Ardawi Mohammed Salleh M, Nasrat Hassan A, Rouzi Abdulrahim A, Mustafa Bader E
Department of Clinical Biochemistry and Laboratory of Medicine, New Jeddah Clinic Hospital, Kingdom of Saudi Arabia.
Saudi Med J. 2002 Jun;23(6):651-7.
To evaluate the relative importance of thyroid hormones and human chorionic gonadotropin in relation to the risk of gestational thyrotoxicosis in Saudi women living in Jeddah, Kingdom of Saudi Arabia.
A prospective study was conducted on Saudi healthy pregnant women (N=406) at 12-15 weeks of gestation and compared with healthy non-pregnant controls (N=200). Maternal serum levels of free thyroxine free triiodothyronine, thyrotropin, human chorionic gonadotropin and free b-human chorionic gonadotropin together with urinary iodine excretion were determined. Analysis of variance was used to examine differences among the groups for different variables and the Bonferroni criterion was used when significance tests were made.
Pregnant women were classified into 2 groups according to the lower limit of serum thyrotropin levels in non-pregnant euthyroid controls at >= 0.3 mIU/L (Group one) or < 0.30 mIU/L (Group 2). Suppressed levels of serum thyrotropin (< 0.30 mIU/L) were found in 11.1% of pregnant women which was accompanied by significant increases in free thyroxine (P<0.001), free triiodothyronine (P < 0.05), human chorionic gonadotropin (P<0.001) and b-human chorionic gonadotropin (P<0.001). A significant negative correlation between serum levels of thyrotropin and that of human chorionic gonadotropin (r=-0.381, P<0.001) was observed. The relative risk of having a serum thyrotropin level of < 0.30 mIU/L was 4.89 (P<0.001) for the pregnant women examined as compared with non-pregnant controls. Approximately 5.6% of the women examined exhibited biochemical evidence of thyrotoxicosis.
The results of the present study show that Saudi pregnant women are at risk of developing biochemical evidence of thyrotoxicosis during early gestation, and thus, are likely to be at greater risk of clinically evident gestational thyrotoxicosis and hyperemesis gravidarum. Genetically determined differences in the synthesis or metabolism of human chorionic gonadotropin isoforms, or both may contribute to this increased risk.
评估甲状腺激素和人绒毛膜促性腺激素与沙特阿拉伯王国吉达市沙特女性妊娠甲状腺毒症风险的相对重要性。
对406名妊娠12 - 15周的沙特健康孕妇进行前瞻性研究，并与200名健康非孕妇对照组进行比较。测定孕妇血清游离甲状腺素、游离三碘甲状腺原氨酸、促甲状腺激素、人绒毛膜促性腺激素和游离β-人绒毛膜促性腺激素水平以及尿碘排泄量。采用方差分析检验不同组间不同变量的差异，进行显著性检验时使用邦费罗尼标准。
根据非妊娠甲状腺功能正常对照组血清促甲状腺激素水平下限≥0.3 mIU/L（第一组）或<0.30 mIU/L（第二组），将孕妇分为两组。11.1%的孕妇血清促甲状腺激素水平降低（<0.30 mIU/L），同时游离甲状腺素（P<0.001）、游离三碘甲状腺原氨酸（P < 0.05）、人绒毛膜促性腺激素（P<0.001）和β-人绒毛膜促性腺激素（P<0.001）显著升高。观察到血清促甲状腺激素水平与人绒毛膜促性腺激素水平之间存在显著负相关（r=-0.381，P<0.001）。与非孕妇对照组相比，所检查孕妇血清促甲状腺激素水平<0.30 mIU/L的相对风险为4.89（P<0.001）。约5.6%的受检女性表现出甲状腺毒症的生化证据。
本研究结果表明，沙特孕妇在妊娠早期有发生甲状腺毒症生化证据的风险，因此，临床明显的妊娠甲状腺毒症和妊娠剧吐的风险可能更高。人绒毛膜促性腺激素异构体合成或代谢的遗传决定差异，或两者都可能导致这种风险增加。
