Department of Obstetrics and Gynecology, The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
Lipids Health Dis. 2022 Dec 19;21(1):142. doi: 10.1186/s12944-022-01744-5.
Thyroid function is widely considered a lipid metabolism regulator. However, studies on lipid metabolism in pregnant women with low free thyroxine (FT) levels are limited and inconclusive. Furthermore, the association between maternal FT deficiency and adverse lipid metabolic parameters is unknown. Therefore, we aimed to investigate this association and the effects of levothyroxine (L-T) treatment on these metabolic indicators.
This retrospective study included 164 patients with isolated hypothyroidism (IH) (FT levels below the 5 percentile with normal thyroid stimulating hormone levels according to the gestational-specific reference range) and 407 euthyroidism patients (control group who had regular antenatal examinations at Zhejiang Provincial People's Hospital, Hangzhou, China) between January 1, 2019, and December 31, 2020. Patients with IH were divided into levothyroxine (L-treatment group, n = 77) and dietary iodine supplement treatment groups (dietary treatment group, n=87) according to the hospital's treatment policy and clinical experience. The intervention lasted for at least 8 weeks. Metabolic indicators, including thyroid function and lipid parameters, were collected at least twice before and after the intervention. Other data collected included maternal age, history of abortion, prepregnancy BMI, and gestational weight gain (Fig. 1).
Compared with the control group, Patients with IH had a higher degree of dyslipidemia, reflected in elevated total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and apolipoprotein B (Apo B) levels. In IH patients, an inverse correlation was found between FT and TG levels, which remained after adjusting for prepregnancy BMI. The L-treatment group demonstrated a significantly slower rate of hypercholesterolemia progression during pregnancy than the dietary treatment group. In addition, there was a relationship between the therapeutic effect and the degree of disease, with the main factors being FT, TSH and TG levels prior to starting treatment.
Low FT levels were associated with elevated blood lipid levels. Serum FT and lipid levels in patients could be improved by medical intervention.
甲状腺功能被广泛认为是脂质代谢的调节剂。然而，关于游离甲状腺素（FT）水平较低的孕妇的脂质代谢研究有限且结果不一致。此外，母体 FT 缺乏与不良脂质代谢参数之间的关系尚不清楚。因此，我们旨在研究这种相关性以及左甲状腺素（L-T）治疗对这些代谢指标的影响。
这项回顾性研究纳入了 2019 年 1 月 1 日至 2020 年 12 月 31 日期间在浙江省人民医院进行常规产前检查的 164 例单纯性甲状腺功能减退症（IH）患者（FT 水平低于根据妊娠特异性参考范围的第 5 百分位，同时甲状腺刺激激素水平正常）和 407 例甲状腺功能正常患者（对照组）。根据医院的治疗政策和临床经验，将 IH 患者分为左甲状腺素（L-治疗组，n=77）和饮食碘补充治疗组（饮食治疗组，n=87）。干预至少持续 8 周。在干预前后至少两次采集代谢指标，包括甲状腺功能和血脂参数。收集的其他数据包括产妇年龄、流产史、孕前 BMI 和妊娠体重增加（图 1）。
与对照组相比，IH 患者的血脂异常程度更高，表现为总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和载脂蛋白 B（Apo B）水平升高。在 IH 患者中，FT 与 TG 水平呈负相关，调整孕前 BMI 后仍然存在。与饮食治疗组相比，L-治疗组在妊娠期间发生高胆固醇血症的进展速度较慢。此外，治疗效果与疾病程度之间存在关系，主要因素是治疗前的 FT、TSH 和 TG 水平。
低 FT 水平与血液脂质水平升高有关。通过医学干预可以改善患者的血清 FT 和血脂水平。
