孕期左甲状腺素治疗：适应证、疗效及治疗方案
Levothyroxine treatment in pregnancy: indications, efficacy, and therapeutic regimen.
作者信息
Klubo-Gwiezdzinska Joanna, Burman Kenneth D, Van Nostrand Douglas, Wartofsky Leonard
机构信息
Section of Endocrinology, Department of Medicine, Washington Hospital Center, Washington, DC 20010, USA.
出版信息
J Thyroid Res. 2011;2011:843591. doi: 10.4061/2011/843591. Epub 2011 Aug 25.
Abstract
The prevalence of overt and subclinical hypothyroidism during pregnancy is estimated to be 0.3-0.5% and 2-3%, respectively. Thyroid autoantibodies are found in 5-18% of women in the childbearing age. The aim of this review is to underscore the clinical significance of these findings on the health of both the mother and her offspring. Methods of evaluation of thyroid function tests (TFTs) during pregnancy are described as are the threshold values for the diagnosis of overt and subclinical hypothyroidism or hypothyroxinemia. Anticipated differences in TFTs in iodine-sufficient and iodine-deficient areas are discussed and data are provided on potential complications of hypothyroidism/hypothyroxinemia and autoimmune thyroid disease during pregnancy and adverse effects for the offspring. The beneficial effects of levothyroxine therapy on pregnancy outcomes and offspring development are discussed with a proposed treatment regimen and follow up strategy.
摘要
据估计，孕期显性和亚临床甲状腺功能减退的患病率分别为0.3%-0.5%和2%-3%。育龄女性中5%-18%可检测到甲状腺自身抗体。本综述的目的是强调这些发现对母亲及其后代健康的临床意义。文中描述了孕期甲状腺功能检查（TFT）的评估方法以及显性和亚临床甲状腺功能减退或低甲状腺素血症的诊断阈值。讨论了碘充足和碘缺乏地区TFT的预期差异，并提供了甲状腺功能减退/低甲状腺素血症和自身免疫性甲状腺疾病在孕期的潜在并发症以及对后代的不良影响的数据。文中讨论了左甲状腺素治疗对妊娠结局和后代发育的有益作用，并提出了治疗方案和随访策略。
相似文献
1
Levothyroxine treatment in pregnancy: indications, efficacy, and therapeutic regimen.孕期左甲状腺素治疗：适应证、疗效及治疗方案
J Thyroid Res. 2011;2011:843591. doi: 10.4061/2011/843591. Epub 2011 Aug 25.
2
Indications for treatment of subclinical hypothyroidism and isolated hypothyroxinaemia in pregnancy.妊娠亚临床甲状腺功能减退症和单纯甲状腺素血症的治疗指征。
Best Pract Res Clin Endocrinol Metab. 2020 Jul;34(4):101436. doi: 10.1016/j.beem.2020.101436. Epub 2020 Jun 18.
3
Isolated Hypothyroxinemia in Iranian Pregnant Women, the Role of Iodine Deficiency: A Population-Based Cross-Sectional Study.伊朗孕妇孤立性甲状腺素血症，碘缺乏的作用：一项基于人群的横断面研究。
Thyroid. 2020 Feb;30(2):262-269. doi: 10.1089/thy.2019.0047. Epub 2019 Dec 20.
4
Hypothyroidism and isolated hypothyroxinemia in pregnancy, from physiology to the clinic.孕期甲状腺功能减退症和单纯低甲状腺素血症：从生理到临床
Taiwan J Obstet Gynecol. 2019 Nov;58(6):757-763. doi: 10.1016/j.tjog.2019.09.005.
5
Interventions for clinical and subclinical hypothyroidism in pregnancy.妊娠期临床和亚临床甲状腺功能减退症的干预措施。
Cochrane Database Syst Rev. 2010 Jul 7(7):CD007752. doi: 10.1002/14651858.CD007752.pub2.
6
Subclinical hypothyroidism and thyroid autoimmunity in recurrent pregnancy loss: a systematic review and meta-analysis.亚临床甲状腺功能减退症与复发性流产患者的甲状腺自身免疫：系统评价和荟萃分析。
Fertil Steril. 2020 Mar;113(3):587-600.e1. doi: 10.1016/j.fertnstert.2019.11.003.
7
Differences in Diagnostic Criteria Mask the True Prevalence of Thyroid Disease in Pregnancy: A Systematic Review and Meta-Analysis.妊娠期甲状腺疾病的真实患病率因诊断标准的差异而被掩盖：系统评价和荟萃分析。
Thyroid. 2019 Feb;29(2):278-289. doi: 10.1089/thy.2018.0475. Epub 2018 Dec 31.
8
Prevalence of hypothyroidism during pregnancy in a highly specialised referral centre in Mexico.
J Obstet Gynaecol. 2016 Nov;36(8):1069-1075. doi: 10.1080/01443615.2016.1196482. Epub 2016 Oct 20.
9
Screening for thyroid disease and iodine deficiency.甲状腺疾病和碘缺乏症筛查。
Pathology. 2012 Feb;44(2):153-9. doi: 10.1097/PAT.0b013e32834e8e83.
10
Insignificant Effect of Isolated Hypothyroxinemia on Pregnancy Outcomes During the First and Second Trimester of Pregnancy.单纯性甲状腺素血症对妊娠前半期（妊娠 1 至 2 期）妊娠结局无显著影响。
Front Endocrinol (Lausanne). 2020 Oct 16;11:528146. doi: 10.3389/fendo.2020.528146. eCollection 2020.
引用本文的文献
1
The Thyroid Hormone Axis and Female Reproduction.甲状腺激素轴与女性生殖。
Int J Mol Sci. 2023 Jun 6;24(12):9815. doi: 10.3390/ijms24129815.
