Kung A W, Lorentz T, Tam S C
Department of Medicine, Biochemistry, University of Hong Kong.
Clin Endocrinol (Oxf). 1993 Nov;39(5):535-40. doi: 10.1111/j.1365-2265.1993.tb02405.x.
Hyperthyroidism is associated with increased bone turnover and decreased bone mass. This study aimed to evaluate the bone mineral density (BMD) of post-menopausal women on long-term thyroxine suppressive therapy.
An age and sex-matched cross-sectional study.
Thirty-four post-menopausal women with carcinoma of thyroid, post total thyroidectomy and 131I ablation, on L-T4 for 12.2 +/- 6.6 years (mean +/- SD). Controls were 34 age-matched healthy Southern Chinese women.
Total body and regional BMDs were determined by dual-energy X-ray absorptiometry. Bone turnover was assessed by biochemical markers.
In the thyroxine treated group, total body mineral content was significantly lower than the controls (1652 +/- 356 vs 1994 +/- 270 g mean +/- SD, P < 0.005). They also had lower BMDs in the lumbar spine, femoral neck, trochanter and Ward's triangle (0.75 +/- 0.15 vs 0.92 +/- 0.16 g/cm2, P < 0.005; 0.62 +/- 0.12 vs 0.70 +/- 0.12 g/cm2, P < 0.01; 0.55 +/- 0.14 vs 0.63 +/- 0.15 g/cm2, P < 0.001; 0.55 +/- 0.14 vs 0.63 +/- 0.14 g/cm2, P < 0.005 respectively.) The thyroxine treated group also had higher serum alkaline phosphatase and osteocalcin levels as well as urinary hydroxyproline excretion, suggesting that they had high turnover bone loss. However, the Z-scores of the various regional BMDs were correlated only with the serum osteocalcin level and showed no correlation with the serum thyroxine level or with the dosage or duration of thyroxine treatment.
Long-term thyroxine suppressive therapy was associated with bone loss and preventive therapy may be indicated in these post-menopausal women at risk of osteoporosis.
甲状腺功能亢进与骨转换增加及骨量减少有关。本研究旨在评估接受长期甲状腺素抑制治疗的绝经后女性的骨密度（BMD）。
一项年龄和性别匹配的横断面研究。
34例绝经后甲状腺癌女性，全甲状腺切除及131I消融术后，服用左甲状腺素（L-T4）12.2±6.6年（均值±标准差）。对照组为34例年龄匹配的健康中国南方女性。
采用双能X线吸收法测定全身及局部骨密度。通过生化标志物评估骨转换。
在甲状腺素治疗组中，全身矿物质含量显著低于对照组（均值±标准差分别为1652±356 vs 1994±270 g，P<0.005）。她们在腰椎、股骨颈、大转子和沃德三角区的骨密度也较低（分别为0.75±0.15 vs 0.92±0.16 g/cm2，P<0.005；0.62±0.12 vs 0.70±0.12 g/cm2，P<0.01；0.55±0.14 vs 0.63±0.15 g/cm2，P<0.001；0.55±0.14 vs 0.63±0.14 g/cm2，P<0.005）。甲状腺素治疗组血清碱性磷酸酶和骨钙素水平以及尿羟脯氨酸排泄也较高，表明她们存在高转换型骨质流失。然而，各局部骨密度的Z值仅与血清骨钙素水平相关，与血清甲状腺素水平或甲状腺素治疗的剂量及疗程无关。
长期甲状腺素抑制治疗与骨质流失有关，对于这些有骨质疏松风险的绝经后女性可能需要采取预防性治疗。
