青中年男性甲状腺功能亢进症患者治疗前后性激素和性激素结合球蛋白的变化

Changes of sex hormones and sex hormone-binding globulin levels in male adults with hyperthyroidism before and after antithyroid drug treatment

目的观察男性甲状腺功能亢进症(甲亢)患者应用抗甲状腺药物治疗前后性激素和性激素结合球蛋白(SHBG)水平的变化趋势。方法2015年1月至2016年7月在北京协和医院内分泌科门诊招募男性甲亢患者40例,年龄19~52岁冲位年龄33.1岁。在治疗前和治疗后1、2、3和5个月时采血测定甲状腺功能、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮、游离睾酮、雌二醇、催乳素、SHBG水平。结果共入组40例,完成随访者35例,治疗前患者甲功、SHBG和性激素水平偏高。治疗前游离甲状腺素(FT4)(0.30±0.12)prnol/L,游离三碘甲状腺原氨酸(FT3)(9.68±4.73)pmol/L,SHBG(146±111)nmol/L,LH(8.41±3.61)U/L,雌二醇(19.9±7.7)pmol/L,睾酮(29.9±9.5)nmol/L,游离睾酮(0.24±0.08)nmol/Lo治疗后甲状腺素、三碘甲状腺原氨酸、FT4,FT3均逐渐下降至正常(均P><0.001),促甲状腺激素(TSH)逐渐升高至正常(P<0.001),LH和雌二醇水平逐渐下降(均P<0.001),FSH有下降趋势但差异无统计学意义,催乳素无明显变化(均P>0.05),睾酮.SHBG水平明显下降(均P<0.001),游离睾酮、游离睾酮百分比(FT%),生物活性睾酮(BAT)、生物活性睾酮百分比(BAT%)、游离雄激素指数(FAI)水平上升并趋于平稳(均P<0.001)。睾酮几H和雌二醇/LH治疗前后差异均无统计学意义(均P>0.05),游离睾酮/LH逐渐上升,差异有统计学意义(P<0.001)。结论男性甲亢患者LH、雌二醇、睾酮和SHBG水平明显升高,游离睾酮水平降低,抗甲状腺药物治疗后逐渐恢复正常。

Objective To observe the changes of sex hormone and sex hormone-binding globulin (SHBG) levels in young male patients with hyperthyroidism before and after antithyroid drug (ATD) treatment. Methods Between January 2015 and July 2016, forty male patients with hyperthyroidism aged 19-52 years (with an median age of 33.1 years) were enrolled in the Department of Endocrinology of Peking Union Medical College Hospital. Blood samples were taken before treatment and at 1 month, 2 months, 3 months and 5 months after treatment to evaluate thyroid function, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone(T), free testosterone(FT), estradiol(E2), prolactin and SHBG. Results A total of 40 patients were enrolled but only 35 patients completed the follow-up. The patients had high levels of thyroid function, SHBG and sex hormones before treatment. Before treatment, free thyroxine (FT4), free triiodothyronine (FT3), SHBG, LH, estradiol, testosterone and free testosterone was (0.30 ±0.12) pmol / L,(9.68±4.73) pmol/L,(146±111) nmol/L,(8.41±3.61) U/L,(19.9±7.7) pmol/L,(29.9±9.5) nmol/L and (0.24± 0.08) nmol/L, respectively. After treatment, the level of triiodothyronine, thyroxine, FT3 and FT4 gradually decreased to normal (all PvO.001). Thyroid stimulating hormone (TSH) gradually increased to normal (P< 0.001). LH and estradiol levels gradually decreased (all PvO.001). FSH decreased but the difference was not statistically significant. Prolactin did not change significantly. Testosterone and SHBG levels decreased significantly while the levels of free testosterone, free testosterone percentage (FT%), bio-available testosterone (BAT), bio-available testosterone percentage (BAT%), free androgen index (FAI) gradually increased and stabilized (all PvO.001). The difference was not statistically significant between T/LH and E2/ LH before and after treatment (all P>0.05). However FT / LH gradually increased and its difference was statistically significant (PvO.001). Conclusion The levels of LH, estradiol, testosterone and SHBG in male patients with hyperthyroidism significantly in creased, while the free testosterone level decreased, but they all gradually returned to normal with the lowering of thyroid hormone levels during ATD treatment.