分化型甲状腺癌长期TSH抑制治疗对绝经后健康结局的影响
本研究为横断面研究，纳入107例全甲状腺切除后接受TSH抑制治疗≥3年的绝经后分化型甲状腺癌（DTC）患者、80例左甲状腺素（LT4）替代治疗的甲状腺功能减退患者和97例甲状腺功能正常对照。结果显示DTC组LE8评分、UQoL评分更低，cIMT更高，骨质疏松患病率更高，肌肉量更少；累积LT4剂量与更低LE8和UQoL评分独立相关，而较高血清TSH水平与两者正相关。结论提示长期TSH抑制可能对绝经后健康产生不良影响，尤其低风险无病患者应避免不必要的长期抑制。
要点
- DTC长期TSH抑制患者绝经后心血管健康、生活质量、骨密度及肌肉量均差于对照。
- 累积LT4剂量越高，LE8和UQoL评分越低；血清TSH越高，两者评分越高。
- 低风险无病DTC绝经后女性应避免不必要的长期TSH抑制。
核心结论
- 长期TSH抑制可能对绝经后健康产生不良影响，尤其低风险无病DTC女性。
- 临床应避免不必要的长期TSH抑制，更年期特异性评估工具可用于仍需抑制者的补充评估。
研究设计与样本
- 横断面研究，纳入三组绝经后女性：107例DTC全甲状腺切除后TSH抑制≥3年、80例原发性甲减LT4替代、97例甲功正常对照。
- 排除认知障碍、骨质疏松史或心血管疾病者。
主要发现
- DTC组LE8评分、UQoL评分显著低于其他两组，cIMT值更高（p均<0.001）。
- DTC组骨质疏松患病率更高（p=0.003），肌肉量减少（p=0.017）。
- 多变量回归：累积LT4剂量与更低LE8评分（β=-0.354，p<0.001）和UQoL评分（β=-0.396，p<0.001）独立相关。
- 较高血清TSH水平与更高LE8评分（β=0.271，p=0.002）和UQoL评分（β=0.487，p<0.001）正相关。
临床怎么用
- 对低风险、无病DTC绝经后女性，应避免不必要的长期TSH抑制。
- 对仍需TSH抑制者，可考虑用更年期特异性工具评估心血管健康、生活质量、肌肉和骨骼。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: There is uncertainty regarding whether thyroid-stimulating hormone (TSH) suppression therapy in postmenopausal women with differentiated thyroid cancer (DTC) is associated with menopause-specific health concerns. This study aimed to determine whether prolonged TSH suppression confers an additional burden on postmenopausal health by comprehensively evaluating cardiovascular health (CVH), quality of life (QoL), muscle mass, and bone health using menopause-specific assessment tools. METHODS: A cross-sectional study was conducted involving three groups of postmenopausal women 107 patients with DTC receiving TSH suppression therapy following total thyroidectomy for ≥3 years, 80 women receiving levothyroxine (LT4) replacement for primary hypothyroidism, and 97 euthyroid controls. Women with cognitive impairment, a history of osteoporosis, or cardiovascular disease were excluded. CVH was assessed using Life's Essential 8 (LE8) score, carotid intima-media thickness (cIMT), and electrocardiography. QoL was assessed using the Utian QoL (UQoL) Scale, cognition by the Mini-Mental State Examination, body composition by bioelectrical impedance analysis, and bone density by dual-energy X-ray absorptiometry. RESULTS: Women with DTC demonstrated significantly lower LE8 scores, lower UQoL scores, higher cIMT values, higher prevalence of osteoporosis, and reduced muscle mass than those in the other two groups (p < 0.001, p < 0.001, p < 0.001, p = 0.003, and p = 0.017, respectively). Multivariable regression analysis revealed that cumulative LT4 dose was independently associated with lower LE8 and UQoL scores (β = -0.354, p < 0.001; and β = -0.396, p < 0.001, respectively), while higher serum TSH levels were positively associated with both LE8 and UQoL scores (β = 0.271, p = 0.002; and β = 0.487, p < 0.001, respectively). CONCLUSIONS: Prolonged TSH suppression may adversely affect postmenopausal health, particularly in low-risk, disease-free women with DTC. The primary clinical implication of these findings is the need to avoid unnecessary long-term TSH suppression. Menopause-specific assessment tools may have a complementary role in selected patients in whom TSH suppression remains clinically indicated.
引用
- Candemir B, Akın S, Candemir M, et al. Menopause-Related Health Outcomes in Women with Differentiated Thyroid Carcinoma Receiving Long-Term TSH Suppression after Total Thyroidectomy. Thyroid. 2026. PMID: 41969134. doi:10.1177/10507256261442839
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。