Argatska A, Nonchev B, Obretsova M, Pehlivanov B
Akush Ginekol (Sofiia). 2015;54(3):3-8.
The risk factors and mechanisms for the development of postpartum thyroid dysfunction have been widely discussed. However data on patients suffered spontaneous or induced abortion during early pregnancy are scarce.
To reveal the characteristics of thyroid dysfunction in women after an abortion in the first trimester of pregnancy.
A total of 28 women (18 euthyroid, 10 with thyroid dysfunction), mean age 30.46 ± 1.01 years following abortion in the first trimester have been included in the study. Thyroid-stimulating hormone (TSH), free triiodthyronine (FT3), free thyroxine (FT4), thyreoglobulin antibodies (TgAb), thyroid peroxidase antibodies (TPOAb) were measured and ultrasound assessment of the thyroid was performed 3 and 9 months after the interruption of pregnancy.
Hypothyroidism was found in 6 of the women with thyroid dysfunction and thyrotoxicosis--in 4. Clinical features of thyroid dysfunction were observed in 3 patients while in the remaining 7 cases, diagnosis was made on the basis of hormonal levels. Positive titers of thyroid autoantibodies were detected in the majority of the cases with functional disordes. In 6 patients thyroid dysfunction was transient and in 4 hormonal abnormalities persisted on by the 9th month after the abortion. The comparative analysis showed that the volume of the thyroid gland and the degree of hypoehogenicity were significantly higher in patients with thyroid dysfunction compared to euthyroid women.
Thyroid dysfunction after abortion in the first trimester is mainly of autoimmune pathogenesis and its characteristics do not differ from those of postpartum thyroiditis. In the majority of patients these disorders are subclinical and may remain unrecognized. A close active follow up of patients at increased risk of functional thyroid disorders after an abortion is required in order to prevent morbidity and identify the cases developing permanent thyroid dysfunction.
产后甲状腺功能障碍发生的风险因素及机制已得到广泛讨论。然而，关于孕早期自然流产或人工流产患者的数据却很稀少。
揭示孕早期流产后女性甲状腺功能障碍的特征。
本研究纳入了28例孕早期流产后的女性（18例甲状腺功能正常，10例甲状腺功能障碍），平均年龄30.46±1.01岁。分别于妊娠终止后3个月和9个月测定促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、甲状腺球蛋白抗体（TgAb）、甲状腺过氧化物酶抗体（TPOAb），并对甲状腺进行超声评估。
甲状腺功能障碍的女性中有6例出现甲状腺功能减退，4例出现甲状腺毒症。3例患者出现甲状腺功能障碍的临床特征，其余7例根据激素水平做出诊断。大多数功能障碍病例检测到甲状腺自身抗体阳性滴度。6例患者的甲状腺功能障碍为暂时性，4例在流产后第9个月激素异常仍持续存在。比较分析表明，与甲状腺功能正常的女性相比，甲状腺功能障碍患者的甲状腺体积和低回声程度明显更高。
孕早期流产后的甲状腺功能障碍主要为自身免疫发病机制，其特征与产后甲状腺炎无异。大多数患者这些障碍为亚临床状态，可能未被识别。为预防发病并识别发生永久性甲状腺功能障碍的病例，需要对流产后甲状腺功能障碍风险增加的患者进行密切积极的随访。
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