Mazokopakis Elias E, Starakis Ioannis K, Papadomanolaki Maria G, Batistakis Antony G, Papadakis John A
Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece.
Curr Med Res Opin. 2006 Jul;22(7):1369-73. doi: 10.1185/030079906X115612.
We studied the effect of levothyroxine (L-T(4)) suppressive therapy on bone mineral density (BMD) in pre-menopausal women with total thyroidectomy and radioactive iodine ((131)I) ablation therapy post-operatively for differentiated thyroid cancer (DTC).
We prospectively studied 26 athyroid pre-menopausal women (median age 39 years, range 28-48 years) receiving suppressive L-T(4) therapy postoperatively for 48 months. BMD was measured by dual energy X-ray absorptiometry (DEXA) at the femoral neck, femoral trochanter and Ward's triangle, before (basal) and during (12th and 48th month) the follow-up period. None of the women gave a medical history that could possibly affect bone metabolism. Patients were free of thyroid cancer in clinical and laboratory examinations at the time of the study. Paired t-test was used for comparisons among BMD measurements during the suppressive therapy.
There were statistically significant decreases of BMD at all measured regions during (12th and 48th month) L-T(4) suppressive therapy. The overall decreases in BMD at the femoral neck, femoral trochanter and Ward's triangle were 7.5%, 10.9% and 3.4%, respectively, at the end of the follow-up period. The coefficient of variation (CV) of all BMD measurements was around 10%, showing a rather homogenous group of patients. Our patients had a statistically significant decrease in their body mass index (BMI) and weight at the end of the follow-up period. However, there was no significant correlation between the decrease in BMI and BMD. Patients did not experience significant adverse effects from L-T(4) suppressive therapy during the study.
L-T(4) suppressive therapy for at least 1 year in pre-menopausal women with DTC causes a reduction in BMD of the femoral neck, femoral trochanter and Ward's triangle.
我们研究了左甲状腺素（L-T4）抑制疗法对绝经前接受全甲状腺切除术及术后放射性碘（131I）消融治疗的分化型甲状腺癌（DTC）患者骨密度（BMD）的影响。
我们前瞻性地研究了26例甲状腺切除术后接受L-T4抑制治疗48个月的绝经前无甲状腺患者（中位年龄39岁，范围28 - 48岁）。在随访期之前（基础值）以及随访期间（第12个月和第48个月），通过双能X线吸收法（DEXA）测量股骨颈、股骨转子和沃德三角区的骨密度。所有女性均无可能影响骨代谢的病史。在研究时，患者在临床和实验室检查中均未发现甲状腺癌。采用配对t检验比较抑制治疗期间的骨密度测量值。
在L-T4抑制治疗期间（第12个月和第48个月），所有测量部位的骨密度均有统计学意义的下降。随访期末，股骨颈、股骨转子和沃德三角区的骨密度总体下降分别为7.5%、10.9%和3.4%。所有骨密度测量的变异系数（CV）约为10%，表明患者群体相当均匀。我们的患者在随访期末体重指数（BMI）和体重有统计学意义的下降。然而，BMI下降与骨密度之间无显著相关性。在研究期间，患者未经历L-T4抑制治疗的显著不良反应。
DTC绝经前女性接受至少1年的L-T4抑制治疗会导致股骨颈、股骨转子和沃德三角区骨密度降低。
