Negro R, Formoso G, Coppola L, Presicce G, Mangieri T, Pezzarossa A, Dazzi D
Department of Endocrinology, AUSL LE/1, P.O. V. Fazzi, Piazza F. Muratore, 73100 Lecce, Italy.
J Endocrinol Invest. 2007 Jan;30(1):3-8. doi: 10.1007/BF03347388.
Thyroid dysfunction and the presence of thyroid antibodies increase the risk of infertility and miscarriage. The aim of the present study was to assess if patients with autoimmune thyroid disease undergoing assisted reproduction technologies (ART) are afflicted by poor pregnancy and/or delivery rate and if the outcome is conditioned by pre-ART thyroid status. The study was retrospective (from January 2000 to January 2005) and was carried out at the Division of Physiopathology of Human Reproduction. Women who underwent ART were tested for TSH, free T4 (FT4), thyroid peroxidase antibodies (TPOAb) before and during pregnancy. A total of 416 euthyroid women were selected; 42 (10.1%) were TPOAb (+). Women >35 yr were excluded. The endpoints were pregnancy and delivery rates.
no differences in pregnancy and delivery rates were observed between women with and without antibodies. In TPOAb (+), women who failed to become pregnant or miscarried displayed higher TSH values before ART (2.8 mIU/l) compared to the ones who delivered (1.6 mIU/l; p=0.032) and compared to TPOAb (-) (1.1 mIU/l; p=0.018).
in euthyroid women undergoing ART the pregnancy and delivery rates are not affected by the presence of TPOAb. In TPOAb (+) high-normal TSH values are associated with increased risk of unsuccessful pregnancy or subsequent miscarriage. Further studies are required to ascertain possible benefits of levo-T4 (L-T4) in such patients.
甲状腺功能障碍及甲状腺抗体的存在会增加不孕和流产的风险。本研究的目的是评估接受辅助生殖技术（ART）的自身免疫性甲状腺疾病患者是否受孕率和/或分娩率较低，以及该结果是否受ART前甲状腺状态的影响。该研究为回顾性研究（2000年1月至2005年1月），在人类生殖生理病理学部门进行。接受ART的女性在怀孕前及怀孕期间检测促甲状腺激素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）。共选取416名甲状腺功能正常的女性；42名（10.1%）为TPOAb阳性。排除年龄>35岁的女性。观察终点为受孕率和分娩率。
有抗体和无抗体的女性在受孕率和分娩率上未观察到差异。在TPOAb阳性女性中，未受孕或流产的女性在ART前的TSH值（2.8 mIU/l）高于分娩的女性（1.6 mIU/l；p=0.032），且高于TPOAb阴性女性（1.1 mIU/l；p=0.018）。
在接受ART的甲状腺功能正常的女性中，TPOAb的存在不影响受孕率和分娩率。在TPOAb阳性女性中，TSH值略高于正常与妊娠失败或随后流产的风险增加相关。需要进一步研究以确定左甲状腺素（L-T4）对此类患者可能的益处。
