慢性病毒性肝炎合并甲状腺疾病的临床研究

目的：研究慢性乙型和丙型肝炎患者在干扰素治疗前及治疗期间出现甲状腺疾病的临床特征。方法对2009年9月至2012年9月首都医科大学附属北京地坛医院住院诊断为慢性病毒性肝炎合并甲状腺疾病的143例患者的临床资料进行回顾性分析并加以归纳总结,对其进行描述性分析,分别监测干扰素治疗前、中、后游离甲状腺素（FT4）及促甲状腺激素（TSH）。结果143例慢性病毒性肝炎合并甲状腺疾病患者,男性38例,女性105例;其中聚乙二醇化干扰素（PegIFN）α-2a治疗前合并甲状腺疾病85例,23例男性患者中甲状腺功能亢进者13例（56.5%）和甲状腺机能减退者10例（43.5%）;62例女性患者中甲状腺功能亢进者23例（37.1%）和甲状腺机能减退者39例（62.9%）。PegIFN-α-2a治疗中出现甲状腺疾病为58例,既往无甲状腺疾病,15例男性患者中甲状腺功能亢进者8例（53.3%）和甲状腺机能减退者7例（46.7%）;43例女性患者中甲状腺功能亢进者12例（27.9%）和甲状腺机能减退者31例（72.1%）。PegIFN-α-2a治疗中,甲状腺疾病多出现在治疗的第4～6个月。结论慢性肝炎患者中女性合并甲状腺疾病发病率较男性高,且女性以甲状腺机能减退更常见。     

不同年龄患者甲状腺腺叶切除术后甲状腺功能变化的研究

目的：探讨不同年龄甲状腺良性肿瘤患者行单侧腺叶切除术后甲状腺功能的变化及激素替代治疗的必要性。 方法：将120例因甲状腺良性肿瘤行单侧腺叶切除术的患者根据年龄不同分为青年组（≤30岁,23例）、中年组（<30~<60岁,69例）、老年组（≥60岁,28例）,检测各组患者术前及术后1周,1、3、6个月,1、2年游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）和促甲状腺激素（TSH）水平。 结果：青年组FT3水平在术后1周、1个月时较术前明显降低（P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）;FT4水平术后各时间较术前均无明显变化（P>0.05）;TSH水平在术后1周,1、3个月时较术前比明显升高（均P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）。中年组术后各时间点FT3、FT4、TSH与术前比较均无统计学差异（P>0.05）。老年组患者FT3水平在术后1周,1、3个月时较术前明显降低（P>0.05）,后期各时间点则术前无统计学差异（P>0.05）;FT4水平在术后1、3、6个月时较术前明显降低（P<0.05）,其余各时间点则与术前无统计学差异（P>0.05）;TSH水平在术后1周,1、3、6个月时均较术前比升高（P<0.05）,后期各时间点则与术前无统计学差异（P>0.05）。3组患者均未出现临床甲状腺功能减退症状。 结论：不同年龄甲状腺良性肿瘤患者行单侧腺叶切除术后甲状腺功能恢复情况不同。中年患者术后代偿能力强,可不予激素替代治疗;青年对甲状腺激素需求量相对较大而老年患者代偿能力较差,故青年患者术后半年内、老年患者术后1年内给予激素替代治疗较合适。     

39例原发性甲状腺功能减退合并心包积液患者的临床特征

目的：分析原发性甲状腺功能减退合并心包积液的临床特征。方法：对104例原发性甲状腺功能减退患者的临床资料进行了回顾性分析,根据超声心动图检查结果将其分为合并心包积液组与无心包积液组,比较两组甲状腺功能、血常规、血脂、心肌酶等的差异。结果：104例原发性甲状腺功能减退症患者中39例发生心包积液,发生率为37．5％。与无心包积液组患者相比,合并心包积液患者的总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）更低,促甲状腺激素（TSH）、肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）、天门冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、羟丁酸脱氢酶（HBDH）、总胆固醇（TC）、低密度脂蛋白-胆固醇（LDL—C）的升高更为明显（P〈0．05）。结论：原发性甲状腺功能减退合并心包积液患者具有甲状腺功能更低下,心肌酶、胆固醇升高更显著等特征。     

