Barış AKINCI, Tevfik DEMİR, Abdurrahman ÇÖMLEKÇİ, Oğuzhan KARAOĞLU, Mustafa SEÇİL, Sena YEŞİL

Menopoz öncesinde selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik metabolizmasına etkisi

Amaç: Bu prospektif çalışmada, menopoz öncesi kadınlarda selim tiroid nodülleri için uygulanan levotiroksin supresyon tedavisinin kemik döngüsü belirteçleri üzerine etkisi incelendi.Hastalar ve Yöntemler: Çalışmaya, selim tiroid nodülü nedeniyle bir yıl boyunca levotiroksin supresyon tedavisi uygulanan, menopoz öncesi 28 kadın hasta alındı. Levotiroksin supresyon tedavisi öncesi ve sonrasında tiroid bezi ve nodül boyutları, kemik döngüsünün biyokimyasal göstergeleri ve üriner kalsiyum atılımları ölçüldü.Bulgular: Takip süresince tedaviyle ilgili ciddi bir yan etki gözlenmedi. Tedavi sonucunda toplam tiroid hacminde ve nodül büyüklüğündeki azalmalar anlamlı değildi. Levotiroksin supresyon tedavisi ile serum kalsiyum, fosfor düzeyleri ve üriner kalsiyum atılımında farklılık görülmemesine karşın, kemik döngüsü göstergeleri olan serum osteokalsin ve üriner deoksipiridinolin düzeyleri anlamlı artış gösterdi. Serum intakt paratiroid hormon düzeylerinde hafif bir azalma gözlenmekle birlikte, bu farklılık anlamlı bulunmadı.Sonuç: Çalışmamızdan elde edilen veriler, selim tiroid nodülü nedeniyle menopoz öncesi kadınlarda uygulanan levotiroksin supresyon tedavisinin hem osteoblastik hem de osteoklastik aktiviteyi artırdığını göstermektedir

Anahtar Kelimeler:

Kemik yoğunluğu/ilaç etkisi, menopoz öncesi, tiroid nodülü/ilaç tedavisi, tiroksin/terapötik kullanım/yan etki

The effect of levothyroxine suppression therapy for benign thyroid nodules on bone metabolism in premenopausal women

Objectives: This prospective study was designed to investigate the effect of levothyroxine suppression therapy for benign thyroid nodules on markers of bone turnover in premenopausal women. Patients and Methods: The study included 28 premenopausal women who received levothyroxine suppression therapy for benign thyroid nodules for one year. The size of the thyroid gland and nodules, biochemical markers of bone turnover and urinary calcium excretion were measured before and after levothyroxine suppression therapy. Results: No significant adverse effects were seen during levothyroxine treatment. Decreases in total thyroid volume and the size of the nodules were not significant at the end of treatment. Although levothyroxine suppression therapy did not result in changes in serum levels of calcium and phosphor, and urinary calcium excretion, bone turnover markers, namely serum osteocalcin and urinary deoxypyridinoline levels, increased significantly. Serum intact parathyroid hormone levels showed a minimal decrease, which was not statistically significant. Conclusion: Data from our study suggest that levothyroxine suppression therapy is associated with increased osteoblastic and osteoclastic activity in premenopausal women with benign thyroid nodules.

Keywords:

Bone density/drug effects, premenopause, thyroid nodule/drug therapy, thyroxine/therapeutic use/ adverse effects,

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