Lowery W D, Thomas C G, Awbrey B J, Rosenstein B D, Talmage R V
Surgery. 1986 Dec;100(6):1142-9.
This study was designed to evaluate the effect of subtotal thyroidectomy and/or radioactive iodine therapy on plasma immunocalcitonin (iCT) levels and bone densities in patients treated for Graves' disease. Forty-eight women whose ages ranged from 29 to 79 years (mean, 55 years) were evaluated. All were at least 10 years beyond treatment. Fourteen patients had undergone subtotal thyroidectomy, 22 had received radioactive iodine therapy, and 12 had received both. Serum calcitonin levels were measured with the patient fasting and at 30 minutes and 2 hours after the ingestion of 15 mg of calcium in orange juice. Single photon absorptiometry was used to measure bone mineral density of the middle and distal radius. The mean fasting plasma levels of iCT for patients undergoing subtotal thyroidectomy was 27 +/- 2 mumol/L; women treated with radioactive iodine, 26 +/- 2; women undergoing subtotal thyroidectomy followed by radioactive iodine, 24 +/- 2, and for normal control women, 48.5 +/- 4.7. The mean stimulated iCT level of each of the patient groups was significantly lower than that of the normal controls (p = 0.01). There were no significant differences among the groups. Although there was an increased loss of bone mineral density in postmenopausal patients, with age and race as covariates, the bone densities of the distal radius in women undergoing subtotal thyroidectomy and/or receiving radioactive iodine were not significantly lower than those of normal control subjects (p greater than 0.05). These findings are consistent with other observations that patients treated by thyroidectomy and/or radioactive iodine for Graves' disease have lower basal levels of calcitonin and decreased calcitonin response to a provocative stimulus. Whether this loss of calcitonin reserve is a significant factor in development of postmenopausal osteoporosis remains unanswered.
本研究旨在评估甲状腺次全切除术和/或放射性碘治疗对格雷夫斯病患者血浆免疫降钙素（iCT）水平及骨密度的影响。对48名年龄在29至79岁（平均55岁）的女性进行了评估。所有患者均已接受治疗至少10年。14例患者接受了甲状腺次全切除术，22例接受了放射性碘治疗，12例同时接受了这两种治疗。在患者空腹时以及饮用含15毫克钙的橙汁后30分钟和2小时测量血清降钙素水平。使用单光子吸收法测量桡骨中、远端的骨矿物质密度。接受甲状腺次全切除术患者的空腹血浆iCT平均水平为27±2μmol/L；接受放射性碘治疗的女性为26±2；先接受甲状腺次全切除术再接受放射性碘治疗的女性为24±2，正常对照女性为48.5±4.7。各患者组的平均刺激后iCT水平均显著低于正常对照组（p = 0.01）。各患者组之间无显著差异。尽管绝经后患者骨矿物质密度的丢失有所增加，以年龄和种族作为协变量，但接受甲状腺次全切除术和/或放射性碘治疗的女性桡骨远端骨密度并不显著低于正常对照受试者（p＞0.05）。这些发现与其他观察结果一致，即因格雷夫斯病接受甲状腺切除术和/或放射性碘治疗的患者降钙素基础水平较低，对刺激性刺激的降钙素反应降低。降钙素储备的这种丧失是否是绝经后骨质疏松症发生的一个重要因素仍未得到解答。
