Földes J, Tarján G, Szathmari M, Varga F, Krasznai I, Horvath C
First Department of Medicine, Semmelweis University, Budapest, Hungary.
Clin Endocrinol (Oxf). 1993 Nov;39(5):521-7. doi: 10.1111/j.1365-2265.1993.tb02403.x.
The aim of the present study was to elucidate whether endogenous subclinical hyperthyroidism due to a solitary autonomously functioning thyroid nodule affects bone metabolism and is a risk factor for osteoporosis.
In a cross-sectional study measurements of bone mineral density were performed in premenopausal and post-menopausal women. Patients were categorized into non-toxic nodular goitre (n = 32), subclinical hyperthyroid (n = 37) and toxic solitary autonomous thyroid nodule (n = 22) subgroups and the results were compared with those of sex and age-matched control reference population (n = 68).
Lumbar spine and femoral neck bone mineral densities were measured by dual energy X-ray absorptiometry. Single-photon absorptiometry was applied to the measurement of bone mineral content in the midshaft of the radius.
In the non-toxic nodular goitre group, bone densities for all the scanned sites did not differ from the sex and age-matched reference population. At the L2-4 scanning site a significant decrease in the bone mineral density could be observed only in the toxic nodular goitre group and this decrease was more marked in the postmenopausal (P < 0.001) than in the premenopausal females (P < 0.05). At the femoral neck and midshaft radius the mean densitometric values were slightly, but significantly, lower only in the post-menopausal subclinical hyperthyroid group compared with the reference population (P < 0.01). The bone mineral density of the femoral neck, as well as the bone mineral content of the midshaft radius, was significantly decreased in both the premenopausal and post-menopausal patients with a toxic solitary nodule.
This study indicates that the bone mineral density of the lumbar spine, femoral neck and the midshaft of the radius are not significantly decreased in premenopausal patients with endogenous subclinical hyperthyroidism resulting from a solitary autonomously functioning thyroid nodule. Conversely, findings hint at the possibility that long-lasting endogenous subclinical hyperthyroidism may be a contributing factor to the development of osteoporosis in some post-menopausal women, mostly at sites where cortical bone preponderates.
本研究旨在阐明由单个自主功能性甲状腺结节引起的内源性亚临床甲状腺功能亢进是否会影响骨代谢以及是否为骨质疏松症的危险因素。
在一项横断面研究中，对绝经前和绝经后女性进行骨密度测量。患者被分为非毒性结节性甲状腺肿组（n = 32）、亚临床甲状腺功能亢进组（n = 37）和毒性单个自主甲状腺结节组（n = 22），并将结果与性别和年龄匹配的对照参考人群（n = 68）的结果进行比较。
采用双能X线吸收法测量腰椎和股骨颈骨密度。应用单光子吸收法测量桡骨中段的骨矿物质含量。
在非毒性结节性甲状腺肿组中，所有扫描部位的骨密度与性别和年龄匹配的参考人群无差异。在L2 - 4扫描部位，仅在毒性结节性甲状腺肿组中可观察到骨密度显著降低，且绝经后女性（P < 0.001）的降低比绝经前女性（P < 0.05）更明显。与参考人群相比，仅在绝经后亚临床甲状腺功能亢进组中，股骨颈和桡骨中段的平均骨密度值略有但显著降低（P < 0.01）。绝经前和绝经后患有毒性单个结节的患者，其股骨颈骨密度以及桡骨中段的骨矿物质含量均显著降低。
本研究表明，由单个自主功能性甲状腺结节引起的内源性亚临床甲状腺功能亢进的绝经前患者，其腰椎、股骨颈和桡骨中段的骨密度无显著降低。相反，研究结果提示，长期的内源性亚临床甲状腺功能亢进可能是某些绝经后女性骨质疏松症发生的一个促成因素，主要发生在皮质骨占优势的部位。
