甲状腺功能亢进症合并骨软化1例并文献复习

Hyperthyroidism complicated with osteomalacia: A report of one case and literature review

甲状腺功能亢进(简称甲亢)是导致碱性磷酸酶升高的原因之一,在甲亢的治疗过程中,如碱性磷酸酶进行性升高,伴骨痛,不能排除骨软化的可能性,值得引起注意。随着对代谢病骨病研究的深入,骨软化患者逐渐增多,病因包括维生素D摄入不足、维生素D吸收和代谢障碍、肾脏疾病(肾病综合征、慢性肾衰、肾小管酸中毒、范可尼综合征等),以及遗传性和肿瘤性低磷性骨软化,其他如重金属中毒、高氟摄入、某些药物等。然而,甲状腺功能亢进症患者出现骨质疏松多见,出现骨软化者较少见,罕有报道,容易漏诊和误诊。本文报道l例甲状腺功能亢进患者口服赛治(甲巯咪唑)后碱性磷酸酶进行性升高,伴全身骨痛,应用骨化三醇后碱性磷酸酶逐渐下降和骨痛消失。为此,甲亢治疗期间,结合国外文献报告,考虑骨软化可能性较大,密切观察患者碱性磷酸酶变化,给予积极对症治疗后,骨软化症状明显缓解。因此,应重视碱性磷酸酶的变化及临床特点,以明确是否合并骨软化并予尽早处理。

Hyperthyroidism is one of the causes for elevated alkaline phosphatase. In the treatment of hyperthyroidism,if it appears that the progressive rise of alkaline phosphatase is accompanied by bone pain,we cannot rule out the possibility of osteomalacia,which deserves attention. With the further study of metabolic bone disease,patients with osteomalacia gradually increase,and the causes include deficiency of vitamin D,vitamin D absorption and metabolic disorders,kidney disease( nephrotic syndrome,chronic renal failure,renal tubular acidosis,fanconi syndrome,etc.),as well as hereditary and tumorous low phosphorus osteomalacia,and other causes including heavy metal poisoning,high fluoride intake,certain drugs and so on. However,osteoporosis is more common in patients with hyperthyroidism,and it is rare to for hyperthyroidism patients to have osteomalacia. As it is rarely reported,it is easy to miss diagnosis and misdiagnosis. We report a case of hyperthyroidism with progressive elevation of alkaline phosphatase( ALP) and systemic bone pain after oral administration of methimazole,and alkaline phosphatase decreased and bone pain disappeared after oral administration of calcitriol. Therefore,during the treatment of hyperthyroidism,combined with foreign literature reports,we considered the possibility of osteomalacia,and closely observed the changes of alkaline phosphatase in the patients. After active symptomatic treatment,the symptoms of osteomalacia were significantly alleviated. So we should pay attention to the changes of alkaline phosphatase and its clinical characteristics,so as to make sure whether there is osteomalacia and to treat it as soon as possible.