Department of Medicine, University of Toronto, Toronto, ON, Canada.
Women's College Hospital, Toronto, ON, Canada.
Clin Endocrinol (Oxf). 2022 Feb;96(2):263-269. doi: 10.1111/cen.14488. Epub 2021 May 10.
Thyroid hormones play a crucial role in foetal growth and neurocognitive development. Our aim was to compare a weight-based dosing method of starting thyroxine to a fixed-dose method in newly diagnosed women with subclinical hypothyroidism during pregnancy.
We performed a retrospective cohort study of consecutive women with newly diagnosed subclinical hypothyroidism during pregnancy seen at Mount Sinai Hospital and Women's College Hospital, Toronto, Canada 2015-2018.
We identified women that were treated based on pre-pregnancy weight and those that were given a fixed dose of 50 mcg/day.
The percent of women who reached the target TSH of <2.5 mIU/L within 4-8 weeks was compared using a chi-squared test and a logistic regression model, adjusting for age, initial TSH and gestational age treatment was started.
393 women were included: 252 treated using a fixed-dose approach; 141 treated based on pre-pregnancy weight. In the unadjusted analysis, there was no difference between the groups in the percentage of women in the target range within 4-8 weeks (89.6% in the fixed-dose group vs 88.8% in the weight-based group (p = .954)). However, after adjustment for between-group differences in age, initial TSH and gestational age treatment was started, there was a significantly greater odds of achieving the target range using the weight-based dosing (OR 4.26 (1.60-11.7), p = .004).
Treating women with newly diagnosed subclinical hypothyroidism during pregnancy with a weight-based strategy increased the odds of reaching the target TSH range within 4-8 weeks. Clinicians caring for these women should consider this approach when starting treatment during pregnancy.
甲状腺激素在胎儿生长和神经认知发育中起着至关重要的作用。我们的目的是比较体重为基础的左甲状腺素起始剂量方法与固定剂量方法在妊娠期间新诊断的亚临床甲状腺功能减退症女性中的疗效。
我们对 2015 年至 2018 年在加拿大多伦多西奈山医院和女子学院医院就诊的妊娠期间新诊断为亚临床甲状腺功能减退症的连续女性进行了回顾性队列研究。
我们确定了根据孕前体重治疗的女性和给予 50 mcg/天固定剂量的女性。
使用卡方检验和逻辑回归模型比较了在 4-8 周内达到目标 TSH<2.5 mIU/L 的女性比例，调整了年龄、初始 TSH 和开始治疗的孕龄。
共纳入 393 例女性：252 例采用固定剂量法治疗；141 例基于孕前体重治疗。在未调整的分析中，两组在 4-8 周内达到目标范围内的女性比例无差异（固定剂量组为 89.6%，体重为基础组为 88.8%（p=0.954））。然而，在校正了组间年龄、初始 TSH 和开始治疗的孕龄差异后，使用体重为基础的剂量治疗达到目标范围的可能性显著增加（OR 4.26（1.60-11.7），p=0.004）。
对妊娠期间新诊断的亚临床甲状腺功能减退症女性采用体重为基础的治疗策略可增加在 4-8 周内达到目标 TSH 范围的可能性。治疗这些女性的临床医生在开始妊娠期间治疗时应考虑这种方法。