2
The Prevalence of Subclinical Hypothyroidism During Early Pregnancy in Pakistan: A Cross-Sectional Study.巴基斯坦早期妊娠期间亚临床甲状腺功能减退症的患病率：一项横断面研究。
Cureus. 2021 Dec 10;13(12):e20316. doi: 10.7759/cureus.20316. eCollection 2021 Dec.
3
Role of hypothyroidism and associated pathways in pregnancy and infertility: Clinical insights.甲状腺功能减退及其相关通路在妊娠和不孕中的作用：临床见解
Tzu Chi Med J. 2020 Apr 10;32(4):312-317. doi: 10.4103/tcmj.tcmj_255_19. eCollection 2020 Oct-Dec.
4
Interactive Effects of Exercise, Sex Hormones, and Transient Congenital Hypothyroidism on Long-Term Potentiation in Hippocampal Slices of Rat Offspring.运动、性激素和短暂性先天性甲状腺功能减退对大鼠后代海马切片长时程增强的交互作用。
Basic Clin Neurosci. 2019 Mar-Apr;10(2):119-135. doi: 10.32598/bcn.9.10.170. Epub 2019 Mar 1.
5
Maternal use of thyroid hormone replacement therapy before, during, and after pregnancy: agreement between self-report and prescription records and group-based trajectory modeling of prescription patterns.孕期前后母体甲状腺激素替代疗法的使用情况：自我报告与处方记录的一致性以及基于群组的处方模式轨迹建模
Clin Epidemiol. 2018 Dec 3;10:1801-1816. doi: 10.2147/CLEP.S175616. eCollection 2018.
6
Prevalence of subclinical hypothyroidism in pregnancy in Saudi Arabia.沙特阿拉伯孕期亚临床甲状腺功能减退症的患病率。
Saudi Med J. 2018 Mar;39(3):254-260. doi: 10.15537/smj.2018.3.21621.
7
Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease.无症状自身免疫性甲状腺疾病孕妇的个体化随访
Int J Mol Sci. 2016 Jan 12;17(1):88. doi: 10.3390/ijms17010088.
8
Hypothyroidism in clinical practice.临床实践中的甲状腺功能减退症
J Family Med Prim Care. 2014 Apr;3(2):98-101. doi: 10.4103/2249-4863.137609.
9
High prevalence of thyroid dysfunction among pregnant women in Lubumbashi, Democratic Republic of Congo.刚果民主共和国卢本巴希孕妇甲状腺功能障碍的高患病率。
Thyroid. 2014 Mar;24(3):568-75. doi: 10.1089/thy.2013.0261. Epub 2013 Oct 30.
本文引用的文献
1
Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.美国甲状腺协会关于妊娠期及产后甲状腺疾病诊断和管理的指南。
Thyroid. 2011 Oct;21(10):1081-125. doi: 10.1089/thy.2011.0087. Epub 2011 Jul 25.
2
Maternal thyroid function in different conditions of iodine nutrition in pregnant women exposed to mild-moderate iodine deficiency: an observational study.碘营养不同条件下孕妇甲状腺功能：一项观察性研究。
Clin Endocrinol (Oxf). 2011 Jun;74(6):762-8. doi: 10.1111/j.1365-2265.2011.04007.x.
3
Maternal thyroid function and the outcome of external cephalic version: a prospective cohort study.母体甲状腺功能与外倒转术结局：一项前瞻性队列研究。
BMC Pregnancy Childbirth. 2011 Jan 26;11:10. doi: 10.1186/1471-2393-11-10.
4
Early pregnancy reference intervals of thyroid hormone concentrations in a thyroid antibody-negative pregnant population.甲状腺自身抗体阴性的妊娠人群中甲状腺激素浓度的早孕期参考区间。
Thyroid. 2011 Mar;21(3):291-8. doi: 10.1089/thy.2010.0337. Epub 2011 Jan 22.
5
Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection.亚临床甲状腺功能减退症对行体外受精/卵胞浆内单精子注射不孕妇女的体外受精和妊娠结局的影响。
Fertil Steril. 2011 Apr;95(5):1650-4. doi: 10.1016/j.fertnstert.2010.12.004. Epub 2010 Dec 30.
6
The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism.患有原发性甲状腺功能减退症的女性在怀孕期间促甲状腺激素水平与增加左甲状腺素剂量需求的关系。
Thyroid. 2010 Oct;20(10):1175-8. doi: 10.1089/thy.2009.0457.
7
High thyrotrophin levels at end term increase the risk of breech presentation.足月时促甲状腺素水平升高增加臀位分娩的风险。
Clin Endocrinol (Oxf). 2010 Nov;73(5):661-5. doi: 10.1111/j.1365-2265.2010.03846.x.
8
Maternal thyroid function at 11 to 13 weeks of gestation and subsequent fetal death.妊娠 11 至 13 周时的母体甲状腺功能与随后的胎儿死亡。
Thyroid. 2010 Sep;20(9):989-93. doi: 10.1089/thy.2010.0058.
9
Interventions for clinical and subclinical hypothyroidism in pregnancy.妊娠期临床和亚临床甲状腺功能减退症的干预措施。
Cochrane Database Syst Rev. 2010 Jul 7(7):CD007752. doi: 10.1002/14651858.CD007752.pub2.
10
Thyroid function and human reproductive health.甲状腺功能与人类生殖健康。
Endocr Rev. 2010 Oct;31(5):702-55. doi: 10.1210/er.2009-0041. Epub 2010 Jun 23.
Zotero 插件