肾9方治疗膜性肾病对甲状腺功能的影响

研究发现,原发性肾病综合征(primary nephrotic syndrome,PNS)患者存在甲状腺功能低下[1]。膜性肾病(membranous nephropathy,MN)是原发性肾病综合征的常见病理类型之一,在膜性肾病伴大量蛋白尿期间可见T3、T4、FT3、FT4降低,TSH升高的现象[2]。为此,笔者对膜性肾病伴甲状腺功能减退的患者做了随访观察,通过益气活血化湿方案对膜性肾病的治疗,观察其甲状腺激素(thyroid hormone,TH)水平的变化。     

不同剂量左旋甲状腺素对妊娠合并亚临床性甲状腺功能减退症患者甲状腺功能和叶酸水平及母婴结局影响的观察

目的:探讨不同治疗剂量左旋甲状腺素(L-T4)对妊娠合并亚临床性甲状腺功能减退症(亚甲减)患者甲状腺功能、叶酸水平及母婴结局的影响.方法:将安阳市第六人民医2018年7月—2020年9月收治的93例妊娠合并亚甲减孕妇作为研究对象,按照随机数字表法分为对照组和观察组.依据患者血清促甲状腺激素(TSH)水平(<8.00 mU/L,8.01～10.00 mU/L,>10.00 mU/L),对照组46例分别给予小剂量(50、75、100μg/d)的L-T4治疗,观察组47例给予大剂量(75、100、125μg/d)L-T4治疗,比较两组患者治疗前和分娩后血清TSH、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)和叶酸水平,新生儿发育水平,妊娠结局,不良反应发生情况.结果:两组治疗前、分娩后FT3、FT4水平差异无统计学意义(P>0.05);两组分娩后TSH水平较治疗前降低,观察组较对照组更低;叶酸水平较治疗前升高,观察组较对照组更高(P<0.05).观察组出生6个月后的新生儿智能发育指数(MDI)、运动发育指数(PDI)评分较对照组高(P<0.05).观察组的剖宫产率(6.38％,3/47例)低于对照组(15.22％,7/46例),不良母婴结局发生率(10.64％,5/47例)低于对照组(23.91％,11/46例),不良反应发生率(8.51％,4/47例)高于对照组(4.35％,2/46例),但差异均无统计学差异(P>0.05).结论:使用大剂量L-T4治疗妊娠合并亚甲减孕妇,可调节血清TSH、FT3、FT4、叶酸水平,最终调控母婴结局,改善新生儿发育水平,有较好的安全性.     

超声引导下微波消融术治疗甲状腺良性结节对患者甲状腺功能及并发症的影响

目的 对甲状腺良性结节患者实施超声引导下微波消融术治疗,分析其临床疗效及对患者甲状腺功能及并发症的影响。方法选取义乌復元第一医院及浙江大学医学院附属第四医院2021年2月至2023年2月医院收治的甲状腺良性结节患者74例,分为观察组37例与对照组37例,对照组实施常规甲状腺结节切除术治疗,观察组实施超声引导下微波消融术治疗,对两组临床疗效及对患者甲状腺功能及并发症的影响进行比较。结果 临床疗效方面,观察组治疗总有效率97.3%与对照组81.1%比较显著提高（P<0.05）;围术期指标方面,观察组手术时间、住院时间较对照组显著缩短,切口长度、术中出血量较对照组显著降低（P<0.05）;甲状腺功能方面,术前,两组促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）水平比较差异无显著性,术后,两组TSH水平均较术前明显提高,FT4、FT3水平均明显降低,其中观察组TSH水平较对照组显著降低,FT4、FT3水平显著提高（P<0.05）;术后,观察组并发症总发生率5.4%与对照组24.3%比较显著降低（P<0.05）。结论 对甲状腺良性结节患者实...     

甲状腺功能亢进的内科治疗

甲状腺功能亢进（甲亢）是指甲状腺合成和分泌入血的甲状腺激素（T3,T4）增多，需要抗甲状腺药物长程治疗。疼痛性或无痛性亚急性甲状腺炎（亚甲炎）时滤泡破裂、释放入血的游离T3和游离甲状腺素（FT4）一过性增多（不是T3、T4合成增多）。一旦滤泡上皮附着在滤泡基底膜上增生，最终修复破裂的滤泡，则在发病6—8周后T3、T4水平自动恢复正常，常常不应该应用抗甲状腺药物。因此，T3，T4水平升高究竟是合成增多还是释放增多？鉴别二者十分重要。     

