天津医药

天津医药 ›› 2016, Vol. 44 ›› Issue (11): 1297-1301.doi: 10.11958/20161144

• 内分泌专题 •    下一篇

妊娠期甲状腺功能减退症的诊治进展

单忠艳△   

  1. 中国医科大学附属第一医院内分泌与代谢病科 （邮编 110001）
  • 收稿日期:2016-10-11 修回日期:2016-10-24 出版日期:2016-11-15 发布日期:2016-11-15
  • 通讯作者: △通讯作者 E-mail: shanzhongyan@medmail.com.cn E-mail:shanzhongyan@medmail.com.cn
  • 作者简介:单忠艳（1964-）， 二级教授， 博士研究生导师， 享受国务院特殊津贴。毕业于中国 医科大学， 曾在美国斯坦福大学医学院做博士后研究。现任中国医科大学附属第一医院内分泌 与代谢病科主任， 中华医学会内分泌学分会副主任委员、 甲状腺学组组长， 中国内分泌代谢病医 师协会常委。辽宁省医学会内分泌学分会候任主任委员。辽宁省医学会糖尿病学分会前任主任 委员。《中华糖尿病杂志》、《中国实用内科杂志》 副主编，《中华内分泌代谢杂志》、《中华内科杂志》 等编委。研究方向为甲状腺疾病和代谢综合征。

Update in diagnosis and management of hypothyroidism during pregnancy

SHAN Zhongyan△   

  1. Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang 110001, China
  • Received:2016-10-11 Revised:2016-10-24 Published:2016-11-15 Online:2016-11-15
  • Contact: △Corresponding Author E-mail: shanzhongyan@medmail.com.cn E-mail:shanzhongyan@medmail.com.cn
  • About author:Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang 110001, China

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摘要： 甲状腺功能减退症（甲减）是妊娠期最常见的甲状腺功能异常。妊娠期甲减包括临床甲减和亚临床甲减 （SCH）。SCH （患病率 3%~5%） 比临床甲减 （<1%） 常见。目前， 临床倾向采用妊娠特异性促甲状腺激素 （TSH） 和血清 游离甲状腺素 （FT4） 参考值诊断妊娠期甲减。妊娠前已确诊的临床甲减在妊娠期间需增加血清左甲状腺素 （L-T4） 的剂量； 而妊娠期新诊断的临床甲减， 应立即给予 L-T4 治疗并尽快使 TSH 水平达到目标值。对于 SCH， 虽然对母 胎获益的相关临床研究结果不一致， 国内外指南的治疗建议也不尽相同， 但是， 最近几年的研究提示对 SCH 无论是 否伴有甲状腺自身抗体阳性均可考虑治疗。本文就妊娠期临床甲减及 SCH 诊治相关的研究现状进行综述。

关键词: 甲状腺功能减退症, 妊娠并发症, 甲状腺素, 促甲状腺素, 预后, 综述

Abstract: Hypothyroidism including overt hypothyroidism (OH) and subclinical hypothyroidism (SCH) is the most frequent condition of thyroid dysfunction during pregnancy. The prevalence of SCH during pregnancy ranges from 3% to 5%. In contrast, OH has a prevalence of less than 1% . Currently, pregnancy- specific reference ranges for serum thyrotropin (TSH) and free thyroxin (FT4) are used in the clinical diagnosis of hypothyroidism during pregnancy. More levothyroxine dosage should be taken in pregnant women with OH diagnosed before pregnancy, whereas, pregnant women with newly diagnosed OH should immediately start on levothyroxine (L-T4) therapy to ensure that TSH reaches the target value as soon as possible. As for pregnant women with SCH, there has been a controversy regarding the benefit of L- T4 therapy in preventing adverse pregnancy-related outcome and the suggestion in national and international guidelines. However, recent studies have recommended L-T4 replacement in all SCH women during pregnancy regardless of whether TPO antibodies are positive or negative. This paper reviews the research status of OH and SCH related diagnosis and treatment in pregnancy.

Key words: hypothyroidism, pregnancy complications, thyroxine, thyrotropin, prognosis, review