Glinoer D, Soto M F, Bourdoux P, Lejeune B, Delange F, Lemone M, Kinthaert J, Robijn C, Grun J P, de Nayer P
Department of Endocrinology, Saint-Pierre Hospital, Université Libre de Bruxelles, Belgium.
J Clin Endocrinol Metab. 1991 Aug;73(2):421-7. doi: 10.1210/jcem-73-2-421.
A prospective study was undertaken during pregnancy in 120 euthyroid women presenting with mild thyroid abnormalities (TA): 11 with a past history of thyroid disorder, 44 with goiter, 20 with nodules, and 45 with thyroid autoantibodies. The aims of the study were to assess whether the pattern of thyroid alterations during gestation was different in women with TA compared to that in healthy control pregnant subjects and to evaluate possible obstetrical and neonatal repercussions. The overall prevalence of underlying subtle thyroid abnormalities in the cohort was 17%, probably as the result of the environmental moderately low iodine intake. Despite the intrinsic heterogeneity of the four groups of women with TA, the adaptation of the thyroid to the stress of pregnancy was different from that of the control subjects. Noteworthy were 1) the marked elevation of serum thyroglobulin in women with past history of thyroid disorder, goiter and thyroid nodules; 2) the increase in goiter size in a third of the goitrous women, associated with biochemical evidence of functional stimulation of the gland; 3) the indirect evidence of partial thyroidal autonomy in goitrous patients; and 4) the increase in the number and size of thyroid nodules during gestation. Taken together, the data indicated that pregnancy was associated with a greater thyroidal risk in patients with TA compared to healthy subjects. In relation to thyroid autoimmunity, most patients remained euthyroid during gestation, but in a few cases, TSH was elevated at delivery, suggesting diminished thyroidal reserve. Also, 40% of newborns from mothers with thyroid autoimmunity had elevated thyroid peroxidase antibody titers at birth, and there was a highly significant correlation between maternal and neonatal thyroid peroxidase antibody titers. Finally, thyroid autoimmunity was clearly associated with an increased risk of spontaneous abortion (13.3 vs. 3.3%; P less than 0.001). Thyroid function in newborns from mothers with TA was normal and not different from that in controls; similarly, obstetrical features were similar in patients with TA and control subjects. In conclusion, pregnancy is associated with a greater thyroidal risk in women with TA, thereby emphasizing a potential link between pregnancy and thyroid disorders. It is recommended that patients with known, even subtle, thyroid abnormalities be closely monitored during pregnancy, in particular those with a goiter, nodules, or thyroid autoimmunity, especially in areas with a moderately low iodine intake, where the prevalence of mild thyroid disturbances is high.
对120例患有轻度甲状腺异常（TA）的甲状腺功能正常孕妇进行了一项前瞻性研究：11例有甲状腺疾病病史，44例有甲状腺肿，20例有结节，45例有甲状腺自身抗体。该研究的目的是评估与健康对照孕妇相比，TA孕妇在妊娠期甲状腺改变模式是否不同，并评估可能的产科和新生儿影响。队列中潜在的轻微甲状腺异常总体患病率为17%，可能是环境中碘摄入量适度偏低的结果。尽管患有TA的四组女性存在内在异质性，但甲状腺对妊娠应激的适应性与对照受试者不同。值得注意的是：1）有甲状腺疾病病史、甲状腺肿和甲状腺结节的女性血清甲状腺球蛋白显著升高；2）三分之一的甲状腺肿女性甲状腺肿大小增加，伴有腺体功能刺激的生化证据；3）甲状腺肿患者存在部分甲状腺自主性的间接证据；4）妊娠期甲状腺结节数量和大小增加。总体而言，数据表明与健康受试者相比，TA患者妊娠时甲状腺风险更高。关于甲状腺自身免疫，大多数患者在妊娠期甲状腺功能正常，但在少数情况下，分娩时促甲状腺激素升高，提示甲状腺储备减少。此外，甲状腺自身免疫母亲的新生儿中有40%出生时甲状腺过氧化物酶抗体滴度升高，母亲和新生儿甲状腺过氧化物酶抗体滴度之间存在高度显著的相关性。最后，甲状腺自身免疫显然与自然流产风险增加相关（13.3%对3.3%；P<0.001）。TA母亲的新生儿甲状腺功能正常，与对照组无差异；同样，TA患者和对照受试者的产科特征相似。总之，妊娠与TA女性更高的甲状腺风险相关，从而强调了妊娠与甲状腺疾病之间的潜在联系。建议已知有甲状腺异常（即使是轻微异常）的患者在妊娠期间密切监测，特别是那些有甲状腺肿、结节或甲状腺自身免疫的患者，尤其是在碘摄入量适度偏低、轻度甲状腺疾病患病率高的地区。
