Department of Medical Health Psychology, University of Tilburg, Tilburg, The Netherlands.
Maxima Medical Center, Eindhoven, The Netherlands.
Clin Endocrinol (Oxf). 2017 Dec;87(6):838-843. doi: 10.1111/cen.13433. Epub 2017 Aug 17.
To evaluate whether women during early pregnancy with "hypothyroidism" symptoms are at risk of biochemically defined hypothyroidism. The 2017 Guidelines of the American Thyroid Association (ATA) recommend case-finding on the basis of symptoms to identify these women during pregnancy, while evidence is lacking.
Construct validation of a thyroid hypofunction symptom checklist during the first trimester of pregnancy comparing high scores with biochemically defined hypothyroidism.
A total of 2198 healthy pregnant women from an iodine-sufficient area in 2013-2014.
Completion of a draft questionnaire with "classical" symptoms of hypothyroidism at 12 weeks of gestation. The 2.5th and 97.5th percentiles of TSH and fT4 during pregnancy in TPO-Ab-negative (<35 kU/L) women were used to define euthyroid women and those with overt (clinical) and subclinical hypothyroidism. The prevalence of overt (subclinical) hypothyroidism was compared between women with high symptom scores and those with low symptom scores.
According to fT4 and TSH cut-offs (0.23-4.0 mIU/L and 11.5-18.0 pmol/L, respectively), there were 15 women with "to treat hypofunction" (overt hypothyroidism or TSH >10 mIU/L) and 68 women with subclinical hypothyroidism. Questionnaire construct validation revealed a 12-item hypothyroid checklist with normally distributed scores. The cut-off indicating high scores of OH was set at 1 SD > mean. Women with high symptom scores did not present more often with biochemically defined thyroid hypofunction.
This study does not support the ATA recommendation that pregnant women who require levothyroxine therapy can be identified by case-based screening of women with symptoms of thyroid disease.
评估在孕早期出现“甲状腺功能减退”症状的女性是否存在生化定义的甲状腺功能减退的风险。美国甲状腺协会（ATA）2017 年指南建议根据症状进行病例发现，以在怀孕期间识别这些女性，而目前缺乏相关证据。
在妊娠早期，通过与生化定义的甲状腺功能减退症比较，对甲状腺功能减退症状检查表进行甲状腺功能减退症病例验证。
2013-2014 年，一个碘充足地区的 2198 名健康孕妇。
在妊娠 12 周时完成一份带有“典型”甲状腺功能减退症状的问卷草稿。在 TPO-Ab 阴性（<35 kU/L）的女性中，TSH 和 fT4 在妊娠期间的第 2.5 和 97.5 百分位数被用于定义甲状腺功能正常的女性以及显性（临床）和亚临床甲状腺功能减退症患者。比较高症状评分组和低症状评分组女性中显性（亚临床）甲状腺功能减退症的患病率。
根据 fT4 和 TSH 截断值（分别为 0.23-4.0 mIU/L 和 11.5-18.0 pmol/L），有 15 名女性存在“需要治疗的功能减退症”（显性甲状腺功能减退症或 TSH >10 mIU/L），68 名女性存在亚临床甲状腺功能减退症。问卷构建验证显示，甲状腺功能减退症的 12 项检查表具有正态分布的评分。高评分 OH 的截断值设定为 1 SD>平均值。高症状评分的女性并不更常出现生化定义的甲状腺功能减退症。
本研究不支持 ATA 的建议，即需要左甲状腺素治疗的孕妇可以通过对有甲状腺疾病症状的妇女进行基于病例的筛查来识别。
