Endocrine Research Center; Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Thyroid. 2020 Aug;30(8):1186-1192. doi: 10.1089/thy.2019.0440. Epub 2020 May 7.
Autoimmune thyroid disease is the most common autoimmune disorder. Evidence regarding causes of the high prevalence and incidence of thyroid autoimmunity in women, and especially women of reproductive age, is still inconclusive and previous studies have suggested genetic, environmental, and existential factors to play a role in its pathogenesis. In this study, we aimed to investigate the effect of parity and other reproductive factors on the incidence of thyroid autoimmunity within the framework of the Tehran Thyroid Study (TTS). This study was conducted within the framework of the TTS and 1999 nonpregnant euthyroid thyroid peroxidase antibody (TPOAb) negative women were followed up for an average of 8.3 years. A pooled logistic regression model was used to assess the association (odds ratio) between time-dependent covariates parity, menopause, and abortion, and incidence of TPOAb positivity. The total incidence rate of TPOAb positivity was 8.65 [7.35-10.18] per 1000 person-years. We found no significant association between changes in the number of parity and risk of developing TPOAb using multiple pooled logistic models both as crude effect and after adjustment for age, body mass index, and smoking. Similarly, there was no association between changes of parity, menopause, and abortion status, and incidence of TPOAb positivity. Parity does not seem to have an independent role in triggering thyroid autoimmunity, but vast immunological and physiological changes during pregnancy may act as a precipitating factor in the context of other genetic and environmental modifiers.
自身免疫性甲状腺疾病是最常见的自身免疫性疾病。关于女性，尤其是育龄女性甲状腺自身免疫高患病率和发病率的原因的证据仍不明确，先前的研究表明遗传、环境和生存因素在其发病机制中起作用。在这项研究中，我们旨在在德黑兰甲状腺研究（TTS）的框架内研究生育和其他生殖因素对甲状腺自身免疫发生的影响。 该研究是在 TTS 框架内进行的，对 1999 年未怀孕的甲状腺过氧化物酶抗体（TPOAb）阴性的甲状腺功能正常女性进行了平均 8.3 年的随访。使用 pooled logistic 回归模型评估随时间变化的协变量（比值比）与生育次数、绝经和流产与 TPOAb 阳性发生率之间的关联。TPOAb 阳性的总发生率为 8.65 [7.35-10.18] / 1000 人年。我们发现，使用多个 pooled logistic 模型，无论是原始效应还是在调整年龄、体重指数和吸烟状况后，生育次数的变化与 TPOAb 发病风险之间均无显著关联。同样，生育次数、绝经和流产状态的变化与 TPOAb 阳性的发生率之间也没有关联。生育次数似乎没有独立引发甲状腺自身免疫的作用，但妊娠期间广泛的免疫和生理变化可能在其他遗传和环境修饰因子的背景下作为诱发因素。
