JCEM:长期接受左旋甲状腺素治疗可能提高放射性椎体骨折发病率

2017-11-08 MedSci MedSci原创

目前已经有在接受TSH抑制治疗的分化型甲状腺癌(DTC)患者中发生了骨丢失和非脊椎骨折的相关报道。放射性椎体骨折(VFs)是骨脆性早期和重要的临床标志,但是目前还没有相关研究。Gherardo Mazziotti等人则进行了一项横断面研究,评估接受LT4治疗的DTC患者放射性VFs的患病率及决定因素,并将研究结果发表在近日的JCEM杂志上。

目前已经有在接受TSH抑制治疗的分化型甲状腺癌(DTC)患者中发生了骨丢失和非脊椎骨折的相关报道。放射性椎体骨折(VFs)是骨脆性早期和重要的临床标志,但是目前还没有相关研究。Gherardo Mazziotti等人则进行了一项横断面研究,评估接受LT4治疗的DTC患者放射性VFs的患病率及决定因素,并将研究结果发表在近日的JCEM杂志上。

该研究共纳入179例DTC女性患者(中位年龄59岁;其中1例已绝经),已行甲状腺切除并且正在进行LT4治疗(中位治疗持续时间5年)以期达到不同目标的TSH水平( I组:83例,TSH<0.5μg/L;II组:50例,TSH 0.5-1.0mU/L;III组:46例,TSH>1.0mU/ L),对其放射性VFs和骨密度(BMD)进行评估。

研究结果显示共发现51例(28.5%)VFs患者,与II组(24%)和III组(4.3%)相比,I组(44.6%)发生率显着增高。I组中, VFs的发生率在BMD正常、骨量减少或骨质疏松患者中并没有显着差别,但是在骨质疏松患者中较TSH值大于0.5mU/L的骨量减少或BMD正常患者中发生更频繁。在整个群体中,VFs与TSH<1.0mU/L、任何骨骼部位骨质疏松症的诊断、年龄及LT4治疗时间明显且独立相关。

该研究是第一次显示出进行长期LT4抑制治疗的DTC妇女VFs患病率高,为后续的研究指明了方向。

原始出处:

Gherardo Mazziotti .et al.HIGH PREVALENCE OF RADIOLOGICAL VERTEBRAL FRACTURES IN WOMEN ON TSH-SUPPRESSIVE THERAPY FOR THYROID CARCINOMA. J Clin Endocrinol Metab. 2017.

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    2017-12-17 achengzhao
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    2018-02-04 smallant2015
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    2017-11-10 dingxiaobo
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AACE 2016:左旋甲状腺素治疗甲状腺功能减退症或可改为每周一次用药

左旋甲状腺素从从每日一次切换到每周一次(剂量为每日剂量的7倍量)可有效治疗女性的甲状腺功能减退症,实现甲状腺功能。古尔加翁公园医院的Satish C. Wasoori博士和同事对40名25-55岁长期甲状腺功能减退(至少5年)的女性进行了研究,这些患者目前服用每日剂量的左旋甲状腺素,评估切换到每周一次(剂量为每日剂量的7倍量)对甲状腺功能减退症的疗效。参与者被分为两组:1组(n = 20),TSH

重复:N Engl J Med:左旋甲状腺素对亚临床甲减老年患者或是无用的治疗

亚临床甲状腺功能减退患者是否应接受左旋甲状腺激素治疗仍存在争议。2017年6月,发表在《N Engl J Med》上的一项研究显示,左旋甲状腺素未给亚临床甲状腺功能减退老年患者提供明显益处。

JCEM:左旋甲状腺素对于甲状腺过氧化物酶抗体阴性的亚临床甲减孕妇有何影响?

大家都知道目前关于甲状腺过氧化物酶抗体阴性的亚临床甲减孕妇(SCH-TPOAb-)的甲状腺筛查和左旋甲状腺素(LT4)治疗尚未达成共识。而近日在JCEM上发表的一篇文章则评估了LT4对于SCH-TPOAb-妊娠结局的治疗效益。

JAMA Intern Med:左旋甲状腺素可能过度用于临界甲状腺问题

10月7日在线发表于《JAMA内科学》杂志的一项研究显示,左旋甲状腺素钠被越来越多地用于临界甲状腺激素水平的患者中。 英国加的夫大学的Peter N. Taylor和同事们利用“英国临床实践研究数据链”,发现在2001年1月1日与2009年10月30日之间,有52,298名患者接受了左旋甲状腺素的处方。研究人员提取了左旋甲状腺素治疗开始前和治疗5年时的促甲状腺素水平数据。【原文下载】 研究人员

注意!牛奶或可影响左旋甲状腺素吸收

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