Kim Duk Jae, Khang Young Ho, Koh Jung-Min, Shong Young Kee, Kim Ghi Su
Division of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Korea.
Clin Endocrinol (Oxf). 2006 Jan;64(1):86-90. doi: 10.1111/j.1365-2265.2005.02422.x.
Hyperthyroidism is accompanied by low bone mass. Because the reference range of TSH levels is defined statistically, some individuals with low normal TSH levels may have mild hyperthyroidism and reduced bone mass. We therefore determined whether serum TSH levels correlate with bone mineral density (BMD).
A cross-sectional hospital-based survey. Participants Nine hundred and fifty-nine healthy postmenopausal women.
We measured BMD at the lumbar spine and femoral neck using dual energy X-ray absorptiometry, and serum TSH concentrations using immunoluminometry.
BMD at the lumbar spine and femoral neck increased with TSH level (P for trend < 0.001 at both sites). Even after adjustment for age, years since menopause and body mass index, subjects with low normal TSH levels (0.5-1.1 mU/l) had significantly lower BMDs at the lumbar spine (0.863 +/- 0.009 g/cm2 vs 0.900 +/- 0.009 g/cm2, P = 0.004) and femoral neck (0.660 +/- 0.006 g/cm2 vs 0.683 +/- 0.006 g/cm2, P = 0.006) than those with high normal TSH levels (2.8-5.0 mU/l), as well as a 2.2-fold increased risk of osteoporosis (95% confidence interval: 1.2-4.0).
These results suggest that low normal TSH levels may not be physiological for postmenopausal women and, during treatment of hypothyroidism, may not be adequate for avoiding osteoporosis.
甲状腺功能亢进症伴有低骨量。由于促甲状腺激素（TSH）水平的参考范围是通过统计学定义的，一些TSH水平处于正常低值的个体可能存在轻度甲状腺功能亢进症且骨量减少。因此，我们确定血清TSH水平是否与骨矿物质密度（BMD）相关。
基于医院的横断面调查。参与者959名健康的绝经后妇女。
我们使用双能X线吸收法测量腰椎和股骨颈的骨密度，并使用免疫发光法测量血清TSH浓度。
腰椎和股骨颈的骨密度随TSH水平升高而增加（两个部位的趋势P均<0.001）。即使在调整年龄、绝经年限和体重指数后，TSH水平处于正常低值（0.5 - 1.1 mU/l）的受试者在腰椎（0.863±0.009 g/cm² 对 0.900±0.009 g/cm²，P = 0.004）和股骨颈（0.660±0.006 g/cm² 对 0.683±0.006 g/cm²，P = 0.006）的骨密度仍显著低于TSH水平处于正常高值（2.8 - 5.0 mU/l）的受试者，骨质疏松风险增加2.2倍（95%置信区间：1.2 - 4.0）。
这些结果表明，TSH水平正常低值对绝经后妇女可能并非生理状态，并且在甲状腺功能减退症治疗期间，可能不足以避免骨质疏松。
