Rodien Patrice, Jordan Nicola, Lefèvre Anne, Royer Julien, Vasseur Claudine, Savagner Frédérique, Bourdelot Aline, Rohmer Vincent
Service d'Endocrinologie, INSERM EMI U0018, Centre Hospitalier Universitaire d'Angers, Angers, France.
Hum Reprod Update. 2004 Mar-Apr;10(2):95-105. doi: 10.1093/humupd/dmh008.
Pregnancy induces physiological alterations in thyroid function which may make difficult the interpretation of results of thyroid hormone measurement. A state of hyperstimulation of the thyroid gland is common in early pregnancy. In a few cases, thyroid hormone values will deviate from the normal range, which corresponds to the gestational transient thyrotoxicosis. This syndrome is closely associated with hyperemesis gravidarum. The relationship between the two syndromes, demonstrated by epidemiological studies, has been illustrated by an exceptional case of familial recurrent gestational thyrotoxicosis presenting as hyperemesis gravidarum due to hypersensitivity of the thyrotrophin receptor to hCG. However, the exact mechanisms of hyperemesis gravidarum have not yet been identified. Gestational transient thyrotoxicosis has to be distinguished from Graves' disease, because the latter is associated with potential maternal and fetal complications when thyrotoxicosis is not controlled, whereas the former has usually a favourable outcome. The existence of other cases of thyroid hypersensitivity or hCG endowed with abnormal thyrotrophic activity is suspected. They may be identified only by assessment of the thyroid function in cases of hyperemesis gravidarum. The identification of these cases would be helpful to understand the mechanisms of specificity of glycoprotein hormone receptors.
妊娠会引起甲状腺功能的生理改变，这可能会使甲状腺激素测量结果的解读变得困难。甲状腺过度刺激状态在妊娠早期很常见。在少数情况下，甲状腺激素值会偏离正常范围，这与妊娠期一过性甲状腺毒症相对应。这种综合征与妊娠剧吐密切相关。流行病学研究表明的这两种综合征之间的关系，已通过一例家族性复发性妊娠期甲状腺毒症的特殊病例得到说明，该病例表现为由于促甲状腺素受体对人绒毛膜促性腺激素（hCG）过敏而导致的妊娠剧吐。然而，妊娠剧吐的确切机制尚未明确。妊娠期一过性甲状腺毒症必须与格雷夫斯病相区分，因为当甲状腺毒症未得到控制时，后者会伴有潜在的母婴并发症，而前者通常预后良好。怀疑存在其他甲状腺过敏或具有异常促甲状腺活性的hCG病例。只有通过对妊娠剧吐患者的甲状腺功能进行评估才能识别出这些病例。识别这些病例将有助于理解糖蛋白激素受体特异性的机制。
