桥本甲状腺炎女性在妊娠早期的促甲状腺素水平和甲状腺功能。

Preconception Thyrotropin Levels and Thyroid Function at Early Gestation in Women With Hashimoto Thyroiditis.

机构信息

Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Messina, 98125 Messina, Italy.

Dipartimento di Economia, Università degli Studi di Messina, 98125 Messina, Italy.

出版信息

J Clin Endocrinol Metab. 2023 Jun 16;108(7):e464-e473. doi: 10.1210/clinem/dgac748.

DOI:10.1210/clinem/dgac748

PMID:36620924

Abstract

CONTEXT

Preconception optimization of thyroid function in women with Hashimoto thyroiditis (HT) is highly recommended to prevent/reduce the risk of thyroid insufficiency at early gestation.

OBJECTIVE

This work aimed to evaluate the prevalence of first-trimester thyroid insufficiency in HT women with preconception thyrotropin (T0-TSH) values consistently less than or equal to 2.5 mIU/L with or without levothyroxine (LT4) treatment, and to calculate T0-TSH cutoffs that best preconceptionally identified HT women requiring first-trimester LT4 adjustment/prescription.

METHODS

Serum TSH was obtained at 4- to 6-week intervals from 260 HT pregnant women (122 on LT4 [Hypo-HT]; 138 euthyroid without LT4 [Eu-HT]), prospectively followed from preconception up to pregnancy term. Receiver operating characteristic (ROC) curves were plotted to identify T0-TSH cutoffs best predicting first-trimester TSH levels greater than 2.5 mIU/L (diagnostic criterion [DC] 1) and greater than 4.0 mIU/L (DC 2).

RESULTS

At first trimester, TSH was greater than 2.5 mIU/L in approximately 30% of both Hypo-HT and Eu-HT women, and greater than 4.0 mIU/L in 19.7% Hypo-HT and 10.1% Eu-HT women (P = .038). The optimal ROC-based T0-TSH cutoffs found were 1.24 mIU/L/1.74 mIU/L in Hypo-HT, and 1.73 mIU/L/2.07 mIU/L in Eu-HT women, for DC 1 and DC 2, respectively. T0-TSH values exceeding these cutoffs resulted in a statistically significantly increased risk of first-trimester thyroid insufficiency (odds ratio [OR] [95% CI)] 15.92 [5.06-50.15] and 16.68 [5.13-54.24] in Hypo-HT; 16.14 [6.47-40.30] and 17.36 [4.30-70.08] in Eu-HT women, for DC 1 and DC 2, respectively).

CONCLUSION

The preconception TSH cutoffs that guaranteed a first-trimester TSH less than 2.5 mU/L in hypothyroid- and euthyroid-HT women were, respectively, almost 50% (1.24 mU/L) and 30% (1.73 mU/L) lower than this gestational target, and 1.74 mU/L and 2.07 mU/L in hypothyroid- and euthyroid-HT women, respectively, for a gestational target of 4.0 mU/L.

摘要

背景

强烈建议桥本甲状腺炎（HT）女性在受孕前优化甲状腺功能，以预防/降低早期妊娠甲状腺功能减退的风险。

目的

本研究旨在评估 T0-TSH 值持续小于或等于 2.5 mIU/L 的 HT 女性在受孕前甲状腺功能减退的发生率，以及确定 T0-TSH 切点，以便最佳地识别需要在孕早期调整/开具 LT4 处方的 HT 女性。

方法

前瞻性地从 260 名 HT 孕妇（122 名服用 LT4 [Hypo-HT]；138 名甲状腺功能正常未服用 LT4 [Eu-HT]）中获得血清 TSH，从受孕前至妊娠结束，每隔 4-6 周进行一次检查。绘制受试者工作特征（ROC）曲线，以确定 T0-TSH 切点最佳预测孕早期 TSH 水平大于 2.5 mIU/L（诊断标准[DC]1）和大于 4.0 mIU/L（DC 2）。

结果

在孕早期，大约 30%的 Hypo-HT 和 Eu-HT 女性的 TSH 大于 2.5 mIU/L，19.7%的 Hypo-HT 和 10.1%的 Eu-HT 女性的 TSH 大于 4.0 mIU/L（P=0.038）。基于 ROC 的最佳 T0-TSH 切点分别为 Hypo-HT 女性 1.24 mIU/L/1.74 mIU/L，Eu-HT 女性 1.73 mIU/L/2.07 mIU/L，用于 DC 1 和 DC 2。T0-TSH 值超过这些切点会导致孕早期甲状腺功能减退的风险显著增加（比值比[OR]（95%CI]15.92 [5.06-50.15]和 16.68 [5.13-54.24]在 Hypo-HT；16.14 [6.47-40.30]和 17.36 [4.30-70.08]在 Eu-HT 女性，用于 DC 1 和 DC 2）。

结论

在 Hypo-HT 和 Eu-HT 女性中，保证孕早期 TSH 小于 2.5 mU/L 的 TSH 切点分别比这个妊娠目标低近 50%（1.24 mU/L）和 30%（1.73 mU/L），而 Hypo-HT 和 Eu-HT 女性的 TSH 切点分别为 1.74 mU/L 和 2.07 mU/L，用于妊娠目标为 4.0 mU/L。