Shih Yu-Hsiang, Hsieh Chia-Jung, Wang Shao-Jing, Lu Chien-Hsing, Tseng Jenn-Jhy
Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Public Health, Chung Shan Medical University, Taichung, Taiwan.
Front Endocrinol (Lausanne). 2025 Aug 29;16:1656498. doi: 10.3389/fendo.2025.1656498. eCollection 2025.
Emerging evidence links gestational diabetes mellitus (GDM) with thyroid dysfunction, but the long-term risk of clinically diagnosed thyroid diseases after GDM remains unclear.
To assess the long-term risk of specific thyroid disorders in women with prior GDM compared with those without GDM.
We performed a retrospective cohort study using the TriNetX U.S. Collaborative Network, including de-identified records from >80 healthcare organizations. Women aged 16-45 years with pregnancies from 2001 to 2015 were eligible; those with pre-existing hypertension, diabetes, thyroid disease, thyroid surgery, or preeclampsia/eclampsia were excluded. GDM was identified by ICD codes. The primary outcome was first diagnosis of thyroid disorders-hyperthyroidism, hypothyroidism, toxic/non-toxic goiter, thyroiditis (acute, subacute, Hashimoto's), benign thyroid neoplasms, and thyroid cancer-after the index pregnancy. Propensity score matching (1:1) accounted for age, race, overweight/obesity, nicotine dependence, and alcohol abuse. Follow-up extended up to 20 years. Hazard ratios (HRs) were estimated using Cox models; cumulative incidence was compared with Kaplan-Meier analysis.
After matching, GDM was associated with higher risks of hyperthyroidism (HR 1.60, 95% CI 1.30-1.99), hypothyroidism (HR 1.33, 95% CI 1.17-1.51), thyroiditis (HR 1.55, 95% CI 1.21-2.00), Hashimoto's thyroiditis (HR 1.37, 95% CI 1.02-1.83), toxic goiter (HR 1.70, 95% CI 1.19-2.44), and non-toxic goiter (HR 1.26, 95% CI 1.10-1.45). No association was found for benign neoplasms or thyroid cancer. Risks were greater in women aged 35-45 years and those with BMI >25.
GDM is linked to increased long-term risk of multiple thyroid diseases, warranting extended thyroid monitoring in older and overweight/obese women.
新出现的证据将妊娠期糖尿病（GDM）与甲状腺功能障碍联系起来，但GDM后临床诊断的甲状腺疾病的长期风险仍不明确。
评估既往患有GDM的女性与未患GDM的女性相比，患特定甲状腺疾病的长期风险。
我们使用TriNetX美国协作网络进行了一项回顾性队列研究，包括来自80多个医疗机构的去识别记录。纳入2001年至2015年期间怀孕的16至45岁女性；排除患有高血压、糖尿病、甲状腺疾病、甲状腺手术史或先兆子痫/子痫的女性。通过国际疾病分类代码识别GDM。主要结局是在本次索引妊娠后首次诊断出甲状腺疾病——甲状腺功能亢进、甲状腺功能减退、毒性/非毒性甲状腺肿、甲状腺炎（急性、亚急性、桥本氏）、良性甲状腺肿瘤和甲状腺癌。倾向评分匹配（1:1）考虑了年龄、种族、超重/肥胖、尼古丁依赖和酒精滥用情况。随访长达20年。使用Cox模型估计风险比（HRs）；通过Kaplan-Meier分析比较累积发病率。
匹配后，GDM与甲状腺功能亢进（HR 1.60，95%CI 1.30-1.99）、甲状腺功能减退（HR 1.33，95%CI 1.17-1.51）、甲状腺炎（HR 1.55，95%CI 1.21-2.00）、桥本氏甲状腺炎（HR 1.37，95%CI 1.02-1.83）、毒性甲状腺肿（HR 1.70，95%CI 1.19-2.44）和非毒性甲状腺肿（HR 1.26，95%CI 1.10-1.45）的较高风险相关。未发现与良性肿瘤或甲状腺癌有关联。35至45岁的女性以及BMI>25的女性风险更高。
GDM与多种甲状腺疾病的长期风险增加有关，因此有必要对年龄较大以及超重/肥胖的女性进行更长时间的甲状腺监测。