糖尿病肾病中医证型与甲状腺功能关系探讨

目的：探讨糖尿病肾病的中医证型分布特征与甲状腺功能的关系。方法：将315例糖尿病肾病患者分为阴虚燥热、气阴两虚、脾肾气虚（阳）、阴阳两虚4种本证组和兼湿证、兼瘀证、兼痰瘀证3种标证组,以化学发光免疫分析法测定T3、T4、FT3、FT4、TSH,分析中医证型与甲状腺功能关系。结果：随着糖尿病肾病中医本证证型从阴虚燥热型向脾肾气虚（阳）型、气阴两虚型、阴阳两虚型的逐渐发展,甲状腺功能减退的患病率有逐渐增高的趋势,甲状腺功能亢进的患病率有逐渐降低的趋势。组与组间存在着差异有统计学意义（P〈0.05）。甲状腺功能亢进者其主证以阴虚燥热型为主,标证以无兼证为主;甲状腺功能减退者主证以阴阳两虚型为主,标证以痰瘀证为主。结论：甲状腺功能与糖尿病肾病中医证型相关,在一定程度上为中医辨证分型提供客观依据。     

兔甲状腺近全切除术＋131I清甲的甲状腺功能减退模型建立

目的通过对兔行甲状腺近全切除术＋131I清甲建立短期甲状腺功能减退的动物模型。方法新西兰大白兔60只,随机分成假甲状腺切除术组（ST组）、双侧甲状腺近全切除术组（NT组）和双侧甲状腺近全切除＋131I清甲组（NT＋131I组）。检测术前、术后3周和术后5周各组TSH、FT3、b3＇4及术后5周各组兔甲状腺显影结果。结果与术前比NT组和NT＋131I组在术后3周和术后5周甲状腺功能均明显降低。与sT组比较,NT组和NT＋131I组甲状腺显影明显减低,其中NT＋ 131I组甲状腺未见明显显影。结论可以通过甲状腺近全切除术＋131I清甲建立兔甲状腺功能减退模型。     

甲状腺部分切除术后甲状腺功能减退的相关原因分析

目的　探讨继发于部分甲状腺 ( 5 0 %～ 70 % )切除术后甲状腺功能减退 (甲减 )的发病率和相关原因。方法　回顾性分析 1988～ 2 0 0 0年行部分甲状腺切除术 12 10例患者的临床资料 ,包括年龄、性别、血清TSH水平、甲状腺球蛋白抗体 (TGA )、甲状腺过氧化物酶抗体 (TPO )、切除甲状腺组织重量等 ,以确定外科术后甲减的发生率和相关原因。结果　 12 10例中有 41例 ( 3 .4% )诊断为甲减 ,其中亚临床甲减 2 8例 ,临床甲减 13例。术后TSH平均水平为 ( 9.2 2± 3 .3 6)mU /L。与甲状腺功能正常患者的术前TSH水平 [( 1.0 7± 0 .72 )mU /L]相比 ,甲减者术前TSH平均水平 [( 3 .14±1.0 5 )mU /L ]明显升高 (P 0 .0 5 ) ;术前、术后的TGA及TPO水平比术后功能正常者明显升高 (P 0 .0 5 )。在年龄、性别或切除甲状腺组织重量上无显著性差异。平均甲状腺片的有效治疗剂量为1mg/ (kg·d) [范围 0 .3～ 1.3mg/ (kg·d) ]。 结论　继发于部分甲状腺切除术后的甲减常见于术前TSH和甲状腺自身抗体水平较高的病例 ,而与年龄、性别或切除甲状腺组织重量等因素无关 ,通常是症状轻微或无症状者 ,且用小剂量的甲状腺激素治疗效果良好。     

Assessment of thyroid function with hormone assays

Measurement of serum thyroid hormone and TSH levels provide diagnostic information in the majority of patients with thyroid dysfunction. The test strategy in hyperthyroidism differs from that in hypothyroidism. Serum T4 is a good test for hyperthyroidism in patients with normal thyroid hormone-binding protein levels. When binding proteins are abnormal serum free T4 is a much more accurate test for hyperthyroidism than serum T4. Serum T3 and the TSH response to TRH are useful tests for the early diagnosis of hyperthyroidism. Serum TSH is a very sensitive indicator of primary hypothyroidism rising already at the subclinical stage of the disease. Serum T4 and free T4, but not serum T3, are useful for the verification of clinical hypothyroidism. Determination of the TRH-stimulated TSH level is important for the differential diagnosis of pituitary and hypothalamic hypothyroidism. It is imperative to recognize that thyroid tests are often abnormal in various non-thyroidal diseases and that administration of drugs can affect these tests. Serum rT3 is of some value for the assessment of thyroid function in patients with non-thyroidal disease.     

