Endocrine Abstracts

Objectives: Primary - Study of Correlation between Serum Osteoprotegerin, and Biomarkers of Bone Metabolism in Patients with treatment-naive Graves’ Disease (GD). Secondary- Serum level of Osteoprotegerin, TNF alfa and Biomarkers of Bone Metabolism in Patients 3 months after treatment of GD with methimazole (MMI).

Material and Methods: A total of thirty-five treatment-naive newly diagnosed GD were recruited for the study, most of them were female. All patients were started with MMI for the treatment and various blood parameters were measured at baseline and after 3months of treatment.

Measurements: Serum calcium, phosphorus, and bone-specific alkaline phosphatase (B-ALP), OPG (osteoprotegerin), TNF-alpha and urine deoxypyridinoline (Udpd) along with serum-free T3 and T4, TSH and TR-ab were analysed at baseline and three months after MMI treatment. All the patients were euthyroid at 3months of MMI treatment.

Results: Mean Serum OPG (0.94±1.39 v 0.63±.27ng/ml; P=0.262)level at base line and after treatment with MMI did not show any significant change. Mean TSH level (0.207 0.59 vs 1.00 1.95, P=0.025) was significanly low at base line than after treatment;FT4 (5.9±5.22 v 1.77±1.89 ng/dl;P<0.001), FT3 (12.19±6.91 v 4.99±3.55pg/ml;P<0.001), and TNG -alfa values decreased significanly after treatment, however PTH (58.09±28.75 v 75.57±41.50;P<0.026) increased significantly after treatment. There is no correlation of OPG with thyroid hormone profile, TSH, thyroid receptor antibody (TR-ab) and bone metabolic parameters such as serum calcium, phosphorus, and bone-specific alkaline phosphatase (B-ALP), TNF-alpha and urine deoxypyridinoline (Udpd) in our study. Mean TNF-alfa decreased significantly (393.43±270.473 v 139.34±101.264pg/ml; P=0.001)level after treatment with MMI. TNF-alfa was positively correlated with TR-ab (r= 0.374; P=0.027)and B-ALP (r= 0.388;p0.021).

Discussion: The bone turnover marker in GD seems to be mediated other than OPG. We observed increased circulating TNF-alfa in GD with a significant decrease after treatment. TNF-alfa could be a marker of GD activity as evidenced by a close positive correlation with TR-ab a sensitive marker of GD autoimmunity. TNF-alfa could be the factor associated with the bone turnover marker in GD despite the euthyroid state.