Wakasugi M, Wakao R, Tawata M, Gan N, Inoue M, Koizumi K, Onaya T
Third Department of Internal Medicine, University of Yamanashi Medical School, Japan.
Thyroid. 1994 Summer;4(2):179-82. doi: 10.1089/thy.1994.4.179.
Because of the previous controversial findings in studies of bone mineral density in patients with hyperthyroidism with older methodologies, we assessed bone mineral density in 15 Japanese patients with Graves' disease (8 males and 7 females) before and after treatment using dual energy X-ray absorptiometry (DEXA). Bone mineral density of the lumbar vertebrae and the femur, and thyroid function, and several metabolic parameters were measured before treatment and again after patients achieved a euthyroid state following treatment with methimazole for 4 to 20 months (mean 10.6 months). The bone mineral density of patients was calculated as the percentage of the mean value (%BMD) in an age- and sex-matched control group, and correlations between the changes in bone mineral density and metabolic parameters before and after treatment were investigated. The %BMD of vertebrae in patients with Graves' disease before treatment was 89.7% of that found in the normal population. When patients became euthyroid after treatment, %BMD increased significantly to 94.9%, although it still remained below the control level. TSH receptor antibody, osteocalcin, and alkaline phosphatase were elevated before treatment, but decreased significantly after treatment. The change between pre- and posttreatment TSH receptor antibody was negatively correlated with the change in bone mineral density. In conclusion, these findings suggest that bone mineral density is decreased in patients with Graves' disease and that successful treatment of hyperthyroidism results in a significant increase in bone mineral density within a short period of time. Furthermore, TSH receptor antibody is a useful marker of changes in bone metabolism in this group of patients.
由于以往采用较旧方法对甲状腺功能亢进症患者进行骨矿物质密度研究时结果存在争议，我们使用双能X线吸收法（DEXA）对15例日本Graves病患者（8例男性和7例女性）治疗前后的骨矿物质密度进行了评估。在患者接受甲巯咪唑治疗4至20个月（平均10.6个月）达到甲状腺功能正常状态之前和之后，测量了腰椎和股骨的骨矿物质密度、甲状腺功能以及几个代谢参数。患者的骨矿物质密度计算为年龄和性别匹配对照组平均值的百分比（%BMD），并研究了治疗前后骨矿物质密度变化与代谢参数之间的相关性。Graves病患者治疗前椎骨的%BMD为正常人群的89.7%。治疗后患者甲状腺功能正常时，%BMD显著增加至94.9%，尽管仍低于对照组水平。治疗前促甲状腺激素受体抗体、骨钙素和碱性磷酸酶升高，但治疗后显著下降。治疗前后促甲状腺激素受体抗体的变化与骨矿物质密度的变化呈负相关。总之，这些发现表明Graves病患者骨矿物质密度降低，甲状腺功能亢进症的成功治疗导致骨矿物质密度在短时间内显著增加。此外，促甲状腺激素受体抗体是该组患者骨代谢变化的有用标志物。
