The Effect Of Differentiated Thyroid Carcinoma After RAI Remnant Ablation On Bone Metabolism

Objective: To study the influence on bone metabolism levels in patients with differentiated thyroid carcinoma(DTC) after RAI remnant ablation treatment. To observed the changes of bone metabolism before surgery and after TSH suppression therapy.Methods: According to the 2015 American Thyroid Association(ATA)guidelines recommended that the standards of 131 I treatment, 152 patients with intermediate-risk and high-risk DTC were diagnosised and treatmented in the hospital,including 37 males, 115 females, 71 cases of premenopausal women, 11 cases of postmenopausal women, 33 cases of perimenopausal women. All patients were given levothyroxine after 131 I treatment. Before surgery and TSH suppressive therapy for 1months, 3 months, 6 months to detect thyroid stimulating hormone(TSH), free triiodothyronine(FT3), free thyroid hormone(FT4), parathyroid hormone(PTH),osteocalcin(N-MID), total amino terminal propeptide of type I collagen(TP1NP), βcollagen degradation products(CTX) and 25-hydroxy vitamin D(VD) level changes,respectively. Before surgery and TSH suppressive therapy for one year measured the lumbar spine and double hip bone mineral density level changes. 124 cases of normal control group of healthy adults to select the same period medical appeal groups were compared.Results: In preoperative, patient group compared with the control group, the difference between thyroid function and markers of bone metabolism showed no significant difference(P>0.05). After TSH suppression therapy, the high-risk group,intermediate-risk group in menopausal women and postmenopausal women which the bone metabolism markers with TP1 NP, CTX, N-MID have statistical significance(P<0.05), but menopausal women was little difference. The level of bone metabolism markers with premenopausal women and men showed no significant differences(P>0.05). Correlation analysis showed that the PTH and VD level were not associatedwith serum FT3, FT4 or TSH in postmenopausal with high-risk group, while TP1NP(R2=0.416,P=0.024)、CTX(R2=0.343,P=0.045)and N-MID(R2=0.483,P=0.012)was significantly associated with FT3. In postmenopausal with middle-risk group, the PTH and VD level were not associated with serum FT3, FT4 or TSH, while TP1NP(R2=0.369,P=0.036), CTX(R2=0.445,P=0.018)and N-MID(R2=0.426,P=0.021)were significantly associated with FT3.Conclusion: The patients with DTC after RAI remnant ablation has a certain effect on bone metabolism in postmenopausal women. Serum FT3 concentration as the predominant and independent risk factor.