A longitudinal evaluation of thyroid function in critically ill surgical patients.

Thyroid hormone alterations (known as the "sick-euthyroid syndrome") are common following major surgery, but the time course for appearance and recovery from these alterations has not previously been longitudinally studied in a large group of surgical patients. The authors prospectively studied 59 patients undergoing major surgery (coronary artery bypass grafting, pneumonectomy, or subtotal colectomy). Compared with preoperative values, the mean serum T4, T3, free T3, and TSH concentrations decreased significantly (p less than 0.05) following surgery. Serum reverse T3 and T3 resin uptake index increased, while free T4 levels remained unchanged. These changes were seen within 6 hours of surgery and normalized by 1 week after surgery. Although the serum TSH response to TRH was normal before and after surgery in 56 of the 59 patients, the maximal TRH-induced increase in serum TSH and the integrated serum TSH response to TRH were suppressed in the early perioperative period. This postoperative TSH suppression correlated with elevated postoperative plasma dopamine concentrations (r = 0.57, p less than 0.05). Three patients with compensated primary hypothyroidism were detected in the study and represent the first documentation of serial thyroid hormone and TSH levels in hypothyroid patients undergoing major surgery. These patients had similar changes in thyroid hormone values compared with euthyroid patients. The serum TSH response to TRH was suppressed into the normal range in two of these patients on the day following surgery. The authors conclude that the sick-euthyroid syndrome occurs within a few hours of major surgery and remits with convalescence. Postoperative decreases in serum TSH may mask the diagnosis of hypothyroidism. Surgical consultants should be aware of these rapid postoperative changes so that thyroid function tests are properly interpreted in patients who have undergone major surgery.     

Hypothyroidisim following hemithyroidectomy: incidence, risk factors, and management

BACKGROUND: The purpose of this study was to characterize the hypothyroidism that occurs following hemithyroidectomy. METHODS: The records of all euthyroid patients who underwent hemithyroidectomy from 1992 to 2000 were reviewed to determine the frequency of postsurgical hypothyroidism and the predisposing factors. All patients were evaluated for age, gender, serum thyrotropin (TSH) levels, weight of resected thyroid tissue, and associated thyroiditis. Hypothyroid patients were evaluated for symptoms, timing of diagnosis, and treatment doses of levothyroxine (L-T(4)). RESULTS: Hypothyroidism was diagnosed in 25 (35%) of 71 patients, subclinical in 16 and overt in 9 with a mean postoperative TSH level of 8.51 +/- 6.53 microIU/L. The mean preoperative TSH level was 1.94 +/- 1.00 microIU/L in hypothyroid compared with 1.10 +/- 0.74 microIU/L in euthyroid patients (P <.05). Lymphocytic thyroiditis was present in 10 (40%) of 25 hypothyroid compared with 10 (22%) of 46 euthyroid patients (P = not significant). There were no significant differences in age, gender, or weight of resected thyroid tissue. The average therapeutic dose of L-T(4) was 1.3 microg/kg (range, 0.5 to 1.9 microg/kg). All but 2 hypothyroid patients were diagnosed within 2 months of operation. CONCLUSIONS: Hypothyroidism following hemithyroidectomy occurs in patients with higher preoperative TSH levels, is usually mild and asymptomatic, and can be treated with reduced doses of L-T(4).     

Abnormalities of thyroid function in Japanese patients with metastatic renal cell carcinoma treated with sorafenib: A prospective evaluation

The objective of this study was to characterize features of thyroid dysfunction in Japanese patients with metastatic renal cell carcinoma (RCC) who were treated with sorafenib. We performed a prospective observational study including 69 Japanese patients who were diagnosed as having metastatic RCC refractory to cytokine therapy and subsequently treated with sorafenib for at least 12 weeks. Thyroid function was assessed before and every 4 weeks after the initiation of sorafenib treatment. Of the 69 patients, 23 (33.3%) did not show any biochemical thyroid abnormality, while the remaining 46 (67.7%) developed hypothyroidism. However, 11 (23.9%) of these 46 hypothyroid patients initially had a suppressed thyroid-stimulating hormone (TSH) value accompanying the increase in free triiodothyronine (T3) and/or free thyroxine (T4) before developing hypothyroidism, suggesting sorafenib-induced thyroiditis. During the observation period of this study, 4 patients (5.8%) demonstrated severe clinical symptoms caused by hypothyroidism and received thyroid hormone replacement. Among several factors examined, only age was significantly associated with the risk for hypothyroidism. These findings suggest that although the incidence of clinically significant hypothyroidism requiring thyroid hormone replacement therapy was not very high, biochemical thyroid abnormality was frequently observed in Japanese RCC patients treated with sorafenib. Accordingly, regular surveillance of thyroid function by the measurement of TSH, free T3, and T4 is warranted during sorafenib treatment in Japanese RCC patients.     

