Dash Subhash C, Sahoo Nalinikanta, Rout Udaybhanu, Mishra Sujata P, Swain Jayashree, Mazumder Arijit G
Department of Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND.
Department of Obstetrics & Gynecology, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, IND.
Cureus. 2022 May 14;14(5):e24984. doi: 10.7759/cureus.24984. eCollection 2022 May.
Introduction Adverse pregnancy outcomes in women with subclinical hypothyroidism (SCH) are well documented, whereas data regarding the risk and benefit of levothyroxine treatment in such cases are insufficient and inconsistent. Our study aimed to evaluate the effects of levothyroxine treatment on pregnancy outcomes in these women. Materials and methods Healthy women with a singleton pregnancy were screened before 12 weeks of gestation for subclinical hypothyroidism using 2017 American Thyroid Association guidelines. They were treated with an initial dose of 50 mcg of levothyroxine and the dose was adjusted at six-week intervals to achieve a normal thyrotropin level. All the participants were followed up with thyroid function tests and ultrasonography till delivery. Pregnancy outcomes were compared with those of healthy pregnant women with normal thyroid function. Results A total of 1058 women were screened and 5.1% (n=54) were found to have subclinical hypothyroidism, out of which 57.4% (n=31) were thyroid peroxidase antibody positive. The median gestational age at the initiation of levothyroxine treatment was nine weeks. The risks for miscarriage (odds ratio (OR): 1.284, p=0.811), gestational hypertension (OR: 1.993, p=0.365), intra-uterine growth restriction (OR: 1.688, p=0.488), low birth weight (OR: 1.591, p=0.392), and preterm birth (OR: 1.606, p=0.529) were not significantly higher in women with subclinical hypothyroidism as compared to euthyroid women. However, the risk of gestational diabetes mellitus was significantly higher in women with SCH (OR: 3.432, 95% confidence interval (95% CI): 1.115-10.562). Conclusion Levothyroxine therapy initiated in the first trimester of pregnancy has possible beneficial effects in subclinical hypothyroidism but with a higher risk for gestational diabetes.
引言 亚临床甲状腺功能减退症（SCH）女性的不良妊娠结局已有充分记录，而关于此类病例中左甲状腺素治疗的风险和益处的数据不足且不一致。我们的研究旨在评估左甲状腺素治疗对这些女性妊娠结局的影响。
材料与方法 采用2017年美国甲状腺协会指南，在妊娠12周前对单胎妊娠的健康女性进行亚临床甲状腺功能减退症筛查。她们初始接受50微克左甲状腺素治疗，剂量每六周调整一次以达到促甲状腺激素水平正常。所有参与者均通过甲状腺功能测试和超声检查进行随访直至分娩。将妊娠结局与甲状腺功能正常的健康孕妇进行比较。
结果 共筛查了1058名女性，发现5.1%（n = 54）患有亚临床甲状腺功能减退症，其中57.4%（n = 31）甲状腺过氧化物酶抗体呈阳性。左甲状腺素治疗开始时的中位孕周为9周。与甲状腺功能正常的女性相比，亚临床甲状腺功能减退症女性的流产风险（优势比（OR）：1.284，p = 0.811）、妊娠期高血压（OR：1.993，p = 0.365）、宫内生长受限（OR：1.688, p = 0.488）、低出生体重（OR：1.591, p = 0.392）和早产（OR：1.606, p = 0.529）并无显著升高。然而，SCH女性患妊娠期糖尿病的风险显著更高（OR：3.432，95%置信区间（95%CI）：1.115 - 10.562）。
结论 在妊娠早期开始左甲状腺素治疗对亚临床甲状腺功能减退症可能有有益作用，但妊娠期糖尿病风险较高。
