# Hypothyroidism and Mandibular Cortical Alterations Evaluated on Panoramic Radiography: A Cross-Sectional Study in Women

## TL;DR

This study found no significant differences in jawbone cortical markers between women with hypothyroidism and healthy controls after adjusting for age.

## Contribution

The study is the first from Spain to investigate mandibular cortical changes in hypothyroid women using panoramic radiography, integrating endocrinological and dental perspectives.

## Key findings

- Mandibular cortical indices (MCI, PMI, MCW) did not significantly differ between hypothyroid and euthyroid women after age adjustment.
- A crude difference in left MCW in hypothyroid women was not significant after adjusting for age.
- The study suggests panoramic indices have limited value in detecting jawbone changes in treated hypothyroid patients.

## Abstract

What are the main findings?
In adult women treated for primary hypothyroidism, panoramic mandibular cortical markers (MCI, PMI, and MCW) did not significantly differ from those in euthyroid controls after adjusting for age. While the left MCW initially appeared higher, this difference was found to be statistically insignificant after age adjustment, and no relevant differences were observed in the right MCW.This study found no significant differences in mandibular cortical indices (MCI, PMI, MCW) between women treated for primary hypothyroidism and euthyroid controls after age adjustment. Beyond the specific findings, the value of this work lies in its integration of endocrinological and maxillofacial perspectives, demonstrating how systemic endocrine conditions may have radiographic correlates in dental imaging.

In adult women treated for primary hypothyroidism, panoramic mandibular cortical markers (MCI, PMI, and MCW) did not significantly differ from those in euthyroid controls after adjusting for age. While the left MCW initially appeared higher, this difference was found to be statistically insignificant after age adjustment, and no relevant differences were observed in the right MCW.

This study found no significant differences in mandibular cortical indices (MCI, PMI, MCW) between women treated for primary hypothyroidism and euthyroid controls after age adjustment. Beyond the specific findings, the value of this work lies in its integration of endocrinological and maxillofacial perspectives, demonstrating how systemic endocrine conditions may have radiographic correlates in dental imaging.

What is the implication of the main finding?
These findings suggest that routinely derived panoramic indices (MCI, PMI, MCW) have limited discriminatory value for detecting mandibular cortical alterations in women treated for primary hypothyroidism. Future studies should incorporate longitudinal, multicentre designs with rigorously controlled confounders (such as age, menopausal status, BMD, and LT4 treatment parameters) to clarify potential subtle effects and assess their clinical relevance.While panoramic indices appear to have limited utility in detecting mandibular cortical alterations in treated hypothyroid patients, the interdisciplinary approach of this study reinforces the potential of dental radiographs as a window into systemic health. Highlighting this intersection strengthens the clinical relevance of the findings and supports broader collaboration between medical and dental specialties.

These findings suggest that routinely derived panoramic indices (MCI, PMI, MCW) have limited discriminatory value for detecting mandibular cortical alterations in women treated for primary hypothyroidism. Future studies should incorporate longitudinal, multicentre designs with rigorously controlled confounders (such as age, menopausal status, BMD, and LT4 treatment parameters) to clarify potential subtle effects and assess their clinical relevance.

While panoramic indices appear to have limited utility in detecting mandibular cortical alterations in treated hypothyroid patients, the interdisciplinary approach of this study reinforces the potential of dental radiographs as a window into systemic health. Highlighting this intersection strengthens the clinical relevance of the findings and supports broader collaboration between medical and dental specialties.

Background/Objectives: Thyroid hormone deficiency may impair bone metabolism, but its mandibular impact remains uncertain. We aimed to compare the prevalence of altered Mandibular Cortical Index (MCI; C2–C3) and Panoramic Mandibular Index (PMI) on digital panoramic radiographs in adult women with primary hypothyroidism versus euthyroid controls, considering age and key clinical covariates. To our knowledge, this is the first study out of Spain addressing this question. Methods: This is a cross-sectional study (September 2021–June 2024) of 179 white women recruited at a university clinic. Cases were on L-thyroxine for ≥6 months, with TSH > 4.5 mIU/L and normal FT4; controls were euthyroid and untreated. Demographics, reproductive history, and BMI were recorded. Panoramic radiographs (Ratograph EVO 3D; 72 kV, 6 mA, 14.4 s) were analysed; MCI was graded (Klemetti C1–C3) distal to the mental foramen; PMI and mandibular cortical width (MCW) were measured bilaterally. Results: Women with hypothyroidism showed higher BMI and a greater number of years since menopause; age was slightly higher, but the difference was not significant. MCI distribution did not differ between groups (C3 and C2–C3, both p > 0.45). PMI (left/right) was similar (p = 0.253/0.160). Left MCW was higher in hypothyroidism in a crude analysis (4.86 ± 0.98 vs. 4.46 ± 0.94 mm; p = 0.039), but lost significance after age adjustment (adjusted p = 0.191); right MCW showed no differences. Total tooth loss tended to be higher (p = 0.055) without conclusive evidence. Conclusions: In this cohort, primary hypothyroidism was not associated with a differential mandibular cortical pattern by MCI or PMI; the crude MCW difference was explained by age. These Spain-based data refine heterogeneous prior findings and indicate that, in women treated for hypothyroidism, mandibular cortical metrics largely resemble those of their euthyroid peers. Longitudinal and multicentre studies are warranted to clarify trajectories and enhance generalisability.