A case of pituitary hyperplasia associated with primary hypothyroidism

A thirteen-year-old girl was admitted complaining of short stature and anemia. The low titers of her serum T3 and T4 and the abnormally high TSH level represented primary hypothyroidism. Although she had normal sellar size, CT demonstrated an intra- and suprasellar round mass with homogeneous enhancement. With thyroid replacement therapy the enhanced mass diminished on CT within 5 months, and her symptoms regressed. Twelve cases with radiological diminution of pituitary mass or visual field improvement after thyroid replacement therapy are reviewed. They were considered to be pituitary hyperplasia, rather than pituitary adenoma, caused by long-standing untreated hypothyroidism. In four of them, the pituitary mass on CT was diminished after the therapy. Characteristic CT findings of pituitary hyperplasia, including our case, was a round isodensity mass with homogeneous enhancement in the midline of the pituitary region. In the experimental studies, pituitary hyperplasia is based on the feedback mechanism of hypothalamic-pituitary-thyroid axis, and ultimately autonomous pituitary adenoma may occur. Pituitary mass with hypothyroidism, visual field defect, amenorrhea or galactorrhea tend to be mistaken for prolactinoma or non-functioning adenoma with pituitary hypothyroidism. Thorough endocrinological examination must be carried out. The first choice of treatment for this type of pituitary mass should be thyroid replacement therapy. If there is no improvement of visual field, no regression of pituitary mass on CT, or continuing high TSH levels, then pituitary surgery must be considered.     

甲状腺腺瘤术后内分泌治疗的研究

目的 探讨甲状腺腺瘤术后内分泌治疗的必要性。方法 对１００例次手术后甲状腺腺瘤标本用ＳＰ法测定ＴＳＨ受体,瘤体周围的甲状腺组织连续病理切片检查有无存在微小瘤灶,并按随机抽签法将病人分成Ａ、Ｂ两组,Ａ组口服甲状腺片治疗,Ｂ组不用任何治疗。术后定期测定血Ｔ３,Ｔ４,ＴＳＨ浓度,＾１３１Ｉ扫描及Ｂ超检查残存甲状腺。结果 甲状腺瘤１００％存在ＴＳＨ受体,８％有微小瘤灶。Ａ组病人血Ｔ３,Ｔ４,ＴＳＨ及残存甲     

Surgical treatment of ischemic heart disease combined with hypothyroidism

Treatment for patients with ischemic heart disease and hypothyroidism contains many difficulties, such as a dilemma that thyroid hormone to hypothyroid patients may worsen angina. The purpose of this study is to propose an appropriate control of thyroid function in these patients before coronary artery bypass grafting (CABG), and to clarify the change of thyroid function during postoperative period. Because of progressive angina pectoris, five hypothyroidism patients underwent CABG. Preoperatively, minimal dose of L-Thyroxine (0-75 micrograms, daily) was administered orally to keep thyroid function at slightly low level before CABG. Ten consecutive CABG patients with normal thyroid function were selected as control group. Between both groups, there was no significant difference in age, coronary artery disease, and the number of bypass grafts. Serum T4, free-T4, T3, free-T3, and TSH were measured at 1st, 2nd, 3rd, and 7th P.O.D. In control group, pituitary-thyroid function was suppressed transiently. In hypothyroid group, T4 revealed no change and was kept at slightly low level during observed period. There was no significant difference in postoperative hemodynamics between both groups. Postoperatively all of hypothyroid patients got free from angina and received an adequate thyroid hormone replacement therapy without complications. It is concluded that CABG for patients with angina and hypothyroidism can be performed safely by keeping preoperative thyroid function at slightly low level.     

