目的 探究不同劑量促甲狀腺激素（TSH）對(duì)分化型甲狀腺癌術(shù)后患者骨生化和骨密度的影響。方法 選取上海市普陀區(qū)利群醫(yī)院2013年1月-2015年1月收治的分化型甲狀腺癌術(shù)后患者80例，隨機(jī)分為對(duì)照（常規(guī)劑量）組和治療（抑制劑量）組各40例，所有患者術(shù)后1個(gè)月行¹³¹I清除殘余甲狀腺組織，隨后給予對(duì)照組左旋甲狀腺素鈉片2.0 μg/kg口服，治療組2.5 μg/kg。另取同期參加體檢的健康志愿者40例為正常對(duì)照組。治療1年后比較3組甲狀腺功能、骨生化和骨密度情況。結(jié)果 治療后，正常對(duì)照組的游離三碘甲狀腺原氨酸（FT3）、血清游離甲狀腺素（FT4）和TSH差異均無(wú)統(tǒng)計(jì)學(xué)意義；治療組FT3和FT4高于對(duì)照組，TSH低于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。3組血清中鈣、磷和堿性磷酸酶（ALP）含量差異均無(wú)統(tǒng)計(jì)學(xué)意義。3組L_2-4椎體、Ward三角、股骨大轉(zhuǎn)子和股骨干4個(gè)部位的骨密度（BMD）差異均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論 分化型甲狀腺癌術(shù)后給予常規(guī)劑量左旋甲狀腺素可維持正常生理需求，而抑制劑量可將甲狀腺功能維持在亞臨床甲亢狀態(tài)。不同劑量左旋甲狀腺素對(duì)骨代謝和BMD的影響較小。

Objective To explore the different doses of levothyroxine on bone biochemical indexes and bone mineral density in postoperative patients with differentiated thyroid carcinoma. Methods Totally 80 cases of postoperative patients with differentiated thyroid carcinoma treated in Putuo District Liqun Hospital in Shanghai from January 2013 to January 2015 were selected. They were randomly divided into control group (conventional dose, n=40) and treatment group (inhibitory dose, n=40). ¹³¹I clearance of residual thyroid tissue was performed in all patients after 1 month of operation. The patients in control group were given levothyroxine sodium 2.0 μg/kg and the patients in treatment group were given 2.5 μg/kg. Other 40 healthy patients were the same as normal control group. The thyroid function, biochemical indexes, and bone mineral density were compared among three groups after one year. Results There were no significant differences in FT3, FT4, and TSH between normal control groups and that of after treatment. The FT3 and FT4 of treatment group were higher than those of control group (P<0.05), and the TSH of treatment group was lower than that of control group (P<0.05). There were no significant differences in biochemical indexes and bone mineral density among three groups. Conclusion The effect of dose of levothyroxine is tiny on biochemical indexes and bone mineral density in postoperative patients with differentiated thyroid carcinoma, conventional dose of it can maintain normal physiological needs, while its inhibitory dose can maintain thyroid function in subclinical hyperthyroidism.

上海市普陀區(qū)2013年臨床重點(diǎn)?？祈?xiàng)目（qzd-2013-03）