Department of Pediatrics, Division of Endocrinology, Oregon Health and Science University, Portland, Oregon 97239, USA.
Curr Opin Endocrinol Diabetes Obes. 2010 Feb;17(1):1-7. doi: 10.1097/MED.0b013e328333b0b2.
The purpose of this review is to briefly summarize current knowledge of fetal and neonatal thyroid function, and then to summarize the most significant new findings over the last year that add to our knowledge of the cause, diagnosis, and management of fetal and neonatal thyroid disorders.
Significant findings from publications in the last year include a report that inadequate iodine intake during pregnancy exists in many parts of the world. Conversely, maternal exposure to iodinated contrast agents did not affect neonatal thyroid function. A small lowering in the screening of thyroid-stimulating hormone cutoff resulted in nearly a doubling of the birth prevalence of congenital hypothyroidism, but more cases had a thyroid gland 'in situ'. Partial iodination defects are relatively common causes of dyshormonogenesis. Tailoring the initial starting levothyroxine dose to severity of hypothyroidism resulted in rapid normalization of thyroid function. Although consensus guidelines recommend an initial starting dose in the 10-15-mug/kg/day range, the Cochrane collaborative did not find sufficient evidence from randomized controlled trials to confirm the high-dose recommendation. Under or overtreatment of childhood hypothyroidism appears to adversely impact adult cardiovascular function. Adults with congenital hypothyroidism are more likely to have quality of life issues.
Investigations of the impact of iodine and thyroid hormone transfer continue to improve our knowledge of maternal-fetal thyroid relationships. Screening programs to detect and treat newborns with congenital hypothyroidism have resulted in a dramatic improvement in neurocognitive outcome. Nevertheless, debate continues on the optimal screening test approach and thyroid hormone treatment.
本文旨在简要概述胎儿和新生儿甲状腺功能的现有知识，然后总结过去一年中关于胎儿和新生儿甲状腺疾病病因、诊断和治疗的重要新发现，以增加我们的知识。
过去一年发表的研究中有一些重要发现，包括报告显示，世界上许多地方的孕妇碘摄入不足。相反，母亲接触碘造影剂不会影响新生儿的甲状腺功能。甲状腺刺激激素（TSH）筛查切点降低，导致先天性甲状腺功能减退症的出生患病率几乎翻了一番，但更多的病例甲状腺“原位”存在。部分碘化缺陷是导致甲状腺功能障碍的常见原因。根据甲状腺功能减退症的严重程度调整左甲状腺素的初始起始剂量可迅速使甲状腺功能正常化。尽管共识指南建议初始起始剂量在 10-15μg/kg/天范围内，但 Cochrane 协作并未从随机对照试验中找到足够的证据来证实高剂量建议。儿童甲状腺功能减退症的治疗不足或过度治疗似乎对成年人心血管功能产生不利影响。先天性甲状腺功能减退症的成年人更有可能出现生活质量问题。
对碘和甲状腺激素转运的影响的研究不断提高我们对母婴甲状腺关系的认识。筛查和治疗新生儿先天性甲状腺功能减退症的筛查项目显著改善了神经认知结局。然而，关于最佳筛查检测方法和甲状腺激素治疗仍存在争议。
