Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Knowledge and Evaluation Research Unit in Endocrinology (KER-Endo), Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota.
Curr Opin Endocrinol Diabetes Obes. 2019 Oct;26(5):225-231. doi: 10.1097/MED.0000000000000491.
Subclinical hypothyroidism (SCH) is a common diagnosis among women of reproductive age. The importance of sufficient maternal thyroid supply during pregnancy is well known. Nevertheless, the effects of SCH during pregnancy and the efficacy of its treatment on maternofetal outcomes are not well established. This review discusses the recent evidence on SCH in pregnancy and how this evidence is reflected in current clinical care.
Recent observational studies have found a positive association between SCH during pregnancy and adverse maternal, neonatal and offspring outcomes, mainly in thyroid peroxidase autoantibody positive women. Although interventional studies have shown a benefit of levothyroxine (LT4) treatment on selected pregnancy outcomes, there was no effect on offspring neurodevelopment.
Current evidence strengthens the association between SCH with both maternofetal and offspring adverse outcomes. An earlier and more individualized diagnostic assessment taking into consideration predictors of thyroid dysfunction and major risk factors for complications could result in better management of SCH during pregnancy. The effectiveness of LT4 on improving maternofetal and long-term offspring outcomes is still not fully elucidated.
亚临床甲状腺功能减退症（SCH）是育龄妇女的常见诊断。众所周知，甲状腺在妊娠期间的充分供应对母婴至关重要。然而，SCH 在妊娠期间的影响及其对母婴结局的治疗效果尚不清楚。本文综述了妊娠期间 SCH 的最新证据，以及这些证据如何反映在当前的临床护理中。
最近的观察性研究发现，SCH 与不良的母婴和后代结局之间存在正相关，主要发生在甲状腺过氧化物酶自身抗体阳性的妇女中。虽然干预性研究表明左甲状腺素（LT4）治疗对某些妊娠结局有益，但对后代神经发育没有影响。
目前的证据加强了 SCH 与母婴和后代不良结局之间的关联。更早和更个体化的诊断评估，考虑甲状腺功能障碍的预测因素和并发症的主要危险因素，可以更好地管理妊娠期间的 SCH。LT4 对改善母婴和长期后代结局的有效性仍未完全阐明。
