Yu Xiaohui, Shan Zhongyan, Li Chenyan, Mao Jinyuan, Wang Weiwei, Xie Xiaochen, Liu Aihua, Teng Xiaochun, Zhou Weiwei, Li Chenyang, Xu Bin, Bi Lihua, Meng Tao, Du Jianling, Zhang Shaowei, Gao Zhengnan, Zhang Xiaomei, Yang Liu, Fan Chenling, Teng Weiping
Endocrine Institute and Liaoning Provincial Key Laboratory of Endocrine Diseases (X.Y., Z.S., Chenyan.L., J.M., W.W., X.X., A.L., X.T., C.F., W.T.), Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang 110001, China; Shenyang Women's and Children's Hospital (W.Z., Chenyang.L.), Shenyang 110011, China; Department of Obstetrics and Gynecology (B.X.), No. 202 Hospital of People's Liberation Army, Shenyang 110003, China; Dalian Obstetrics and Gynecology Hospital (L.B.), Dalian 116033, China; Department of Obstetrics and Gynecology (T.M.), The First Hospital of China Medical University, Shenyang 110001, China; Department of Endocrinology (J.D.), The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China; Department of Endocrinology (S.Z.), No. 202 Hospital of People's Liberation Army, Shenyang 110003, China; Department of Endocrinology (Z.G.), Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian 116033, China; Department of Endocrinology (X.Z.), The First Hospital of Dandong, Dandong118000, China; and Shenyang Women and Children Health Care Center (L.Y.), Shenyang 110032, China.
J Clin Endocrinol Metab. 2015 Apr;100(4):1594-601. doi: 10.1210/jc.2014-3887. Epub 2015 Jan 19.
Isolated hypothyroxinemia during early pregnancy may irreversibly damage the neurodevelopment of offspring. However, the causes are not well clarified.
To explore the association of iron deficiency (ID) with hypothyroid function of women in early pregnancy and nonpregnant women.
A total of 7953 pregnant women of ≤ 12 weeks gestation and 2000 childbearing-aged women were recruited. A subpopulation including 3340 pregnant women and 1052 nonpregnant women with sufficient iodine intake and negative thyroid peroxidase antibody were studied. Mild and severe cases of hypothyroxinemia were defined as free T4 levels below the 10th percentile and the 5th percentile, respectively, with normal TSH. Total body iron, serum ferritin, and serum transferrin receptor were used as indicators for iron nutrition.
Serum free T4 levels were significantly lower in both pregnant and nonpregnant women with ID compared with the corresponding groups without ID (both P < .05). The prevalence of mild and severe hypothyroxinemia was markedly higher in women with ID than those without, in both pregnant and nonpregnant women (all P < .01). Logistic regression indicated that ID was an independent risk factor for both mild and severe hypothyroxinemia in pregnancy (odds ratio [OR] = 2.440, 95% confidence interval [CI]: 1.324-4.496, P = .004; and OR = 3.278, 95% CI: 1.443-7.446, P = .005, respectively) and nonpregnancy (OR = 2.662, 95% CI: 1.330-5.329, P = .006; and OR = 3.254, 95% CI: 1.375-7.700, P = .007, respectively).
An association between ID and isolated hypothyroxinemia was found in both pregnant and nonpregnant childbearing-aged women, independent of the effects of iodine and thyroid autoimmunity. We speculate that ID may be a pathogenic factor for hypothyroxinemia, even in pregnant women during the first trimester.
孕早期孤立性低甲状腺素血症可能会对后代的神经发育造成不可逆的损害。然而，其病因尚未完全明确。
探讨缺铁（ID）与孕早期女性及非孕女性甲状腺功能减退之间的关联。
共招募了7953名妊娠≤12周的孕妇和2000名育龄期女性。对其中3340名孕妇和1052名非孕女性组成的亚组进行研究，这些女性碘摄入充足且甲状腺过氧化物酶抗体为阴性。轻度和重度低甲状腺素血症分别定义为游离T4水平低于第10百分位数和第5百分位数，促甲状腺激素（TSH）正常。采用机体总铁、血清铁蛋白和血清转铁蛋白受体作为铁营养指标。
与相应的非缺铁组相比，缺铁的孕妇和非孕女性血清游离T4水平均显著降低（均P < 0.05）。在孕妇和非孕女性中，缺铁女性轻度和重度低甲状腺素血症的患病率均显著高于非缺铁女性（均P < 0.01）。逻辑回归表明，缺铁是孕期轻度和重度低甲状腺素血症的独立危险因素（比值比[OR]分别为2.440，95%置信区间[CI]：1.324 - 4.496，P = 0.004；以及OR = 3.278，95% CI：1.443 - 7.446，P = 0.005）和非孕期（OR分别为2.662，95% CI：1.330 - 5.329，P = 0.006；以及OR = 3.254，95% CI：1.375 - 7.700，P = 0.007）。
在孕龄期孕妇和非孕女性中均发现缺铁与孤立性低甲状腺素血症之间存在关联，且独立于碘及甲状腺自身免疫的影响。我们推测，即使在孕早期孕妇中，缺铁也可能是低甲状腺素血症的致病因素。
