Al-Shoumer Kamal A S, Vasanthy Bagavathy A, Al-Zaid Mona M
Division of Endocrinology & Metabolic Medicine, Mubarak Al-Kabeer Hospital, Jabriya, and the Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Endocr Pract. 2006 Mar-Apr;12(2):121-30. doi: 10.4158/EP.12.2.121.
To study glucose and bone metabolism in hyperthyroidism, assess their changes after treatment, and investigate their interrelationships.
Thirty patients with hyperthyroidism matched with 32 normal control subjects were studied. After a 10- to 12-hour overnight fast, blood samples were collected for measurement of glucose, insulin, C-peptide, and intact proinsulin levels as well as for measurement of bone markers: serum alkaline phosphatase (ALP), osteocalcin, and procollagen type I C-terminal peptide (PICP) as markers of bone formation and serum C-terminal cross-linked telopeptide of type I collagen (ICTP) as a marker of bone resorption. A 3-hour 75-g oral glucose tolerance test was then performed, with measurement of glucose, insulin, and C-peptide levels every 30 minutes. Patients were studied at baseline and after treatment with an antithyroid drug (carbimazole) for 1 month and 6 months.
Pretreatment fasting glucose, insulin, C-peptide, and intact proinsulin levels were significantly higher in patients with hyperthyroidism than in control subjects. During the 3-hour oral glucose tolerance test, the area under the curve of glucose was significantly elevated in the patients, whereas the 3-hour areas under the curve of insulin and C-peptide were not significantly different between patients and control subjects. Fasting glucose, insulin, C-peptide, and intact proinsulin levels decreased significantly to levels similar to those of the control subjects after 1 month of antithyroid therapy and remained so at 6 months. Pretreatment ALP, osteocalcin, PICP, and ICTP were significantly higher in the patients than in the control subjects. After treatment, all markers of bone turnover decreased significantly to levels similar to those of the control subjects at 1 month (except ALP) and 6 months. Within the study group of patients, baseline PICP, osteocalcin, and ICTP demonstrated positive correlation trends with free triiodothyronine and free thyroxine.
Abnormal glucose metabolism and increased bone turnover are hallmarks of untreated hyperthyroidism. These factors normalize as early as 4 weeks after initiation of antithyroid therapy. Changes in bone markers, particularly those of resorption, are related to the degree of thyroid hyperactivity.
研究甲状腺功能亢进症患者的糖代谢和骨代谢情况，评估治疗后的变化，并探究它们之间的相互关系。
对30例甲状腺功能亢进症患者和32例正常对照者进行研究。在禁食10至12小时后，采集血样以检测血糖、胰岛素、C肽和完整胰岛素原水平，以及骨标志物：血清碱性磷酸酶（ALP）、骨钙素和I型前胶原C端肽（PICP）作为骨形成标志物，血清I型胶原C端交联肽（ICTP）作为骨吸收标志物。然后进行3小时的75克口服葡萄糖耐量试验，每30分钟检测血糖、胰岛素和C肽水平。在基线时以及使用抗甲状腺药物（卡比马唑）治疗1个月和6个月后对患者进行研究。
甲状腺功能亢进症患者治疗前的空腹血糖、胰岛素、C肽和完整胰岛素原水平显著高于对照者。在3小时口服葡萄糖耐量试验期间，患者的血糖曲线下面积显著升高，而胰岛素和C肽的3小时曲线下面积在患者和对照者之间无显著差异。抗甲状腺治疗1个月后，空腹血糖、胰岛素、C肽和完整胰岛素原水平显著下降至与对照者相似的水平，并在6个月时保持不变。患者治疗前的ALP、骨钙素、PICP和ICTP显著高于对照者。治疗后，所有骨转换标志物在1个月（ALP除外）和6个月时均显著下降至与对照者相似的水平。在患者研究组中，基线时PICP、骨钙素和ICTP与游离三碘甲状腺原氨酸和游离甲状腺素呈正相关趋势。
糖代谢异常和骨转换增加是未经治疗的甲状腺功能亢进症的特征。这些因素在开始抗甲状腺治疗后4周内即恢复正常。骨标志物的变化，尤其是骨吸收标志物的变化，与甲状腺功能亢进程度有关。
