抑制剂量的甲状腺激素对40例分化型甲状腺癌患者骨生化和骨密度的影响

Effect of thyroid stimulating hormone with inhibiting dose on bone biochemical and bone mineral density in 40 cases of postoperative patients with differentiated thyroid carcinoma

目的探究不同剂量促甲状腺激素(TSH)对分化型甲状腺癌术后患者骨生化和骨密度的影响。方法选取上海市普陀区利群医院2013年1月-2015年1月收治的分化型甲状腺癌术后患者80例,随机分为对照(常规剂量)组和治疗(抑制剂量)组各40例,所有患者术后1个月行131I清除残余甲状腺组织,随后给予对照组左旋甲状腺素钠片2.0μg/kg口服,治疗组2.5μg/kg。另取同期参加体检的健康志愿者40例为正常对照组。治疗1年后比较3组甲状腺功能、骨生化和骨密度情况。结果治疗后,正常对照组的游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)和TSH差异均无统计学意义;治疗组FT3和FT4高于对照组,TSH低于对照组,差异均有统计学意义(P<0.05)。3组血清中钙、磷和碱性磷酸酶(ALP)含量差异均无统计学意义。3组L2-4椎体、Ward三角、股骨大转子和股骨干4个部位的骨密度(BMD)差异均无统计学意义。结论分化型甲状腺癌术后给予常规剂量左旋甲状腺素可维持正常生理需求,而抑制剂量可将甲状腺功能维持在亚临床甲亢状态。不同剂量左旋甲状腺素对骨代谢和BMD的影响较小。

Objective To explore the different doses of levothyroxine on bone biochemical indexes and bone mineral density in postoperative patients with differentiated thyroid carcinoma. Methods Totally 80 cases of postoperative patients with differentiated thyroid carcinoma treated in Putuo District Liqun Hospital in Shanghai from January 2013 to January 2015 were selected. They were randomly divided into control group（conventional dose, n=40） and treatment group（inhibitory dose, n=40）. 131 I clearance of residual thyroid tissue was performed in all patients after 1 month of operation. The patients in control group were given levothyroxine sodium 2.0 μg/kg and the patients in treatment group were given 2.5 μg/kg. Other 40 healthy patients were the same as normal control group. The thyroid function, biochemical indexes, and bone mineral density were compared among three groups after one year. Results There were no significant differences in FT3, FT4, and TSH between normal control groups and that of after treatment. The FT3 and FT4 of treatment group were higher than those of control group（P 0.05）, and the TSH of treatment group was lower than that of control group（P 0.05）. There were no significant differences in biochemical indexes and bone mineral density among three groups. Conclusion The effect of dose of levothyroxine is tiny on biochemical indexes and bone mineral density in postoperative patients with differentiated thyroid carcinoma, conventional dose of it can maintain normal physiological needs, while its inhibitory dose can maintain thyroid function in subclinical hyperthyroidism.