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目的探究不同剂量促甲状腺激素(TSH)对分化型甲状腺癌术后患者骨生化和骨密度的影响。方法选取上海市普陀区利群医院2013年1月-2015年1月收治的分化型甲状腺癌术后患者80例,随机分为对照(常规剂量)组和治疗(抑制剂量)组各40例,所有患者术后1个月行131I清除残余甲状腺组织,随后给予对照组左旋甲状腺素钠片2.0μg/kg口服,治疗组2.5μg/kg。另取同期参加体检的健康志愿者40例为正常对照组。治疗1年后比较3组甲状腺功能、骨生化和骨密度情况。结果治疗后,正常对照组的游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)和TSH差异均无统计学意义;治疗组FT3和FT4高于对照组,TSH低于对照组,差异均有统计学意义(P<0.05)。3组血清中钙、磷和碱性磷酸酶(ALP)含量差异均无统计学意义。3组L2-4椎体、Ward三角、股骨大转子和股骨干4个部位的骨密度(BMD)差异均无统计学意义。结论分化型甲状腺癌术后给予常规剂量左旋甲状腺素可维持正常生理需求,而抑制剂量可将甲状腺功能维持在亚临床甲亢状态。不同剂量左旋甲状腺素对骨代谢和BMD的影响较小。
Objective To investigate the effects of different doses of thyroid stimulating hormone (TSH) on bone biochemistry and bone mineral density in patients with differentiated thyroid cancer after operation. Methods Eighty patients with differentiated thyroid cancer who were treated in Liqun Hospital, Putuo District, Shanghai from January 2013 to January 2015 were randomly divided into control (conventional dose) group and treatment (inhibitory dose) group, 40 cases each, All patients underwent 131I removal of residual thyroid tissue one month after operation, followed by oral administration of 2.0μg / kg levothyroxine sodium tablets in the control group, 2.5μg / kg in the treatment group. Another take the same period to participate in physical examination of 40 healthy volunteers for the normal control group. One year after treatment, the thyroid function, bone biochemistry and bone mineral density were compared among the three groups. Results After treatment, there were no significant differences in free triiodothyronine (FT3), free thyroxine (FT4) and TSH in the normal control group; FT3 and FT4 in the treatment group were higher than those in the control group, and TSH was lower than that in the control group , The differences were statistically significant (P <0.05). There was no significant difference in the contents of calcium, phosphorus and alkaline phosphatase (ALP) between the three groups. There was no significant difference in BMD between L2-4 vertebra, Ward triangle, femoral trochanter and femoral shaft in 3 groups. Conclusion Differentiated thyroid cancer patients with normal dose of L-thyroxine can maintain normal physiological requirements, and thyroid gland function can be maintained in subclinical hyperthyroidism. Different doses of L-thyroxine had less effect on bone metabolism and BMD.