左甲状腺素和促甲状腺激素对原发性甲状腺功能减退症患者骨质流失的影响。
Effects of Levothyroxine and thyroid stimulating hormone on bone loss in patients with primary hypothyroidism.
作者信息
Karimifar Mansoor, Esmaili Farah, Salari Amirhossein, Kachuei Ali, Faragzadegan Ziba, Karimifar Mozhgan
机构信息
Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Rheumatology, Baghiyatollah University of Medical Sciences, Tehran, Iran.
出版信息
J Res Pharm Pract. 2014 Jul;3(3):83-7. doi: 10.4103/2279-042X.141099.
OBJECTIVE
Previous studies on bone mineral density (BMD) abnormalities associated with hypothyroidism are scarce and not conclusive. The effect of thyroid hormone therapy on BMD has shown mixed results. The aim of the present study was to determine the severities of osteoporosis in female patients with hypothyroidism in comparison to healthy women.
METHODS
This cross-sectional descriptive study was performed on 150 women aged over 50 years. Totally, 100 patients with primary hypothyroidism and 50 healthy subjects were enrolled in this study and divided into three groups. Group A, which consisted the patients who had been recently diagnosed with primary hypothyroidism. The second group of patients diagnosed with primary hypothyroidism for at least 2 years and was treated with levothyroxine (Group B). The third group of healthy individuals was selected as a control group (Group C). Blood samples were taken for the measurements of thyroid stimulating hormone (TSH), and bone densitometry was performed to determine the BMD reported as T-score in order to measure the severity of osteoporosis. T-score of the lumbar vertebra (L2-L4) and femoral neck were measured with dual energy X-ray absorptiometry and were compared between the three groups. Data were analyzed by SPSS using regression analysis and Mann-Whitney, Kruskal-Wallis, or analysis of variances statistical tests. The statistical significance was set at a P < 0.05.
FINDINGS
The average age of patients and baseline serum TSH levels in Group B was significantly different from the other two groups (P < 0.001). T-score of the lumbar spine (L2-L4) in Group B was significantly lower than the other groups (P = 0.01). The linear regression between serum TSH levels and BMD categories were not clearly associated. However, after removing the effect of the baseline TSH level in Group B, bone loss was significantly greater than the other two groups (P = 0.01).
CONCLUSION
According to the present study, it seems that the treatment of hypothyroidism with thyroid hormones reduces both serum levels of TSH and bone density. Hence, proper control of this risk factor can be an effective way in prevention of osteoporosis.
目的
既往关于甲状腺功能减退症相关骨密度（BMD）异常的研究较少且尚无定论。甲状腺激素治疗对骨密度的影响结果不一。本研究的目的是确定甲状腺功能减退症女性患者与健康女性相比骨质疏松的严重程度。
方法
本横断面描述性研究针对150名50岁以上女性进行。总共100例原发性甲状腺功能减退症患者和50名健康受试者纳入本研究并分为三组。A组由最近诊断为原发性甲状腺功能减退症的患者组成。第二组为诊断为原发性甲状腺功能减退症至少2年并接受左甲状腺素治疗的患者（B组）。第三组健康个体作为对照组（C组）。采集血样测量促甲状腺激素（TSH），并进行骨密度测定以确定作为T值报告的骨密度，从而测量骨质疏松的严重程度。使用双能X线吸收法测量腰椎（L2-L4）和股骨颈的T值，并在三组之间进行比较。数据通过SPSS使用回归分析以及Mann-Whitney、Kruskal-Wallis或方差分析统计检验进行分析。统计学显著性设定为P<0.05。
结果
B组患者的平均年龄和基线血清TSH水平与其他两组有显著差异（P<0.001）。B组腰椎（L2-L4）的T值显著低于其他组（P=0.01）。血清TSH水平与骨密度类别之间的线性回归无明显关联。然而，去除B组基线TSH水平的影响后，骨量流失明显大于其他两组（P=0.01）。
结论
根据本研究，似乎用甲状腺激素治疗甲状腺功能减退症会降低血清TSH水平和骨密度。因此，适当控制这一风险因素可能是预防骨质疏松症的有效方法。
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