Division of Internal Medicine, Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan.
Division of Surgery and Director, Center for Excellence in Thyroid Care, Kuma Hospital, Hyogo 650-0011, Japan.
Endocr J. 2022 Feb 28;69(2):165-172. doi: 10.1507/endocrj.EJ21-0109. Epub 2021 Sep 14.
The dose of L-T replacement for hypothyroidism often needs to be increased after pregnancy. In our institution, patients are instructed to double the dose 2 days a week after pregnancy. However, there is scarce evidence supporting the need for a dose increase after pregnancy in patients with preconception thyroid-stimulating hormone (TSH) suppression (TSH <0.3 μIU/mL). This study aimed to determine the need for a dose increase in L-T among women with a TSH-suppressive dose of L-T before pregnancy. In this retrospective observational study, between January 2008 and December 2018, we analyzed 166 pregnancies in 134 patients on TSH suppression treatment after total thyroidectomy for papillary carcinoma. Thyroid function tests were performed before and in the first trimester of pregnancy. The dose was adjusted and maintained during the first trimester of pregnancy in 76 pregnancies (group A) and 90 pregnancies (group B), respectively. The median serum TSH level was significantly lower in group A than that in group B (0.014 μIU/mL (IQR, 0.005-0.071) vs. 0.155 μIU/mL (IQR, 0.021-0.657), p < 0.001). TSH suppression could not be maintained after pregnancy in 15.8% and 38.9% of the pregnancies in groups A and B, respectively. Increasing the post-pregnancy dose by an average of 27.4% resulted in maintenance of TSH suppression after pregnancy in 84.2% of pregnancies. In conclusion, this study suggests that increasing the L-T dose after pregnancy may be appropriate in postoperative thyroid cancer patients whose serum TSH levels should be suppressed.
甲状腺功能减退症患者的 L-T 替代剂量在妊娠后往往需要增加。在我们的机构中，建议患者在妊娠后每周 2 天将剂量增加一倍。然而，对于妊娠前甲状腺刺激激素（TSH）抑制（TSH<0.3 μIU/mL）的患者，妊娠后是否需要增加剂量的证据很少。本研究旨在确定在妊娠前使用 L-T 抑制 TSH 的女性中是否需要增加 L-T 的剂量。在这项回顾性观察性研究中，我们分析了 2008 年 1 月至 2018 年 12 月期间因甲状腺乳头状癌行全甲状腺切除术且正在接受 TSH 抑制治疗的 134 例患者的 166 例妊娠。在妊娠前和妊娠早期进行甲状腺功能检查。在 76 例妊娠（A 组）和 90 例妊娠（B 组）中分别调整和维持了妊娠早期的剂量。A 组的血清 TSH 水平中位数明显低于 B 组（0.014 μIU/mL（IQR，0.005-0.071）比 0.155 μIU/mL（IQR，0.021-0.657），p<0.001）。A 组和 B 组分别有 15.8%和 38.9%的妊娠在妊娠后无法维持 TSH 抑制。妊娠后平均增加 27.4%的 L-T 剂量可使 84.2%的妊娠维持 TSH 抑制。总之，本研究表明，对于术后甲状腺癌患者，其血清 TSH 水平应被抑制，妊娠后增加 L-T 剂量可能是合适的。
