甲状腺全切除术对甲亢患者骨密度恢复的影响。
The effect of total thyroidectomy on the recovery of bone mineral density in subjects with hyperthyroidism.
机构信息
Endocrine Surgery, Government Mohan Kumaramangalam Medical College, Salem, India; Research Scholar, Madras Medical College, The Tamilnadu Dr MGR Medical University, Chennai, India; The Tamilnadu Dr. MGR Medical University, Chennai, India; Endocrine Surgery, SKS Hospital, Salem, India.
The Tamilnadu Dr. MGR Medical University, Chennai, India.
出版信息
Surgery. 2019 Jan;165(1):80-84. doi: 10.1016/j.surg.2018.05.082. Epub 2018 Nov 8.
BACKGROUND
Although hyperthyroidism is associated with high turnover osteopenia and its recovery after treatment, the extent of recovery with different forms of therapy remains controversial. This prospective study evaluated the bone mineral density in thyrotoxic subjects undergoing total thyroidectomy and I radioactive iodine therapy.
METHODS
Newly diagnosed subjects with hyperthyroidism undergoing total thyroidectomy (group 1; n = 127) and I radioactive iodine therapy (group 2; n = 30) were evaluated for bone mineral density by dual energy x-ray absorptiometry at the time of diagnosis (point A), on achieving euthyroidism with antithyroid drugs (point B), and 6 months after definitive treatment (point C).
RESULTS
In group 1, bone mineral density (expressed as g/sq cm; mean ± standard deviation) in the hip (0.842 ± 0.157) and spine (0.97 ± 0.155) at point A, improved at point B (hip, 0.853 ± 0.157 and spine, 0.982 ± 0.155), and further improved at point C (hip, 0.91 ± 0.158 and spine, 1.053 ± 0.161, each P < .001). In group 2, at point C, bone mineral density in the hip (0.761 ± 0.168 versus point A, 0.741 ± 0.146) and spine (0.831 ± 0.159 versus point A, 0.823 ± 0.158) were less than group 1 (each P < .01).
CONCLUSION
Bone mineral density improved significantly after all forms of treatment of hyperthyroidism and was greatest in lumbar vertebrae (8.6%) as early as 6 months after total thyroidectomy. The delayed recovery of bone mineral density after I radioactive iodine therapy needs long-term evaluation.
背景
尽管甲状腺功能亢进症与高转换性骨质疏松症及其治疗后的恢复有关，但不同治疗形式的恢复程度仍存在争议。本前瞻性研究评估了接受甲状腺全切除术和 I 放射性碘治疗的甲状腺功能亢进症患者的骨密度。
方法
新诊断的甲状腺功能亢进症患者（接受甲状腺全切除术的患者 1 组；n=127）和 I 放射性碘治疗的患者 2 组（n=30），在诊断时（点 A）、使用抗甲状腺药物实现甲状腺功能正常时（点 B）和确定性治疗后 6 个月（点 C）时，通过双能 X 线吸收法评估骨密度。
结果
在 1 组中，骨密度（以 g/sq cm 表示；平均值±标准差）在髋关节（0.842±0.157）和脊柱（0.97±0.155）在点 A 时，在点 B 时改善（髋关节，0.853±0.157 和脊柱，0.982±0.155），并在点 C 时进一步改善（髋关节，0.91±0.158 和脊柱，1.053±0.161，每个 P<0.001）。在 2 组中，在点 C 时，髋关节（0.761±0.168 与点 A，0.741±0.146）和脊柱（0.831±0.159 与点 A，0.823±0.158）的骨密度低于 1 组（每个 P<0.01）。
结论
所有形式的甲状腺功能亢进症治疗后，骨密度均显著改善，甲状腺全切除术后 6 个月腰椎（8.6%）改善最大。I 放射性碘治疗后骨密度的延迟恢复需要长期评估。
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