新都区甲亢伴高钙血症的患病率及维生素 D3 治疗这些患者的疗效：一项随机试验。

Prevalence of hyperthyroidism with hypercalcemia in Xindu district and the efficacy of vitamin D3 treatment in these patients: a randomized trial.

机构信息

Department of Endocrinology, The First Affiliated Hospital of Chengdu Medical College, Xindu District, Chengdu, China.

Journal Editorial Office, Chengdu Medical College, Xindu District, Chengdu, China.

出版信息

Ann Palliat Med. 2021 Sep;10(9):9640-9649. doi: 10.21037/apm-21-1947.

DOI:10.21037/apm-21-1947

PMID:34628889

Abstract

BACKGROUND

This trial aimed to analyze the relationship between hyperthyroidism and the morbidity rate of hypercalcemia in the Xindu district, Chengdu, Sichuan province. We observed the level of serum calcium, the bone metabolic and thyroid autoimmune-related antibodies index during vitamin D3 treatment combined with traditional antithyroid drugs (ATD).

METHODS

Our research included hyperthyroid patients with a first-time diagnosis of Graves diseases (GD) combined with hypercalcemia on the basis of conventional anti-hyperthyroidism therapy, which were randomized into a vitamin D3 group (vitamin D3, 800-1,200 IU/day) and an ATD group (methimazole, 15-30 mg/day). All hyperthyroidism patients with hypercalcemia were analyzed, and changes in serum calcium (Ca2+), parathyroid hormone (PTH), thyroid function, thyroid autoimmune-related antibodies, and 25-dihydroxyvitamin D (25-OHVit D) levels during treatment of thyrotoxicosis with added vitamin D3 were explored.

RESULTS

In total, 184 patients with hyperthyroidism were observed, including 36 (19.57%) patients associated with hypercalcemia, with an age of onset of (56.39±5.80) years old. Twelve (6.52%) of these 36 cases reported digestive symptoms as the first manifestation, and four (2.17%) patients presented with a hypercalcemia crisis as the first manifestation. Serum Ca2+, free triiodothyronine (FT3), free thyroxine (FT4), and thyrotropin hormone receptor antibody (TRAb) levels increased in patients with hypercalcemia. Following the addition of vitamin D3 treatment, serum Ca2+, FT3, FT4, and TRAb levels were significantly decreased relative to the ATD group, while the thyroid-stimulating hormone (TSH), PTH, and 25-OHVit D levels were normalized.

CONCLUSIONS

Our study highlighted the importance of taking functional digestive disturbance into consideration in hyperthyroidism diagnosis, even in the absence of the typical symptoms. The level of thyroid related antibodies, thyroid function, and bone metabolism in hyperthyroidism patients combined with hypercalcemia could be improved by vitamin D3 adjuvant therapy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2100047870.

摘要

背景

本研究旨在分析四川省成都市新都区甲亢与高钙血症发病率的关系。我们观察了维生素 D3 联合传统抗甲状腺药物（ATD）治疗时血清钙水平、骨代谢和甲状腺自身免疫相关抗体指标的变化。

方法

我们的研究包括初诊为 Graves 病（GD）的甲亢患者，在常规抗甲亢治疗的基础上合并高钙血症，随机分为维生素 D3 组（维生素 D3，800-1200IU/天）和 ATD 组（甲巯咪唑，15-30mg/天）。对所有合并高钙血症的甲亢患者进行分析，观察加用维生素 D3 治疗甲状腺毒症时血清钙（Ca2+）、甲状旁腺激素（PTH）、甲状腺功能、甲状腺自身免疫相关抗体和 25-羟维生素 D（25-OHVit D）水平的变化。

结果

共观察 184 例甲亢患者，其中 36 例（19.57%）伴有高钙血症，发病年龄（56.39±5.80）岁。其中 12 例（6.52%）以消化道症状为首发表现，4 例（2.17%）以高钙血症危象为首发表现。高钙血症患者血清 Ca2+、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素受体抗体（TRAb）水平升高。加用维生素 D3 治疗后，血清 Ca2+、FT3、FT4、TRAb 水平较 ATD 组明显下降，而促甲状腺激素（TSH）、PTH、25-OHVit D 水平恢复正常。