Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang, P. R. China.
Thyroid. 2019 Apr;29(4):577-585. doi: 10.1089/thy.2018.0097. Epub 2019 Mar 22.
Thyroid peroxidase antibody (TPOAb) positivity can attenuate gestational thyroid responses to human chorionic gonadotropin (hCG) during pregnancy, whereas the effects of thyroglobulin antibodies (TgAb) remain unknown. The aim of our study was to explore the thyroid response to hCG in women with thyrotropin (TSH) levels within the method-specific reference range under different conditions of thyroid autoimmunity.
The study screened 822 women at 7-20 weeks of gestation using the pregnancy-specific reference range for TSH. Serum TSH, free thyroxine (fT4), TPOAb, TgAb, and β-hCG levels were measured using electrochemiluminescence immunoassays.
The enrolled pregnant women were subdivided into four subgroups based on TPOAb/TgAb positivity: co-positive for TPOAb and TgAb (group 1), isolated TPOAb positive (group 2), isolated TgAb positive (group 3), and co-negative for TPOAb and TgAb (group 4). TSH was negatively associated with hCG in all four groups (p < 0.05). fT4 was positively associated with hCG in groups 3 and 4 (p < 0.01) but not in groups 1 (p = 0.096) and 2 (p = 0.758). Group 2 was further stratified into tertiles according to TPOAb concentrations. No negative TSH/hCG association was observed in the middle- and upper-tertile groups when TPOAb were ≥53 IU/mL (p > 0.05). There was no positive fT4/hCG association in any of the three subgroups (p > 0.05). Similarly, group 3 was further stratified into tertiles according to TgAb levels. TSH was negatively associated with hCG in the lower and middle tertiles (p < 0.01), but the association was not found in the upper tertile when TgAb was ≥356 IU/mL (p = 0.191). fT4 was positively associated with hCG in the lower tertile (p = 0.027) but not in subgroups when TgAb was ≥219 IU/mL (p > 0.05).
When TSH was within the pregnancy-specific reference range, high concentrations of TPOAb and TgAb attenuated the fT4 stimulation and suppression of TSH by hCG. The results imply that TgAb, in addition to TPOAb, could also interfere with thyroidal responses to hCG during the first half of pregnancy.
甲状腺过氧化物酶抗体（TPOAb）阳性可减弱妊娠期间甲状腺对人绒毛膜促性腺激素（hCG）的反应，而甲状腺球蛋白抗体（TgAb）的影响尚不清楚。我们的研究目的是探讨在不同甲状腺自身免疫状态下，促甲状腺激素（TSH）处于方法特异性参考范围内的妇女中，hCG 对甲状腺的反应。
本研究使用妊娠特异性 TSH 参考范围筛选了 822 名 7-20 周妊娠的妇女。使用电化学发光免疫分析法测量血清 TSH、游离甲状腺素（fT4）、TPOAb、TgAb 和β-hCG 水平。
纳入的孕妇根据 TPOAb/TgAb 阳性情况分为四组：TPOAb 和 TgAb 均阳性（组 1）、仅 TPOAb 阳性（组 2）、仅 TgAb 阳性（组 3）和 TPOAb 和 TgAb 均阴性（组 4）。在所有四组中，TSH 均与 hCG 呈负相关（p<0.05）。fT4 与 hCG 在组 3 和组 4 呈正相关（p<0.01），但在组 1（p=0.096）和组 2（p=0.758）中不相关。根据 TPOAb 浓度将组 2 进一步分为三分位组。当 TPOAb 浓度≥53IU/ml 时，中、高三分位组中未观察到 TSH/hCG 负相关（p>0.05）。在任何三分位组中，fT4/hCG 均无正相关（p>0.05）。同样，根据 TgAb 水平将组 3 进一步分为三分位组。在低和中三分位组中，TSH 与 hCG 呈负相关（p<0.01），但当 TgAb 浓度≥356IU/ml 时，上三分位组未发现这种相关性（p=0.191）。在低三分位组中，fT4 与 hCG 呈正相关（p=0.027），但在 TgAb 浓度≥219IU/ml 时，各亚组中均无相关性（p>0.05）。
当 TSH 处于妊娠特异性参考范围内时，高浓度的 TPOAb 和 TgAb 减弱了 fT4 对 TSH 的刺激和抑制作用。结果表明，除 TPOAb 外，TgAb 还可干扰妊娠早期 hCG 对甲状腺的反应。
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