Effects Of Methylprednisolone On Adrenocortical Function,Bone Metabolism,and Glycolipid Metabolism In Patients With Subacute Thyroiditis

Objective To observe the effects methylprednisolone on adrenocortical function,bone metabolism and glycolipid metabolism in patients with subacute thyroiditis.Methods 40 patients(30 females and 10 males)who were newly diagnosed with SAT in the endocrinology department of our hospital were given oral methylprednisolone at a starting dose of 16~24mgd,and gradually reduced the dose after treatment until the drug was stopped.Adrenocorticotropic hormone(ACTH)and Cortisol concentrations were measured by chemiluminescence before and after treatment every week,the dynamic changes of adrenal cortex function in patients were observed.Enzyme-Linked immunoassay(ELISA)method was used to determine the serum S-CTX and PINP before and after treatment.Fasting Blood Glucose(FBG),Triglyceride(TG),and Total Cholesterol(TC)were measured by oxidase method,GPO-POD method,enzymatic method,and direct chemiluminescence method,serum TT3?TT4 and thyroid stimulating hormone(TSH)concentrations were compared to compare the differences in biochemical indicators before and after treatment.Oral vitamin D calcium chewable tablets were given to 20 SAT patients as the vitamin D calcium group(group A),and the other 20 were nonvitamin D calcium group(group B).The differences in S-CTX and PINP levels between the two groups were recorded and recorded Visual Analogue Score(VAS)of pain before and after treatment.Results 1.(1)Overall observation In SAT patients,ACTH and cortisol were significantly decreased from 1th~4th weeks after methylprednisolone treatment(P <0.05),There was no significant difference between ACTH treatment from 5th~6th weeks after treatment compared with before treatment.(P> 0.05);Cortisol gradually returned to normal from 5th~6th weeks after treatment(reference value: 138 to 690 nmol / L),but it was still lower than the level before treatment and the difference was statistically significant(P <0.05).(2)Comparison of ACTH and Cortisol between different starting doses of methylprednisolone(1)16mg methylprednisolone: In SAT patients,ACTH and Cortisol were significantly decreased from 1th-3th weeks after methylprednisolone treatment(P <0.05),ACTH was not significantly different at week 4 compared with before treatment(P> 0.05).Cortisol gradually returned to normal at week 4 after treatment.it gradually returned to normal(reference value: 138~690nmol/L),but still lower than the level before treatment,and the difference was statistically significant(P<0.05);(2)20mg~24mg methylprednisolone: compared with before treatment,ACTH and cortisol decreased in the 1th to 4th weeks(P <0.05),ACTH increased in the 5th week(P> 0.05),Cortisol gradually returned to normal in the 6th week after treatment(5th week in a few patients)(reference value: 138~690nmol/L),but still lower than the pre-treatment level,the difference was statistically significant(P <0.05).2.The S-CTX and PINP of the two groups were increased and decreased after treatment(P <0.01),Additionally,the S-CTX of group A was slightly lower than that of group B,and the PINP group was slightly higher than group B after treatment,but the difference was not statistically significant between the two groups(P >0.05).3.After treatment,FBG increased slightly in SAT patients,the difference was not statistically significant(P> 0.05),and TC and TG were significantly increased(P> 0.05).4.The levels of TC,TG,and TSH increased,and TT3 and TT4 decreased.The difference was statistically significant(P <0.05).Conclusion 1.Adrenocortical function in SAT patients was significantly inhibited within 1 week of methylprednisolone treatment and gradually returned to normal at 4 and 6 weeks treatment.2.Methylprednisolone significantly increases bone resorption and inhibits bone formation in patients and supplementation of the vitamin D calcium has certain improvement.3.Methylprednisolone can significantly increase patients' blood lipid levels,but has no significant effect on blood glucose.4.After treatment,VAS in SAT patients was significantly reduced(P<0.01),serumTT3 and TT4 levels were decreased,and TSH levels were increased,and the difference was statistically significant(P <0.01).