Department of Endocrinology, Universitair Ziekenhuis Brussel, UZ Brussel, Vrije Universiteit Brussel, Belgium.
Department of Endocrinology, Universitair Ziekenhuis Brussel, UZ Brussel, Vrije Universiteit Brussel, Belgium.
Best Pract Res Clin Endocrinol Metab. 2020 Jul;34(4):101378. doi: 10.1016/j.beem.2020.101378. Epub 2020 Jan 30.
Thyroid autoimmunity (TAI) and/or thyroid dysfunction are prevalent in women of reproductive age and have independently been associated with adverse fertility and pregnancy outcomes, in the case of spontaneous conception or after assisted reproductive technology (ART). Thus, it seems reasonable to screen for thyrotropin (TSH) and thyroid peroxidase autoantibodies (TPO-abs) in infertile women attempting pregnancy. However, even if the relationship between fertility and thyroid dysfunction and/or TAI persists when properly controlled for other variables, it remains challenging to claim causation. Several studies with different designs (cross sectional, case -control, prospective and retrospective cohort studies) have looked at the association between thyroid autoimmunity, thyroid function and fertility. Heterogeneity among study results are related to small numbers of included patients, poor study design, selection of causes of infertility and different assays used to measure TAI, thyroid hormones and TSH reference values. Indeed, there is no consensus regarding the upper limit of normal for TSH to define thyroid dysfunction and the cut-off levels for intervention. Furthermore, data from interventional trials looking at the impact of levothyroxine treatment on fertility outcome in randomised controlled studies are scarce. Despite the recent update of the guidelines by the American Thyroid Association (ATA) for the Diagnosis and Management of Thyroid Disease during Pregnancy and the postpartum, many questions remain unsettled in ART.
甲状腺自身免疫（TAI）和/或甲状腺功能障碍在育龄妇女中很常见，并且已经独立与不良的生育和妊娠结局相关，无论是自然受孕还是辅助生殖技术（ART）后。因此，对试图怀孕的不孕妇女进行促甲状腺激素（TSH）和甲状腺过氧化物酶自身抗体（TPO-abs）筛查似乎是合理的。然而，即使在适当控制其他变量后，生育能力与甲状腺功能障碍和/或 TAI 之间的关系仍然存在，也很难声称存在因果关系。一些具有不同设计（横断面、病例对照、前瞻性和回顾性队列研究）的研究已经研究了甲状腺自身免疫、甲状腺功能和生育能力之间的关联。研究结果的异质性与纳入患者数量少、研究设计不佳、不孕原因的选择以及用于测量 TAI、甲状腺激素和 TSH 参考值的不同检测方法有关。实际上，对于定义甲状腺功能障碍的 TSH 正常上限和干预的截止值，尚无共识。此外，关于随机对照研究中左甲状腺素治疗对生育结局影响的干预试验数据也很少。尽管美国甲状腺协会（ATA）最近更新了关于妊娠和产后期间甲状腺疾病的诊断和管理指南，但在 ART 中仍有许多问题尚未解决。
