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[抗甲状腺药物治疗前后成年男性甲状腺功能亢进症患者性激素及性激素结合球蛋白水平的变化]

[Changes of sex hormones and sex hormone-binding globulin levels in male adults with hyperthyroidism before and after antithyroid drug treatment].

作者信息

Ma W L, Wang X, Mao J F, Cheng X Q, Nie M, Liu Z X, Zheng J J, Yu B Q, Hao M, Huang Q B, Zhang R, Gao Y J, Wu X Y

机构信息

Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.

Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2019 Jun 25;99(24):1875-1880. doi: 10.3760/cma.j.issn.0376-2491.2019.24.008.

Abstract

To observe the changes of sex hormone and sex hormone-binding globulin (SHBG) levels in young male patients with hyperthyroidism before and after antithyroid drug (ATD) treatment. Between January 2015 and July 2016, forty male patients with hyperthyroidism aged 19-52 years (with an median age of 33.1 years) were enrolled in the Department of Endocrinology of Peking Union Medical College Hospital. Blood samples were taken before treatment and at 1 month, 2 months, 3 months and 5 months after treatment to evaluate thyroid function, follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone(T), free testosterone(FT), estradiol(E2), prolactin and SHBG. A total of 40 patients were enrolled but only 35 patients completed the follow-up. The patients had high levels of thyroid function, SHBG and sex hormones before treatment. Before treatment, free thyroxine (FT(4)), free triiodothyronine (FT(3)), SHBG, LH, estradiol, testosterone and free testosterone was (0.30±0.12) pmol/L, (9.68±4.73) pmol/L, (146±111) nmol/L, (8.41±3.61) U/L, (19.9±7.7) pmol/L, (29.9±9.5) nmol/L and (0.24±0.08) nmol/L, respectively. After treatment, the level of triiodothyronine, thyroxine, FT(3) and FT(4) gradually decreased to normal (all 0.001). Thyroid stimulating hormone (TSH) gradually increased to normal (0.001). LH and estradiol levels gradually decreased (all 0.001). FSH decreased but the difference was not statistically significant. Prolactin did not change significantly. Testosterone and SHBG levels decreased significantly while the levels of free testosterone, free testosterone percentage (FT%), bio-available testosterone (BAT), bio-available testosterone percentage (BAT%), free androgen index (FAI) gradually increased and stabilized (all 0.001). The difference was not statistically significant between T/LH and E2/LH before and after treatment (all 0.05). However FT/LH gradually increased and its difference was statistically significant (0.001). The levels of LH, estradiol, testosterone and SHBG in male patients with hyperthyroidism significantly increased, while the free testosterone level decreased, but they all gradually returned to normal with the lowering of thyroid hormone levels during ATD treatment.

摘要

观察抗甲状腺药物(ATD)治疗前后年轻男性甲亢患者性激素及性激素结合球蛋白(SHBG)水平的变化。2015年1月至2016年7月,北京协和医院内分泌科收治了40例年龄在19 - 52岁(中位年龄33.1岁)的男性甲亢患者。在治疗前及治疗后1个月、2个月、3个月和5个月采集血样,以评估甲状腺功能、促卵泡生成素(FSH)、促黄体生成素(LH)、睾酮(T)、游离睾酮(FT)、雌二醇(E2)、催乳素和SHBG。共纳入40例患者,但仅35例完成随访。患者治疗前甲状腺功能、SHBG及性激素水平均较高。治疗前,游离甲状腺素(FT(4))、游离三碘甲状腺原氨酸(FT(3))、SHBG、LH、雌二醇、睾酮和游离睾酮分别为(0.30±0.12)pmol/L、(9.68±4.73)pmol/L、(146±111)nmol/L、(8.41±3.61)U/L、(19.9±7.7)pmol/L、(29.9±9.5)nmol/L和(0.24±0.08)nmol/L。治疗后,三碘甲状腺原氨酸、甲状腺素、FT(3)和FT(4)水平逐渐降至正常(均P<0.001)。促甲状腺激素(TSH)逐渐升至正常(P<0.001)。LH和雌二醇水平逐渐下降(均P<0.001)。FSH下降但差异无统计学意义。催乳素无明显变化。睾酮和SHBG水平显著下降,而游离睾酮水平、游离睾酮百分比(FT%)、生物可利用睾酮(BAT)、生物可利用睾酮百分比(BAT%)、游离雄激素指数(FAI)逐渐升高并稳定(均P<0.001)。治疗前后T/LH和E2/LH差异无统计学意义(均P>0.05)。然而FT/LH逐渐升高且差异有统计学意义(P<0.001)。甲亢男性患者LH、雌二醇、睾酮和SHBG水平显著升高,而游离睾酮水平下降,但在ATD治疗期间随着甲状腺激素水平降低,它们均逐渐恢复正常。

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