Background: While TSH suppression is essential in patients with differentiated thyroid cancer (DTC) to reduce the risk of recurrence, it has also been linked to side effects, particularly a reduction in bone mineral density that may contribute to osteoporosis. However, previous studies investigating this association have yielded inconsistent results. This study aimed to evaluate bone density using Hounsfield units from PET/CT scans in a longitudinal analysis including both sexes.Methods: Patients with DTC under continuous TSH suppression who underwent two PET/CT scans were included. Hounsfield units were measured for each lumbar vertebra (L1–L5) in the CT by placing an elliptical region of interest (ROI) in the center of the vertebra, avoiding hyperdense edges. Laboratory parameters were also collected.Results: A total of 50 patients were included in the study (25 male, 25 female), with a mean age of 57.2 (±15.3) years at the time of the first scan. The mean duration of TSH suppression before the first scan was 3.7 ± 3.9 years, and the mean interval between both scans was 4.4 ± 4.0 years. At the follow-up scan, bone density was significantly lower compared with baseline for all lumbar vertebrae (L1–L5 combined and individually) (allp< 0.05). Subgroup analysis revealed a significant decline in women at L1, L2, L4, and L5 and for overall lumbar bone density, while men showed nonsignificant trends.Conclusions: Our study suggests a sustained reduction in vertebral bone density during TSH suppression. The results support routine monitoring in both sexes, risk stratification by age and duration of suppression, and, when oncologically appropriate, consideration of lower suppression intensity or initiation of bone-protective therapy in high-risk patients.
背景：虽然促甲状腺激素（TSH）抑制对降低分化型甲状腺癌（DTC）患者的复发风险至关重要，但它也与副作用相关，特别是可能导致骨质疏松的骨密度降低。然而，既往探讨该关联的研究结果并不一致。本研究旨在通过包含两性的纵向分析，利用PET/CT扫描的亨氏单位评估骨密度。 方法：研究纳入持续接受TSH抑制治疗且进行过两次PET/CT扫描的DTC患者。在CT图像中，通过在椎体中心放置椭圆形感兴趣区（ROI）并避开高密度边缘，测量每个腰椎（L1-L5）的亨氏单位。同时收集实验室参数。 结果：研究共纳入50例患者（25例男性，25例女性），首次扫描时平均年龄为57.2（±15.3）岁。首次扫描前TSH抑制的平均持续时间为3.7 ± 3.9年，两次扫描的平均间隔时间为4.4 ± 4.0年。在随访扫描中，所有腰椎（L1-L5合并及单独）的骨密度均较基线显著降低（所有p < 0.05）。亚组分析显示，女性在L1、L2、L4、L5及总体腰椎骨密度上均出现显著下降，而男性则显示出不显著的趋势。 结论：我们的研究表明，在TSH抑制期间椎体骨密度持续降低。结果支持对两性患者进行常规监测，根据年龄和抑制持续时间进行风险分层，并在肿瘤学条件允许时，考虑对高风险患者降低抑制强度或启动骨保护治疗。
肿瘤(癌症)患者之家