Negro Roberto, Attanasio Roberto, Papini Enrico, Guglielmi Rinaldo, Grimaldi Franco, Toscano Vincenzo, Niculescu Dan Alexandru, Paun Diana Loreta, Poiana Catalina
Division of Endocrinology, "V. Fazzi" Hospital, Lecce, Italy.
Endocrinology Service, Galeazzi Institute IRCCS, Milan, Italy.
Eur Thyroid J. 2018 Nov;7(6):294-301. doi: 10.1159/000490944. Epub 2018 Jul 26.
Pregnancy induces changes in thyroid function, and thyroid dysfunction during gestation is associated with adverse outcomes. We examined the management of subclinical hypothyroidism and chronic autoimmune thyroiditis in pregnancy among Italian and Romanian endocrinologists.
Members of the Associazione Medici Endocrinologi (AME) and Romanian Society of Endocrinology (RSE) were invited to participate in a web-based survey investigating the topic.
A total of 902 individuals participated in the survey, 759 of whom completed all sections. Among the respondents, 85.1% were aware of the 2017 American Thyroid Association guidelines about thyroid disease and pregnancy, and 82.9% declared that thyroid-stimulating hormone (TSH) screening at the beginning of pregnancy should be warranted. In a patient negative for peroxidase antibodies, 53.6% considered 2.5 mIU/L and 26.2% considered 4.0 mIU/L as the upper normal limit of TSH, and 50% would treat a patient with TSH 3.5 mIU/L with levothyroxine. About 20% did not suggest iodine supplementation. Isolated hypothyroxinemia detected in the first trimester would be treated by 40.8%. In patients undergoing ovarian stimulation, a TSH < 2.5 mIU/L would be targeted by 70%.
Respondents globally appeared well informed about the management of thyroid autoimmunity and subclinical hypothyroidism in pregnancy. A more aggressive attitude in implementing iodine supplementation would be desirable. Most endocrinologists were convinced about an evident association between mild thyroid impairment and adverse outcomes in pregnancy, thus using a TSH value of 2.5 mIU/L as the threshold for diagnosing hypothyroidism and starting levothyroxine in pregnant women.
妊娠会引起甲状腺功能变化，妊娠期甲状腺功能障碍与不良结局相关。我们调查了意大利和罗马尼亚内分泌科医生对妊娠期亚临床甲状腺功能减退和慢性自身免疫性甲状腺炎的管理情况。
邀请意大利内分泌医生协会（AME）和罗马尼亚内分泌学会（RSE）的成员参与一项关于该主题的网络调查。
共有902人参与了调查，其中759人完成了所有部分。在受访者中，85.1%知晓2017年美国甲状腺协会关于甲状腺疾病与妊娠的指南，82.9%宣称妊娠初期应进行促甲状腺激素（TSH）筛查。在过氧化物酶抗体阴性的患者中，53.6%认为TSH的正常上限为2.5 mIU/L，26.2%认为是4.0 mIU/L，50%会用左甲状腺素治疗TSH为3.5 mIU/L的患者。约20%不建议补充碘。孕早期检测到的单纯甲状腺素水平降低有40.8%会进行治疗。在接受卵巢刺激的患者中，70%的目标是使TSH<2.5 mIU/L。
总体而言，受访者似乎对妊娠期甲状腺自身免疫和亚临床甲状腺功能减退的管理有充分了解。在实施碘补充方面采取更积极的态度是可取的。大多数内分泌科医生确信轻度甲状腺功能损害与妊娠不良结局之间存在明显关联，因此将TSH值2.5 mIU/L作为诊断妊娠期甲状腺功能减退和开始使用左甲状腺素的阈值。
