Temboury Molina M Carmen, Rivero Martín M José, de Juan Ruiz Jesús, Ares Segura Susana
Servicio de Pediatría, Hospital del Sureste, Arganda del Rey, Madrid, España.
Servicio de Pediatría, Hospital de Fuenlabrada, Fuenlabrada, Madrid, España.
Med Clin (Barc). 2015 Apr 8;144(7):297-303. doi: 10.1016/j.medcli.2013.10.024. Epub 2014 Jan 30.
Autoimmune thyroid disease is amongst the most frequent endocrine disorders during pregnancy. It is associated with an increase in perinatal morbidity, congenital defects, neurological damage, fetal and neonatal thyroid dysfunction. Maternal thyroid hormones play a key role in child neurodevelopment. We aimed to evaluate the thyroid function and the clinical course of neonates born from mothers with autoimmune thyroid disease during the first months of life in order to define the follow-up.
We monitored thyroid function and clinical status during the first months in 81 newborns of mothers with autoimmune thyroid disease; 16 had Graves disease and 65 autoimmune thyroiditis.
A percentage of 4.93 newborns had congenital defects, and 8.64% neonates showed an increase in thyrotropin (TSH) (>9.5 μUI/mL 2 times) and required thyroxin within the first month of life. A 85.7% of these showed a negative newborn screening (due to a later increase of TSH). A higher TSH value in the newborn was related to an older age of the mother, higher levels of thyroid peroxidase (TPO) antibody during pregnancy and lower birth weight. A higher free thyroxine (FT4) value in the newborn was related to fewer days of life and mothers with Graves disease.
We recommend the evaluation of TSH, T4 and TPO antibodies before 10 weeks in all pregnant women with follow-up if maternal thyroid autoimmunity or disorders is detected. It is also recommended to test children's serum TSH and FT4 at 48 h of life in newborns of mothers with autoimmune thyroid disease and repeat them between the 2nd and 4th week in children with TSH>6 μUI/mL. Careful endocrine follow-up is advised in pregnant women and children if hyperthyroidism is detected.
自身免疫性甲状腺疾病是孕期最常见的内分泌疾病之一。它与围产期发病率增加、先天性缺陷、神经损伤、胎儿及新生儿甲状腺功能障碍有关。母体甲状腺激素在儿童神经发育中起关键作用。我们旨在评估患有自身免疫性甲状腺疾病的母亲所生新生儿在出生后最初几个月的甲状腺功能及临床病程，以便确定随访方案。
我们监测了81名患有自身免疫性甲状腺疾病母亲的新生儿在出生后最初几个月的甲状腺功能及临床状况；其中16名母亲患有格雷夫斯病，65名患有自身免疫性甲状腺炎。
4.93%的新生儿有先天性缺陷，8.64%的新生儿促甲状腺激素（TSH）升高（>9.5 μUI/mL，两次），并在出生后第一个月内需要甲状腺素治疗。其中85.7%的新生儿新生儿筛查结果为阴性（由于TSH后期升高）。新生儿TSH值较高与母亲年龄较大、孕期甲状腺过氧化物酶（TPO）抗体水平较高及出生体重较低有关。新生儿游离甲状腺素（FT4）值较高与出生天数较少及母亲患有格雷夫斯病有关。
我们建议对所有检测出母体甲状腺自身免疫或疾病的孕妇在孕10周前评估TSH、T4和TPO抗体，并进行随访。还建议对患有自身免疫性甲状腺疾病母亲的新生儿在出生后48小时检测其血清TSH和FT4，对于TSH>6 μUI/mL的儿童在出生后第2至4周重复检测。如果检测出甲状腺功能亢进，建议对孕妇和儿童进行仔细的内分泌随访。
