Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Diabetes Research Group, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
J Clin Endocrinol Metab. 2023 Oct 18;108(11):2886-2897. doi: 10.1210/clinem/dgad276.
Optimal thyroid status in pregnancy is essential in reducing the risk of adverse outcomes. The management of hyperthyroidism in women of reproductive age poses unique challenges and it is unclear how preconception treatment strategies impact on thyroid status in subsequent pregnancy.
We aimed to determine trends in the management of hyperthyroidism before and during pregnancy and to assess the impact of different preconception treatment strategies on maternal thyroid status.
We utilized the Clinical Practice Research Datalink database to evaluate all females aged 15-45 years with a clinical diagnosis of hyperthyroidism and a subsequent pregnancy (January 2000 to December 2017). We compared thyroid status in pregnancy according to preconception treatment, namely, (1) antithyroid drugs up to or beyond pregnancy onset, (2) definitive treatment with thyroidectomy or radioiodine before pregnancy, and (3) no treatment at pregnancy onset.
Our study cohort comprised 4712 pregnancies. Thyrotropin (TSH) was measured in only 53.1% of pregnancies, of which 28.1% showed suboptimal thyroid status (TSH >4.0 mU/L or TSH <0.1 mU/L plus FT4 >reference range). Pregnancies with prior definitive treatment were more likely to have suboptimal thyroid status compared with pregnancies starting during antithyroid drug treatment (odds ratio 4.72, 95% CI 3.50-6.36). A steady decline in the use of definitive treatment before pregnancy was observed from 2000 to 2017. One-third (32.6%) of first trimester carbimazole-exposed pregnancies were switched to propylthiouracil while 6.0% of propylthiouracil-exposed pregnancies switched to carbimazole.
The management of women with hyperthyroidism who become pregnant is suboptimal, particularly in those with preconception definitive treatment, and needs urgent improvement. Better thyroid monitoring and prenatal counseling are needed to optimize thyroid status, reduce teratogenic drug exposure, and ultimately reduce the risk of adverse pregnancy outcomes.
怀孕期间甲状腺功能的最佳状态对于降低不良结局的风险至关重要。生育年龄妇女的甲状腺功能亢进症的管理带来了独特的挑战，目前尚不清楚孕前治疗策略如何影响随后妊娠的甲状腺状态。
我们旨在确定孕前和孕期甲状腺功能亢进症管理的趋势，并评估不同孕前治疗策略对产妇甲状腺状态的影响。
我们利用临床实践研究数据链接数据库评估了所有 15-45 岁有临床诊断为甲状腺功能亢进症且随后怀孕的女性（2000 年 1 月至 2017 年 12 月）。我们根据孕前治疗比较了妊娠期间的甲状腺状态，具体为：（1）孕前至妊娠开始时使用抗甲状腺药物，（2）孕前进行甲状腺切除术或放射性碘治疗，（3）妊娠开始时不治疗。
我们的研究队列包括 4712 例妊娠。仅 53.1%的妊娠中测量了促甲状腺激素（TSH），其中 28.1%显示甲状腺功能状态不佳（TSH>4.0 mU/L 或 TSH<0.1 mU/L 且游离甲状腺素>参考范围）。与开始使用抗甲状腺药物治疗的妊娠相比，有孕前明确治疗的妊娠更可能存在甲状腺功能不佳（优势比 4.72，95%置信区间 3.50-6.36）。从 2000 年到 2017 年，孕前明确治疗的应用呈稳步下降趋势。三分之一（32.6%）接受卡比马唑治疗的妊娠在孕早期转为丙基硫氧嘧啶治疗，而 6.0%接受丙基硫氧嘧啶治疗的妊娠转为卡比马唑治疗。
管理怀孕的甲状腺功能亢进症妇女的方法并不理想，特别是那些有孕前明确治疗的患者，需要紧急改进。需要更好的甲状腺监测和产前咨询，以优化甲状腺功能，减少致畸药物暴露，最终降低不良妊娠结局的风险。
