Chen Yu-Min, Zeng Jing, Yan Yue-Rong, Luo Dan, Huang Lu, Huang Hui
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Endocrinology and Metabolism, Chengdu No.2 People's Hospital, Chengdu 610017, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2017 May;48(3):450-454.
To establish the reference intervals of thyroid hormones in normal pregnant women in Chengdu area of China, and to investigate the effects of thyroid autoantibodies on thyroid function in pregnant women.
We included 696 pregnant women who had gestation data from June 2013 to March 2014 in Chengdu Women & Children's Central Hospital. Every subject under went questionnaire survey, physical examination, thyroid ultrasound and measurement of thyroid hormone and thyroid autoantibodies. The normal reference intervals were established according to the percentiles (P-P) of the healthy pregnant women in the same trimester. Another 50 non-pregnant women were selected as the control group.
Of the 696 pregnant women, 579 subjects had negative thyroid autoantibodies and 117 subjects had positive thyroid autoantibodies. The positive rate of thyroid autoantibodies was 16.81%. Of the 579 subjects with negative thyroid autoantibodies, 257 were in the first trimester, 202 in the second trimester and 120 in the third trimester. In the first trimester of normal pregnancy, the reference intervals of serum thyrotropin (TSH) , free triiodothyronine (FT3) and free thyroxine (FT4) were 0.02-4.03 mIU/L, 3.85-6.27 pmol/L and 11.93-21.04 pmol/L respectively. In the second trimester, the reference intervals of serum TSH, FT3 and FT4 were 0.02-4.05 mIU/L, 3.51-5.82 pmol/L and 11.23-19.22 pmol/L respectively. In the thirdtrimester, the reference intervals for serum TSH, FT3 and FT4 were 0.24-5.41 mIU/L, 3.18-4.97 pmol/L and 11.10-17.00 pmol/L, respectively. When compared with non-pregnant women, the median TSH value was increasingly consisted with the progress of pregnancy period, while the median FT4 and FT3 values were decreasing accordingly. The similar tendencies of TSH, FT3, and FT4 were found in pregnant women with positive thyroid autoantibodies, but the trends were more remarkable when compared with those with negative thyroid autoantibodies. In pregnant women with positive thyroid autoantibodies, the incidences of clinical hypothyroidism, subclinical hypothyroidism and clinical hyperthyroidism were 0.85%, 15.38% and 0.85%, respectively.
The thyroid hormone reference ranges of pregnant women is quite different from those of non-pregnant women. It is necessary to establish the reference intervals of thyroid hormones in normal pregnant women. Thyroid function of pregnant women with positive thyroid autoantibodies should be monitored during the pregnant period.
建立中国成都地区正常孕妇甲状腺激素的参考区间，并探讨甲状腺自身抗体对孕妇甲状腺功能的影响。
选取2013年6月至2014年3月在成都市妇女儿童中心医院有妊娠资料的696例孕妇。每位受试者均接受问卷调查、体格检查、甲状腺超声检查以及甲状腺激素和甲状腺自身抗体检测。根据同一孕期健康孕妇的百分位数（P-P）建立正常参考区间。另选取50例非孕妇作为对照组。
696例孕妇中，579例甲状腺自身抗体阴性，117例甲状腺自身抗体阳性。甲状腺自身抗体阳性率为16.81%。579例甲状腺自身抗体阴性的受试者中，孕早期257例，孕中期202例，孕晚期120例。正常妊娠孕早期血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）的参考区间分别为0.02 - 4.03 mIU/L、3.85 - 6.27 pmol/L和11.93 - 21.04 pmol/L。孕中期血清TSH、FT3和FT4的参考区间分别为0.02 - 4.05 mIU/L、3.51 - 5.82 pmol/L和11.23 - 19.22 pmol/L。孕晚期血清TSH、FT3和FT4的参考区间分别为0.24 - 5.41 mIU/L、3.18 - 4.97 pmol/L和11.10 - 17.00 pmol/L。与非孕妇相比，TSH中位数随孕期进展逐渐升高，而FT4和FT3中位数相应降低。甲状腺自身抗体阳性孕妇的TSH、FT3和FT4也有类似趋势，但与甲状腺自身抗体阴性孕妇相比，趋势更明显。甲状腺自身抗体阳性孕妇临床甲减、亚临床甲减和临床甲亢的发生率分别为0.85%、15.38%和0.85%。
孕妇甲状腺激素参考范围与非孕妇有很大差异。建立正常孕妇甲状腺激素参考区间很有必要。孕期应监测甲状腺自身抗体阳性孕妇的甲状腺功能。
