甲亢的骨质与矿物质代谢变化 附100例观察与文献复习

Bony and Mineral Metabolic Changes in Hyperthyroidism,Observation of 100 Cases

甲状腺机能亢进(简称甲亢)是比较常见的一种内分泌疾病,除表现有典型的高能代谢率症候群、甲状腺肿及/或突眼外,一些长期患者还会合并骨质疏松等变化与矿物质代谢紊乱,且与甲状腺的功能及活性维生素D代谢产物有关。

Changes in skeletal density and mineral metabolism of 100 patients including 27 men and 73 women with hyperthyroidism had been studied during 1978-1982. The average age was 38.9 years. The average course of the disease was 4.2 years. On account of their severe symptoms, 85% patients need anti-thyroid treatment with tapazole or carbimazole which could not be discontinued for observation.According to the skeletal density of left ulna or/and lateral view of lumbar vertebrae, these patients were divided into four groups, they are: (1) Roentgenograms revealed obvious osteoporosis in 27 patients, (2)Osteopetrosis in 16 patients, (3) osteoporosis associa ted with osteopetrosis in 3 patients, and (4) normal bone density in 54 patients.These data showed that osteoporosis (27%), hypercalciuria (P<0.05), hypermagneseuria (P<0.05), hypomagnesemia (P<0.05), and increased AKP (P<0.05) were frequent complications of hyperthyroidism. Although changes in blood calcium and phosphate were not statiscally significant, yet some patients frequently showed hypercalcemia(7.45%), hypocalcemia (10.64%), hypophosphatemia(4.3%), hyperphosphatemia(29.07%), increased both of urinary HOP (38.1%) and cAMP (50.0%). Thyroid functions (T3, T4, TSH, PBI, CHO. etc.) of all patients supported the diagnosis of hyperthyroidism.According to these findings, we conclude that the reduction of skeletal density and disturbed mineral metabolism may occur in hyperthyroidism. Hypercalciuria and hypermagneseuria were common in hyperthyroidism during the conventional antithyroid therapy, These data are in accord with the findings of many authors such as Adams, Bergdahl, Mosekilde, Hunstein, Mundy, Manicourt and others.On the other hand, osteoporosis may be caused by renal leak of calcium, abnormal absorption of intestinal calcium, or direct stimulation of bone resorption by thyroid hormones, especially tri-iodothyronine. Changes of PTH, 1,25-(OH)D, cAMP and HOP may also be attributed to hyperthyroidism.We suggest that calcium and vitamin D therapy is necessary for relieving bone pain in osteoporosis of hyperthyroidism. Adequate antithyroid drugs is helpful in osteoporosis of hyperthyroidism. Follow up studies should be carried out until the condition of the patients was completely recovered.