促甲状腺激素抑制对分化型甲状腺癌术后患者甲状腺功能及骨密度指标的影响

Effect of thyrotropin inhibition on postoperative thyroid function and bone mineral density in patients with differentiated thyroid carcinoma

目的探讨分化型甲状腺癌患者术后采用促甲状腺激素(TSH)抑制治疗对甲状腺功能与骨密度指标的影响。方法选取2017年1月至2018年4月间上海市松江区中心医院收治的96例分化型甲状腺癌术后患者。其中,采用左旋甲状腺素钠片抑制剂量治疗的48例患者纳入观察组,采用左旋甲状腺素钠片常规剂量治疗的48例患者纳入对照组。观察两组患者治疗前与治疗1年后的甲状腺功能与骨密度指标变化。结果治疗前,两组患者甲状腺功能比较,差异无统计学意义(P>0.05)。治疗后,两组患者的甲状腺功能均优于治疗前,且观察组患者的甲状腺功能优于对照组患者,差异均有统计学意义(均P<0.05)。治疗前,两组患者钙、磷和碱性磷酸酶(ALP)比较,差异无统计学意义(P>0.05)。治疗后,两组患者的钙、磷和ALP均优于治疗前,且观察组患者的钙、磷和ALP均优于对照组患者,差异均有统计学意义(均P<0.05)。治疗前,两组患者的L2-4椎体、Ward三角、股骨大转子和股骨干等骨密度指标比较,差异无统计学意义(P>0.05)。治疗后,观察组患者L2-4椎体、Ward三角和股骨大转子骨密度优于治疗前,差异均有统计学意义(均P<0.05);对照组患者L2-4椎体、Ward三角、股骨大转子和股骨干处骨密度均优于治疗前,差异均有统计学意义(均P<0.05)。治疗后,两组患者骨密度组间比较,差异无统计学意义(P>0.05)。结论分化型甲状腺癌患者术后给予常规剂量左旋甲状腺素,可帮助患者维持正常生理甲状腺功能,抑制剂量可让患者甲状腺功能保持甲亢状态,两类剂量都可对患者骨生化与骨密度造成影响。

Objective To study the effect of thyroid stimulating hormone(TSH)on postoperative thyroid function and bone mineral density in patients with differentiated thyroid carcinoma.Methods From January 2017 to April 2018,96 patients with differentiated thyroid carcinoma who admitted to Shanghai Songjiang District Central Hospital were selected and were randomly divided into an observation group and a control group with 48 patients in each group.The observation group was given levothyroxine in TSH suppression doses and the control group was given levothyroxine in routine doses.The changes in thyroid function and bone mineral density were observed before and 1 year after the treatment.Results There was no significant difference in thyroid function between groups before the treatment(P>0.05).After the treatment,thyroid function was improved in both groups with the observation group better than the control group.There was no significant difference in calcium,phosphorus and alkaline phosphatase(ALP)between the two groups before the treatment(P>0.05).After the treatment,calcium,phosphorus and ALP were improved in both groups with the levels calcium,phosphorus and ALP better in the observation group than in the control group(all P<0.05).There was no statistically significant difference in bone mineral density measured at lumbar vertebrae 2-4,Ward’s triangle,the femoral trochanter and femoral shaft between the two groups before the treatment(P>0.05).After the treatment,bone mineral density measured at lumbar vertebrae 2-4,Ward’s triangle,the femoral trochanter and femoral shaft were better in the two groups compared with before the treatment(all P<0.05);however,there was no significant difference in bone mineral density between the two groups(P>0.05).Conclusion Routine dose of levothyroxine can help to maintain normal physiological thyroid function after operation,and levothyroxine in TSH suppression doses can help to maintain thyroid hormone levels.Both doses have an effect on bone biochemistry and bone mineral density.