Serum levels of total testosterone and sex hormone binding globulin in hypothyroid patients and normal subjects treated with incremental doses of L-T4 or L-T3

Plasma testosterone (T) and sex hormone binding globulin (SHBG) were assayed in normal controls (N = 9) and hypothyroid patients (N = 17) receiving increasing doses of L-T4 (0.2 mg, 0.4 mg for 30 days), followed first by 30 days without medication and then by 30 days each of 0.05 mg L-T3 and 0.2 mg L-T3. Normal male controls showed a significant increase in plasma T only at high doses of either L-T4 (0.4 mg) or L-T3 (0.2 mg). A small but significant increase in plasma T levels was observed in normal female subjects at 0.4 mg of T4. In both men and women, plasma SHBG increased in a dose-dependent manner with L-T4 or L-T3 and correlated positively and significantly with serum thyroid hormone levels. Hypothyroid male subjects had significantly lower levels of plasma T (mean +/- SD) of 279 +/- 131 ng/dl as compared with normal males (431 +/- 118 ng/dl), which reached the normal range only at a relatively high dose of either L-T4 (0.4 mg) or L-T3 (0.2 mg). No significant changes in plasma T were seen in the hypothyroid female group. Basal plasma SHBG levels were significantly lower in both hypothyroid men and women and increased towards normal levels during L-T4 and L-T3 therapy, although the response to thyroid hormones was significantly lower than that of normal controls. These results indicate that thyroid hormone therapy increases plasma SHBG levels in both normal and hypothyroid patients and that this increase precedes the expected elevation of plasma T in males.     

甲状腺功能异常患者血生化、骨代谢及骨密度特点的临床研究

目的观察甲状腺功能减退症及甲状腺功能亢进症对骨密度以及骨代谢相关指标的影响。方法纳入甲状腺功能减退症女性37例为甲减组,甲状腺功能亢进症女性41例为甲亢组,健康体检女性人员40例为对照组。观察3组甲状腺功能指标血游离三碘甲状腺原氨酸(FT_3)、游离甲状腺激素(FT_4)和高敏感促甲状腺激素(TSH);骨代谢指标血Ca~(2+)、血P~(3+)、1,25-(OH)_2D_3、甲状旁腺激素(PTH)、碱性磷酸酶(ALP)、血清Ⅰ型胶原羧基端吡啶并啉交联肽(ICTP)以及血清骨钙蛋白(BGP)以及左侧股骨颈、正位腰椎1-4(L_(1-4))的骨密度情况。结果甲亢组血清FT_3、FT_4、ALP、BGP、ICTP水平高于对照组(P0.05),甲亢组血清TSH水平低于对照组(P0.05)。甲减组血清TSH水平高于对照组(P0.05),而血清FT_3、FT_4、ALP、BGP、ICTP水平显著低于对照组(P0.05)。甲亢及甲减组L1-4及左股骨颈骨密度显著低于对照组(P0.05)。3组受试者PTH、CT、Ca~(2+)、P~(3+)、1,25-(OH)_2D_3比较无统计学意义(P0.05)。结论甲亢及甲减都可以引起骨量丢失,骨密度降低;主要通过影响骨转化来实现的;应该重视甲状腺功能异常引起的骨密度及骨代谢异常。     

甲状腺功能异常对男性骨密度影响的研究

目的探讨甲状腺功能异常对50～80岁男性骨密度的影响,为这类患者的骨质疏松症防治提供理论基础。方法纳入162名50～80岁男性,根据甲状腺功能分为正常对照组(90名),甲亢组(38例),甲减组(34例)。检测记录三组受试者血清FT3、FT4、TSH、Ca、P、1,25-(OH)_2D_3、ALP以及BGP水平。测量三组受试者正位腰椎1～4与左侧髋关节骨密度。结果甲减组血清FT3、FT4、ALP、BGP水平低于对照组(P0.05),而甲亢组高于对照组(P0.05);甲减组血清TSH高于对照组(P0.05),而甲亢组低于对照组(P0.05);甲亢及甲减组腰椎和髋关节BMD低于对照组(P0.05)。三组受试者血清Ca、P、1,25-(OH)_2D_3差异无统计学意义(P0.05)。相关性结果表明血清BGP和ALP与FT3、FT4间存在统计学正相关,与TSH呈负相关(P0.05);骨密度T值评分与FT3、FT4间存在统计学负相关(P0.05)。Logistic回归结果显示甲减和甲亢均对骨密度有负向影响(P0.05)。结论甲状腺功能异常对50～80岁男性骨密度有负面影响,应重视甲状腺功能异常患者骨密度的改变,这对于骨质疏松症的防治具有重要意义。