促甲状腺素抑制对分化型甲状腺癌术后女性腰椎骨密度的影响

Effect of thyroid stimulating hormone suppression on lumbar spine bone mineral density in postoperative female patients with differentiated thyroid cancer

目的观察促甲状腺素抑制(thyroid-stimulating hormone suppression,TSHS)对分化型甲状腺癌(differential thyroid cancer,DTC)术后女性腰椎骨密度(bone mineral density,BMD)的影响。方法纳入225名2015~2016年期间DTC术后的绝经后妇女。将她们分为TSHS组[中位甲状腺素(TSH)<0. 3μIU/mL]和绝经后对照组[中位甲状腺素(TSH)>0. 3μIU/mL]。腰椎(L1-4)的BMD水平通过双能X射线吸收测定法(DXA)在基线和随访6、12和24个月检测。所有患者均补充钙和维生素D。骨量减少(-1 SD>T≥-2. 5 SD)和骨质疏松症(T<-2. 5 SD)的诊断根据WHO指南进行。结果 TSHS组有154名患者,未抑制的TSH组(绝经后对照组)有71名患者。在TSHS和未抑制TSH患者的治疗前后,基线和治疗前后6、12和24个月腰椎骨密度没有显著差异。与TSHS治疗前相比,2年随访时腰椎(L1~4)骨密度降低了1. 9%。TSHS组(103/152)和绝经后对照组(32/68)随访24个月时骨量减少和骨质疏松症患者数量发现有显著差异(χ2=2. 88,P=0. 004)。TSHS不是骨丢失的重大风险,但会增加DTC绝经后妇女骨量减少的发生率。结论 2年的随访数据表明,TSHS对绝经后DTC女性的BMD几乎没有影响。

Objective The aim of this study was to determine the effect of thyroid stimulating hormone suppression(TSHS) on lumbar spine bone mineral density(BMD) in female patients with differentiated thyroid cancer(DTC). Methods A total of 225 postmenopausal women postoperative of DTC between 2015 and 2017 were enrolled into this study and followed up for 2 years. They were divided into two groups: TSHS group [median thyroid-stimulating hormone(TSH) < 0. 3 μIU/mL]and postmenopausal control group(median TSH >0. 3 μIU/mL). Lumbar spine 1-4 BMD levels were measured by a dual-energy X-ray absorptiometry(DXA) at baseline and 6,12 and 24 months. All patients had calcium and vitamin D supplementation. The diagnosis of osteopenia(-1 SD>Tscore≥-2. 5 SD) and osteoporosis(T-score<-2. 5 SD) was made according to WHO guidelines. Results One hundred and fifty-four patients were in the TSHS group,and 71 patients were in the non-suppressed TSH group(postmenopausal controls). No significant differences were found in the BMD of the lumbar spine between baseline and after 6,12 and 24 months,pre and post treatment in TSHS and non-suppressed TSH patients. Compared with pre-TSHS,there was a reduction in the BMD of 1. 9% at the lumbar spine at the 2-year follow-up. Significant difference in the number of osteopenia and osteoporosis patients at 24 months(χ~2= 2. 88,P = 0. 004)was found between the TSHS(103/152) and postmenopausal control(32/68) groups. TSHS was not a significant risk of bone loss,but it could increase the incidence of osteopenia in postmenopausal women with DTC. Conclusion Our 2-year follow-up data indicated that TSHS had little effect on BMD in postmenopausal women with DTC.