Frusciante V, Carnevale V, Scillitani A, Zingrillo M, Dicembrino F, Giannatempo G M, Ghiggi M R, Minisola S
Department of Nuclear Medicine, Ospedale "Casa Sollievo della Sofferenza", IRCCS di San Giovanni Rotondo (FG), Italy.
Eur J Nucl Med. 1998 Feb;25(2):139-43. doi: 10.1007/s002590050206.
This study was carried out in order to investigate the possible detrimental effects on bone of levothyroxine (l-T4) suppressive therapy in female patients who had undergone surgery for differentiated thyroid cancer (DTC). Twenty female (14 premenopausal and 6 postmenopausal) patients receiving l-T4 suppressive therapy for DTC were studied. The sample was selected in such a way as to avoid factors influencing bone metabolism other than l-T4. All patients were monitored by sensitive thyroid-stimulating hormone, free triiodothyronine and free thyroxine assays throughout the follow-up. Nineteen healthy (12 premenopausal and 7 postmenopausal) matched women served as controls. In all subjects bone turnover was evaluated by the measurement of global skeletal uptake of technetium-99m methylene diphosphonate (GSU); bone mineral density (BMD) was measured by quantitative computed tomography at the lumbar spine (LS) and by dual-energy X-ray absorptiometry both at the LS and at three femoral sites: the femoral neck, Ward's triangle and the greater trochanter. No significant difference was found in either GSU or BMD between patients (treated for an average period of 68 months) and controls in the whole sample or in any subgroup. Furthermore, no correlations were found between either GSU or BMD and the duration of therapy, daily doses of l-T4 or results of thyroid function tests. Our data show that carefully monitored l-T4 therapy does not influence skeletal turnover (directly reflected by GSU) or the bone density of the spine and femur.
本研究旨在调查左甲状腺素（l-T4）抑制疗法对已接受分化型甲状腺癌（DTC）手术的女性患者骨骼可能产生的有害影响。对20名接受l-T4抑制疗法治疗DTC的女性患者（14名绝经前和6名绝经后）进行了研究。样本的选取方式避免了除l-T4之外影响骨代谢的因素。在整个随访过程中，所有患者均通过敏感的促甲状腺激素、游离三碘甲状腺原氨酸和游离甲状腺素检测进行监测。19名健康匹配女性（12名绝经前和7名绝经后）作为对照。在所有受试者中，通过测量99m锝亚甲基二膦酸盐的全身骨骼摄取量（GSU）评估骨转换；通过腰椎（LS）定量计算机断层扫描以及LS和三个股骨部位（股骨颈、沃德三角和大转子）的双能X线吸收法测量骨密度（BMD）。在整个样本或任何亚组中，患者（平均治疗68个月）和对照组之间在GSU或BMD方面均未发现显著差异。此外，在GSU或BMD与治疗持续时间、l-T4每日剂量或甲状腺功能测试结果之间均未发现相关性。我们的数据表明，经过仔细监测的l-T4疗法不会影响骨骼转换（由GSU直接反映）或脊柱和股骨的骨密度。
