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首页> 美国卫生研究院文献>Journal of Thyroid Research >Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism
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Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

机译：对亚临床甲状腺功能减退症甲状腺激素替代治疗妊娠结局的有益作用

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Background. Hypothyroidism and raised thyroid antibody levels have been associated with adverse obstetrical outcomes. Several studies have investigated causal associations, but results have been inconsistent and few studies have reported the effects of thyroxine replacement therapy on pregnancy outcomes in hypothyroid patients. Objective. The primary study objective was to determine the outcome of pregnancies in women diagnosed with overt and subclinical hypothyroidism (SCH) (serum TSH > 2.5 mIU/L) and those with elevated circulating thyroid autoantibody levels in the first trimester of pregnancy and after the institution of appropriate thyroxine replacement therapy to maintain the serum TSH ≤ 2.5 mIU/L. Study Design. This prospective observational study was undertaken between 2013 and 2016. Blood samples were taken from 1025 women at presentation for thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TGAb), and thyroid peroxidase antibodies (TPOAb). Those with a TSH > 2.5 mIU/L were treated with thyroxine and managed appropriately to ensure that the TSH was maintained ≤2.5 mIU/L. Outcomes in these patients were compared to those in euthyroid patients. Maternal antenatal complications and perinatal outcomes were recorded. Results. There were a total of 1025 patients of whom 382 (37.5%) were nulliparous. 10.1% had a TSH level > 2.5 mIU/L and 18.2% had at least one raised thyroid antibody level. No differences in adverse outcomes of pregnancy were evident in women treated for SCH or overt hypothyroidism compared to the euthyroid group. There was also no association between raised thyroid antibodies and adverse pregnancy outcomes in either group. Conclusion. There were no adverse outcomes of pregnancy found in pregnant women who had been diagnosed and treated with thyroxine for SCH at the time of presentation when compared to euthyroid patients. There was also no relationship with thyroid antibodies and adverse pregnancy outcomes in the two groups. It is not possible to unequivocally advocate for thyroxine replacement in pregnant women with subclinical and overt hypothyroidism until large scale randomized controlled trials are performed.
机译：背景。甲状腺功能减退和甲状腺抗体水平升高与不良的产科预后相关。几项研究调查了因果关系，但结果不一致，很少有研究报道甲状腺素替代疗法对甲状腺功能减退患者妊娠结局的影响。目的。初步研究的目的是确定在妊娠前三个月和分娩后被诊断为明显和亚临床甲状腺功能低下（SCH）（血清TSH>2.5μmIU/ L）和循环甲状腺自身抗体水平升高的女性的妊娠结局。适当的甲状腺素替代疗法，以维持血清TSH≤2.5 mIU / L。学习规划。这项前瞻性观察性研究于2013年至2016年进行。从1025名妇女的血液样本中抽取了甲状腺刺激激素（TSH），抗甲状腺球蛋白抗体（TGAb）和甲状腺过氧化物酶抗体（TPOAb）。 TSH> 2.5 mIU / L的患者用甲状腺素治疗并进行适当管理，以确保TSH维持≤2.5mIU / L。将这些患者的结果与正常甲状腺患者的结果进行比较。记录产前产前并发症和围产期结局。结果。共有1025例患者，其中382例（37.5％）为未产妇。 TSH水平>2.5μmIU/ L的占10.1％，甲状腺抗体水平至少一种升高的占18.2％。与正常甲状腺组相比，接受SCH或明显甲状腺功能减退的妇女在妊娠不良结局方面无明显差异。两组中甲状腺抗体升高与不良妊娠结局之间也没有关联。结论。与甲状腺功能正常的患者相比，在出院时已被甲状腺素确诊为SCH的孕妇中，没有发现怀孕的不良后果。两组中与甲状腺抗体和不良妊娠结局也没有关系。在进行大规模的随机对照试验之前，不可能明确主张亚临床和明显甲状腺功能减退的孕妇应更换甲状腺素。

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