Du Hongquan, Jia Aihua, Gu Mingyong, Li Sen, Zhang Pei, Bai Jie
Department of Endocrinology, Liaocheng People's Hospital Liaocheng, Shandong Province, China.
Department of Pathology, Zhongshan-Xuhui Hospital, Fudan University Shanghai, China.
Am J Transl Res. 2021 Feb 15;13(2):803-811. eCollection 2021.
Thyroid hormones have a direct effect on bone mineral homeostasis, leading to increased bone mineral resorption and calcium loss through the kidneys. Osteomalacia is conceptualized as a disorder of bone tissue characterized by inadequate or delayed mineralization of osteoid in mature cortical and spongy bone, and is associated with thyrotoxicosis. This article assessed the impact of thyrotoxicosis on the occurrence and development of osteomalacia for better diagnosis and treatment of the disease. We searched databases such as Pubmed with "osteomalacia" and "thyrotoxicosis", 15 papers were found; with "osteopenia" or "osteomalacia" or "osteoporosis" and "thyrotoxicosis", 129 papers were found. The causes of osteomalacia include insufficient intake of calcium, phosphorus and vitamin D, impaired absorption and metabolism of vitamin D, kidney diseases (nephrotic syndrome, chronic renal failure, renal tubular acidosis, Fanconi syndrome, etc.), hereditary and neoplastic hypophosphatemia, and other diseases such as heavy metal poisoning, high fluoride intake. At present, the pathogenesis of osteomalacia caused by thyrotoxicosis are mainly attributed to catabolism of vitamin D, vitamin D deficiency and mechanisms underlying calcium metabolism disorder. Since thyrotoxicosis can cause osteopenia and may coexist with osteomalacia, attention should be given to the changes of alkaline phosphatase, liver function and clinical symptoms. If necessary, chest X-ray and pelvic X-ray should be carried out to find out potential osteomalacia for timely treatment to avoid the occurrence of fracture and even deformity.
甲状腺激素对骨矿物质稳态有直接影响，导致骨矿物质吸收增加以及钙通过肾脏流失。骨软化症被认为是一种骨组织疾病，其特征是成熟皮质骨和松质骨中类骨质矿化不足或延迟，且与甲状腺毒症相关。本文评估了甲状腺毒症对骨软化症发生发展的影响，以便更好地诊断和治疗该疾病。我们在诸如PubMed等数据库中检索了“骨软化症”和“甲状腺毒症”，共找到15篇论文；检索“骨质减少”或“骨软化症”或“骨质疏松症”和“甲状腺毒症”，共找到129篇论文。骨软化症的病因包括钙、磷和维生素D摄入不足、维生素D吸收和代谢受损、肾脏疾病（肾病综合征、慢性肾衰竭、肾小管酸中毒、范科尼综合征等）、遗传性和肿瘤性低磷血症，以及其他疾病如重金属中毒、高氟摄入。目前，甲状腺毒症所致骨软化症的发病机制主要归因于维生素D的分解代谢、维生素D缺乏以及钙代谢紊乱的潜在机制。由于甲状腺毒症可导致骨质减少且可能与骨软化症并存，应关注碱性磷酸酶、肝功能及临床症状的变化。必要时，应进行胸部X线和骨盆X线检查以发现潜在的骨软化症，以便及时治疗，避免骨折甚至畸形的发生。
