Abstract: ［Abstract］ Objective To study the effects of different doses of levothyroxine （LT4） suppressive therapy on glucolipid metabolism and bone metabolism after radical resection of differentiated thyroid carcinoma （DTC）. Methods Eighty patients with DTC radical resection in our hospital from April 2017 to April 2018 were randomly divided into two groups with 40 cases in each group. 131I was used to clear residual thyroid tissues at 1 month after DTC radical resection and LT4 suppressive therapy was given to patients， and the dose was 2.5 μg/kg in load group and 2.0 μg/kg in routine group， and the course of treatment was 6 months. The changes of thyroid function， glucolipid metabolism， bone metabolism and bone mineral density were compared between the two groups before and after treatment. Results After treatment， the levels of serum FT3 and FT4 were significantly increased （P<0.05） while the serum TSH level was significantly decreased （P<0.05）， and the levels of serum FT3 and FT4 in load group were higher than those in routine group while the serum TSH level was lower than that in routine group （P<0.05）. The levels of FBG， HbA1c and serum TC， TG and LDL?C in the two groups were significantly decreased （P<0.05）， and the levels of FBG， HbA1c and serum TC， TG and LDL?C in load group were lower than those in routine group （P<0.05）. The levels of serum BGP， BALP and ICTP were significantly increased in the two groups （P<0.05）， and the levels of serum BGP， BALP and ICTP in load group were higher than those in routine group （P<0.05）. The BMD values of lumbar vertebrae L2~4， femoral neck and Ward’ s triangle were significantly decreased （P<0.05）， and there were no significant differences between the two groups （P>0.05）. Conclusions LT4 suppressive therapy after DTC radical resection can promote glucolipid metabolism and bone metabolism. The decrease of blood glucose and blood lipids levels in patients will increase with the increase of dose. And there is no obvious relationship between the decrease of bone mineral density and the dose in the short term.

Key words: thyroid cancer, glucolipid metabolism, bone metabolism, levothyroxine, different doses, suppressive therapy

摘要： ［摘要］ 目的 研究分化型甲状腺癌（DTC）根治术后不同剂量左旋甲状腺素（LT4）抑制治疗对糖脂代谢、骨代谢的影响。方法 将2017年4月至2018年4月我院80例DTC根治术患者随机均分为两组各40例，于DTC根治术后1个月采用131I清除剩余甲状腺组织并给予LT4抑制治疗，剂量为负荷组2.5 μg/kg，常规组2.0 μg/kg，疗程3个月，比较两组治疗前后甲状腺功能、糖脂代谢、骨代谢及骨密度等指标变化情况。结果 治疗后，两组血清FT3及FT4水平明显升高（P<0.05），血清TSH水平明显降低（P<0.05），且负荷组血清FT3及FT4水平高于常规组，血清TSH水平低于常规组，差异有统计学意义（P<0.05）；两组FBG、HbA1c及血清TC、TG、LDL?C水平均明显降低（P<0.05），且负荷组FBG、HbA1c及血清TC、TG、LDL?C水平低于常规组，差异有统计学意义（P<0.05）；两组血清BGP、BALP及ICTP水平均明显升高（P<0.05），且负荷组血清BGP、BALP及ICTP水平高于常规组，差异有统计学意义（P<0.05）；两组腰椎L2~4、股骨颈及Ward’s三角BMD均明显降低（P<0.05），两组间差异无统计学意义（P>0.05）。结论 DTC根治术后LT4抑制治疗可促进糖脂代谢和骨代谢，患者血糖和血脂水平降低幅度随着剂量增加而变大，短期内骨密度降低水平与用药剂量间未见明显关系。

关键词: 甲状腺癌, 左旋甲状腺素, 不同剂量, 抑制治疗, 骨代谢, 糖脂代谢