Grant D J, McMurdo M E, Mole P A, Paterson C R
University of Dundee, Ninewells Hospital and Medical School, UK.
Clin Endocrinol (Oxf). 1995 Sep;43(3):339-45. doi: 10.1111/j.1365-2265.1995.tb02041.x.
Hyperthyroidism is a risk factor for osteoporosis, but the relative contributions of the episode of hyperthyroidism and thyroxine replacement for subsequent hyperthyroidism remain uncertain. In this study we have measured bone mineral density (BMD) in post-menopausal women with a previous history of hyperthyroidism, comparing those requiring thyroxine therapy with those remaining euthyroid and with an historical local control population.
Cross-sectional study.
One hundred and six post-menopausal women with a previous history of hyperthyroidism. These were divided into four groups: treated with radioiodine, remaining euthyroid (group RU, n = 15); treated with radioiodine, receiving thyroxine for at least 5 years (group RT, n = 46); treated with surgery, remaining euthyroid (group SU, n = 21); treated with surgery, receiving thyroxine for at least 5 years (group ST, n = 24). There were 102 control subjects.
Forearm bone mineral density at distal and ultradistal sites as measured by single-photon absorptiometry.
Results were expressed as 'Z-scores' i.e. number of standard deviations from the mean of a 5-year age-band from the local control population. Mean Z-scores at distal and ultradistal sites were as follows: -0.61 and -0.81 in group RU; -0.58 and -0.56 in group RT; -0.27 and -0.30 in group SU; -0.81 and -0.57 in group ST. Patients in groups RU, RT and ST but not SU had significantly lower BMD than controls.
Post-menopausal women with previous hyperthyroidism treated with radioiodine have reduced BMD, whether or not receiving thyroxine. They should be targeted for densitometry and protective therapy with oestrogen should be considered. Those treated with surgery appear to be at less risk; this may be because most are diagnosed and treated whilst premenopausal. Thyroxine may have a deleterious effect in this group; longitudinal studies would provide further clarification.
甲状腺功能亢进是骨质疏松的一个风险因素，但甲状腺功能亢进发作及后续甲状腺功能亢进的甲状腺素替代治疗的相对影响仍不明确。在本研究中，我们测量了有甲状腺功能亢进病史的绝经后女性的骨矿物质密度（BMD），将需要甲状腺素治疗的女性与甲状腺功能正常的女性以及当地历史对照人群进行比较。
横断面研究。
106名有甲状腺功能亢进病史的绝经后女性。这些女性被分为四组：接受放射性碘治疗，甲状腺功能正常（RU组，n = 15）；接受放射性碘治疗，接受甲状腺素治疗至少5年（RT组，n = 46）；接受手术治疗，甲状腺功能正常（SU组，n = 21）；接受手术治疗，接受甲状腺素治疗至少5年（ST组，n = 24）。有102名对照受试者。
通过单光子吸收法测量前臂远端和超远端部位的骨矿物质密度。
结果以“Z分数”表示，即与当地对照人群5岁年龄组平均值的标准差数量。远端和超远端部位的平均Z分数如下：RU组为-0.61和-0.81；RT组为-0.58和-0.56；SU组为-0.27和-0.30；ST组为-0.81和-0.57。RU组、RT组和ST组而非SU组的患者BMD显著低于对照组。
接受放射性碘治疗的有既往甲状腺功能亢进病史的绝经后女性，无论是否接受甲状腺素治疗，其BMD均降低。她们应成为骨密度测定的目标人群，应考虑使用雌激素进行保护性治疗。接受手术治疗的女性似乎风险较小；这可能是因为大多数患者在绝经前被诊断和治疗。甲状腺素可能对该组有有害影响；纵向研究将提供进一步的澄清。
