals recommend a minimum of 150 minutes of moderate exercise weekly.

Another vital aspect is ensuring adequate vitamin D intake. While sunlight is a primary source, vitamin D can also be obtained through a well-balanced diet that includes fortified dairy products, vitamin D-enriched orange juice, and fatty fish like salmon.

Individuals with Hashimoto’s or other conditions linked to elevated bone loss risk may consider supplementing certain nutrients. Teitelbaum recommends magnesium, boron, and vitamins K and D, while noting that calcium plays a relatively minor role.

Final Thoughts

Both Teitelbaum and Kharrazian encourage individuals not to hesitate in taking levothyroxine if necessary.

Teitelbaum stresses that he does not wish for the JHU study to deter people from seeking treatment for hypothyroidism, affirming that the benefits significantly outweigh the potential risks of untreated conditions.

Although Kharrazian warns against excessively high doses of levothyroxine, he acknowledges that the study highlights valid concerns.

Still, he insists, “It is essential to balance the risks of bone density reduction with the dangers of untreated hypothyroidism, which may include cardiovascular issues, cognitive decline, and overall health deterioration.”

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