Nonchev Boyan I, Argatska Antoaneta V, Pehlivanov Blagovest K, Orbetzova Maria M
Section of Endocrinology, Department of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
Clinic of Endocrinology and Metabolic Diseases, St. George University Hospital, Plovdiv, Bulgaria
Folia Med (Plovdiv). 2017 Jun 1;59(2):190-196. doi: 10.1515/folmed-2017-0027.
Thyroid dysfunction is common during the postpartum and the predisposing factors for its development are considered specific for the population studied. The aim of this study was to evaluate the risk factors for the occurrence of postpartum thyroid dysfunction (PPTD) in euthyroid women prior to pregnancy.
Forty-five women with PPTD and 55 age-matched euthyroid postpartum women from Plovdiv, Bulgaria were included in the study. TSH, FT4, FT3, TPOAb, TgAb, TRAb were measured and ultrasound evaluation of the thyroid was performed in the first trimester of pregnancy and during the postpartum.
The study found higher risk of developing PPTD in women with family history of thyroid disease (OR 4.42; 95% CI 1.87,10.43), smokers (OR 4.01; 95% CI 1.72,9.35), personal history of autoimmune thyroid disease (OR 5.37; 95% CI 1.15,28.53), positive TPOAb (OR 18.12; 95% CI 4.93,66.65) and thyroid US hypoechogenicity during early pregnancy (OR 6.39; 95% CI 2.53,16.12) and those who needed levothyroxine during pregnancy (OR 3.69; 95% CI 1.28,10.61). BMI before pregnancy was significantly lower in women with PPTD than in euthyroid postpartum women (22.80±0.55 vs 26.25±0.97, p=0.013). The multivariate logistic regression analysis identified as most important independent risk factors for PPTD occurrence the TPOAb positivity during early pregnancy, family history of thyroid disease, smoking and lower BMI before pregnancy.
Our data suggest that in the population studied several factors are associated with an increased risk of PPTD and screening for thyroid disorders among those women can be beneficial.
甲状腺功能障碍在产后很常见，其发生的易感因素被认为因所研究的人群而异。本研究的目的是评估妊娠前甲状腺功能正常的女性发生产后甲状腺功能障碍（PPTD）的风险因素。
本研究纳入了45例患有PPTD的女性和55例来自保加利亚普罗夫迪夫的年龄匹配的甲状腺功能正常的产后女性。在妊娠早期和产后测量促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、甲状腺过氧化物酶抗体（TPOAb）、甲状腺球蛋白抗体（TgAb）、促甲状腺激素受体抗体（TRAb），并对甲状腺进行超声评估。
研究发现，有甲状腺疾病家族史的女性（比值比[OR]4.42；95%置信区间[CI]1.87，10.43）、吸烟者（OR 4.01；95%CI 1.72，9.35）、自身免疫性甲状腺疾病个人史（OR 5.37；95%CI 1.15，28.53）、TPOAb阳性（OR 18.12；95%CI 4.93，66.65）、妊娠早期甲状腺超声低回声（OR 6.39；95%CI 2.53，16.12）以及妊娠期间需要左甲状腺素的女性（OR 3.69；95%CI 1.28，10.61）发生PPTD的风险更高。患有PPTD的女性妊娠前的体重指数（BMI）显著低于甲状腺功能正常的产后女性（22.80±0.55 vs 26.25±0.97，p=0.013）。多因素逻辑回归分析确定，妊娠早期TPOAb阳性、甲状腺疾病家族史、吸烟和妊娠前较低的BMI是PPTD发生的最重要独立风险因素。
我们的数据表明，在所研究的人群中，有几个因素与PPTD风险增加相关，对这些女性进行甲状腺疾病筛查可能有益。
