Abstract:

Objective To investigate the influence of suppressive levothyroxine therapy on bone mineral density（BMD） in women with differentiated thyroid carcinoma after thyroidectomy. Methods A total of 46 female patients with differentiated thyroid carcinoma who underwent total or near total thyroidectomy in Jiangmen Central Hospital from 2010 to 2014, were enrolled in this study. Pre-and post-operative BMD（T-score）of lumbar（L1-L4）and femur were detected and compared in each groups include age, BMI, menopausal status, initial target TSH level and average TSH level. Results Repeated measurement ANOVA showed that T-score of lumbar（L1-L4） and femur after suppressive levothyroxine therapy had significantly differences（P<0.05） in each group included group age, menopausal status and initial target TSH level. There was interaction between time effect and group effect in group initial target TSH level and group average TSH level. Conclusion Elder postmenopausal female patients with DTC who underwent long-term suppressive levothyroxine therapy, should be accepted primary prevention against osteoporosis no matter what TSH level they maintain. And also female patients who have lower initial target TSH level（≤0.01 mIU/L）, should keep on primary prevention against osteoporosis.

Key words: levothyroxine, bone mineral density, TSH suppressive, female patients, differentiated thyroid carcinoma

摘要：

目的 观察分析左旋甲状腺素抑制治疗对分化型甲状腺癌女性患者术后的骨密度的影响。方法 选择2010年至2014年江门市中心医院普通外科一区接受甲状腺双侧腺叶全切或近全切手术，并于术后接受左旋甲状腺素抑制治疗的DTC成年女性患者共46例，按照年龄、体重指数（BMI）、绝经状态、初始TSH目标及随访年限内平均TSH水平分组比较术前、术后1年及术后3年的腰椎（L1～L4）及股骨近端骨密度（T值）。结果 重复测量方差分析结果 显示年龄（P<0.001）、绝经状态（P<0.001）以及初始TSH目标分组（P<0.05）的患者T值在组间的差异明显，均具有统计学意义。其中，多因素分析提示初始TSH目标分组（P<0.001）以及平均TSH水平分组（P<0.001）与时间因素存在交互作用，说明时间因素的作用随TSH的变化而变化。结论 绝经后的高龄女性分化型甲状腺癌患者在长期L-T4抑制治疗过程中，无论其初始TSH目标以及平均TSH水平高低，均应接受抗骨质疏松的初级预防；对于初始TSH抑制目标较低（TSH≤0.1mIU/L）的女性患者，无论其年龄大小及绝经状况，同样应接受抗骨质疏松的初级预防治疗。

关键词: 分化型甲状腺癌, 骨密度 , 左旋甲状腺素, 女性患者, TSH抑制