MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH HO CHI MINH CITY UNIVERSITY OF MEDICINE AND PHARMACY
LAM VAN HOANG
ASSESSMENT OF BONE DENSITY AND CHANGES IN BONE METABOLISM MARKERS OSTEOCALCIN, s-CTx
IN PATIENTS WITH HYPERTHYROIDISM
DOCTORAL THESIS IN MEDICINE
Ho Chi Minh City – 2017
MINISTRY OF EDUCATION AND TRAINING MINISTRY OF HEALTH
HO CHI MINH CITY UNIVERSITY OF MEDICINE AND PHARMACY
LAM VAN HOANG
ASSESSMENT OF BONE DENSITY AND CHANGES IN BONE METABOLISM MARKERS OSTEOCALCIN, s-CTx
IN PATIENTS WITH HYPERTHYROIDISM
DOCTORAL THESIS IN MEDICINE
Major: Endocrinology Code: 62720145
Scientific supervisor: Associate Professor, Dr. NGUYEN THY KHUE
Ho Chi Minh City – 2017
COMMITMENT
I hereby declare that this thesis is my own research work. The data and results presented in the thesis are true and have never been published in any other work.
LAM VAN HOANG |
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INDEX
COVER PAGE GUARANTEE
TABLE OF CONTENTS i
LIST OF ABBREVIATIONS iii
ENGLISH – VIETNAMESE TRANSLATION TABLE vi
LIST OF TABLES vii
LIST OF FIGURES ix
PROBLEM STATEMENT 1
CHAPTER 1 - DOCUMENT OVERVIEW 4
1.1. Osteoporosis 4
1.2. Thyroid and bone diseases 25
1.3. Studies linking hyperthyroidism and osteoporosis. 29
CHAPTER 2 - RESEARCH SUBJECTS AND METHODS 34
2.1. Research subjects 34
2.2. Research methods 35
2.3. Data processing 41
2.4. Ethics in research 42
CHAPTER 3 - RESULTS 43
3.1. General characteristics of research subjects 43
3.2. Rate of osteoporosis in hyperthyroid patients before and after treatment 49
3.3. Changes in bone density and bone metabolism markers after 12 months of hyperthyroidism treatment 51
3.4. Relationship between thyroid hormones, bone metabolism markers and bone density 58
CHAPTER 4 - DISCUSSION 65
4.1. Characteristics of the study population 65
4.2. Rate of osteoporosis in hyperthyroid patients 70
4.3. Changes in bone density of the study subjects after 12 months of treatment72
4.4. Changes in bone metabolism markers before and after 12 months of hyperthyroidism treatment 84
4.5. Relationship between variables and bone density 90
4.6. Advantages and limitations of research 98
CONCLUSION 99
PROPOSAL 101
LIST OF PUBLISHED WORKS RELATED TO THE THESIS REFERENCES
APPENDIX 1. CONSENT FORM FOR PARTICIPATING IN THE RESEARCH APPENDIX 2. RESEARCH INFORMATION COLLECTION FORM APPENDIX 3. BONE DENSITY MONITORING TABLE
APPENDIX 4. ILLUSTRATION OF BONE DENSITY MEASUREMENT AND RESULTS OF BONE METABOLISM MARKER TEST.
APPENDIX 5. LIST OF RESEARCH PARTICIPANTS
LIST OF ABBREVIATIONS
Acronym
ALP | Alkaline Phosphatase |
BMI | Body Mass Index |
BMD | Bone Mineral Density |
BMP-s | Bone Morphogenetic Proteins |
BALP | Bone specific Alkaline Phosphatase |
BSP | Bone Sialoprotein |
BMC | Bone Mineral Content |
BMR | Basic Metabolism Rate |
CSF-1 | Colony Stimulating Factor 1 |
CTP | Carboxy terminal propeptide |
s- CTx | Serum Collagen type 1 cross – linked C – telopeptide 1 |
CLIA | Chemiluminescence Immunoassay |
CS | Spine |
DMP-1 | Dentin Matrix acidic Phosphoprotein 1 |
DIT (T2) | Diiodotyrosine |
DPA | Dual – Photon Absortiometry |
DPD | Deoxypyridinoline |
DXA | Dual-energy X-ray Absorbiometry |
DLC | Standard deviation |
EIA | enzyme immunoassay |
ECLIA | Electro-chemiluminescence immunoassay |
ELISA | Enzyme-Linked Immunosorbent Assay |
FT3
Free Triiodothyronine | |
FT4 | Free Thyroxine |
FGF-3 | Fibroblast Growth Factor 3 |
FGF | Fibroblast Growth Factor |
GH | Growth Hormone |
GHL | Galactosyl – Hydroxylysine |
GGHL | Glycosyl galactosyl – Hydroxylysin |
G-CSF | Granulocyte Colony-Stimulating Factor |
GM-CSF | Granulocyte-Macrophage Colony-Stimulating Factor |
HSHQ | Regression coefficient |
ICTP | Carboxyterminal Type I Collagen Telopeptide |
IGF | Insulin-like Growth Factor |
IL | Interleukin |
IL-1 TNF | Interleukin-1 Tumor Necrosis Factor |
IRMA | Immunoradiometric Assay |
95% confidence interval | 95% confidence interval |
LRP5 | Low-Density Lipoprotein Receptor-Related Protein 5 |
Max | Maximum |
MLX | Bone density |
Min | Minimum |
MIT (T1) | Mono-iodotyrosine |
MRI | Magnetic Resonance Imaging |
NTP | N-Terminal Peptide |
OHP | Hydroxyproline |
OPG | Osteoprotegin |
PICP
Carbon – Carboxy © Terminal Propeptide | |
PINP | N – Amino (N) Terminal Propeptide |
PTH | Parathyroid Hormone |
PYD | Hydroxypyridium |
QCT | Quantitative Computed Tomography |
R | Correlation coefficient |
RANKL | Receptor Activator of Nuclear factor Kappa-B Ligand |
RIA | Radioimmunoassay |
RT3 | Reverse T3 |
SD | Standard Deviation |
SPA | Single Photon Absortiometry |
SSC | Standard error |
SXA | Single-energy X-ray Absorbiometry |
TB | Medium |
T3 | Triiodothyronine |
T4 | Thyroxine |
TNF | Tumor Necrosis Factor |
TSH | Thyroid Stimulating Hormone |
TRa, TRb | Thyroid hormone receptor a, Thyroid hormone receptor b |
X | Average value |
XĐ | Femur |
WHO | World Health Organization |