甲状腺乳头状癌患者骨密度、血清总钙和离子钙、碱性磷酸酶及25-羟基维生素D的评估及其与左甲状腺素抑制促甲状腺激素的关系

Evaluation of Bone Density, Serum Total and Ionized Calcium, Alkaline Phosphatase and 25-hydroxy Vitamin D in Papillary Thyroid Carcinoma, and their Relationship with TSH Suppression by Levothyroxine.

作者信息

Kachui Ali, Tabatabaizadeh Seyed Mashaallah, Iraj Bijan, Rezvanian Hasan, Feizi Awat

机构信息

Department of Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Adv Biomed Res. 2017 Jul 28;6:94. doi: 10.4103/2277-9175.211799. eCollection 2017.

DOI:10.4103/2277-9175.211799

PMID:28828345

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5549548/

Abstract

BACKGROUND

This study aimed to evaluate the situation of Bone Mineral Density (BMD), Z score, T score, serum level of corrected and ionized calcium, alkaline phosphatase and 25-hydroxy vitamin D in percutaneous transhepatic cholangiography (PTC) patients and correlation of these variants with thyroid stimulating hormone (TSH) suppression level by levothyroxine.

MATERIALS AND METHODS

Among the patients referred to Esfahan's endocrinology research center, 34 PTC patients (aged 20-50 years) with a history of thyroidectomy and conceived radioactive iodine and suppressive dose of levothyroxine were evaluated in this case-control study, and 38 healthy persons participated as the control group (matched by age and sex, body mass index). Bone density was evaluated with the DEXA method in four areas: Lumbar spine, femoral neck, and trochanter and distal of forearm. A reference laboratory assessed TSH, corrected and ionized calcium, Alkaline phosphatase (ALP) and 25OH vitamin D levels using fasting plasma and evaluated correlation of TSH level with variants by multivariate variance analysis.

RESULTS

There was no significant difference in bone density and laboratory data (unless TSH) between the groups. In the PTC group, there was no significant correlation between TSH and difference values of BMD, Z score or T score, corrected calcium ( value = 0.12), ionized calcium ( = 0.54), ALP ( = 0.22) and 25 OH vitamin D ( = 0.38). There was no significant correlation in the TSH subgroups with BMD. The TSH suppression level has no relation with the elevated prevalence of low BMD, hypocalcemia and vitamin D deficiency. Difference in odds ratio was not significant for osteopenia and osteoporosis between the TSH subgroups (TSH < 0.02, >0.02 and <0.1 and >0.1 mu/L).

CONCLUSION

Suppressive therapy with levothyroxine cannot decrease BMD, Z score and T score in PTC patients.

摘要

背景

本研究旨在评估经皮肝穿刺胆管造影（PTC）患者的骨密度（BMD）、Z评分、T评分、校正钙和离子钙血清水平、碱性磷酸酶及25-羟维生素D的情况，以及这些变量与左甲状腺素抑制促甲状腺激素（TSH）水平之间的相关性。

材料与方法

在转诊至伊斯法罕内分泌研究中心的患者中，本病例对照研究评估了34例有甲状腺切除术史、接受过放射性碘治疗及左甲状腺素抑制剂量治疗的PTC患者（年龄20 - 50岁），38名健康人作为对照组（按年龄、性别、体重指数匹配）。采用双能X线吸收法（DEXA）在四个部位评估骨密度：腰椎、股骨颈、大转子和前臂远端。一家参考实验室使用空腹血浆评估TSH、校正钙和离子钙、碱性磷酸酶（ALP）及25OH维生素D水平，并通过多变量方差分析评估TSH水平与各变量之间的相关性。

结果

两组之间骨密度和实验室数据（TSH除外）无显著差异。在PTC组中，TSH与BMD、Z评分或T评分、校正钙（相关系数 = 0.12）、离子钙（ = 0.54）、ALP（ = 0.22）及25OH维生素D（ = 0.38）的差值之间无显著相关性。TSH亚组与BMD之间无显著相关性。TSH抑制水平与低骨密度、低钙血症和维生素D缺乏患病率升高无关。TSH亚组（TSH < 0.02、>0.02且<0.1及>0.1 μ/L）之间骨质疏松和骨质减少的优势比差异不显著。