妊娠期甲状腺功能减退的临床研究

Clinical Study of Subclinical Hypothyroidism during Pregnancy

目的观察妊娠期甲减症患者的甲状腺功能指标变化及左旋甲状腺素钠的治疗效果.方法应用化学发光法(CIA)测定并分析不同妊娠期甲减症患者的FT3、FT4、TSH甲功指标变化,给予25～150μg/d不同剂量药物治疗,观察不同妊娠期甲减孕妇的药物剂量变化.结果妊娠中期,临床与亚临床甲减组TSH均高于正常对照组水平(P<0.01).亚临床甲减组的FT4水平高于临床甲减组(P<0.05).妊娠晚期,临床甲减组FT3、FT4水平、比正常对照组低(P<0.05),且TSH显著高于正常对照组水平(P<0.01).临床组妊娠中期和晚期左甲状腺素钠需求剂量显著高于孕早期(P<0.05);亚临床组孕早期的左甲状腺素钠的需求量有显著差异(P<0.01);2组产后左甲状腺素钠需求剂量低于妊娠晚期需求剂量(P<0.05).结论临床和亚临床甲减组患者妊娠中、晚期左旋甲状腺素钠治疗剂量增加.对高危人群妊娠期全程严密地监测甲状腺功能水平,及时诊断和治疗对于孕妇健康具有十分重要的意义.

Objective To observe the change of thyroid function and treatment effect of Levothyroxine for hypothyroidism during pregnancy.Method With high-sensitive chemical irradiance assay（CIA） technique analisis the FT3,FT4,TSH changes thyroid function of different pregnancy period and the 25～150 ug/d changes dose to treat in different dose use it.Results The levels of TSH in groups of patients with hypothyroidism subclinical hypothyroidism were higher than those of the normal groups during pregnancy medium period（P0.01）.The levels of FT4 in the subclinical hypothyroidism patients were higher than those in hypothyroidism patients（P〈0.05）.In the 3rd trimester,the levels of FT3 and FT4 in hypothyroidism patients were lower than those in the normal subjects（P〈0.05）,and the levels of TSH were much higher than the normal groups（P0.01）.The required doses of Levothyroxine in both groups of patients were much higher the first pregnancy period（P〈0.05）.The groups of subclinical patients need more dose in first pregnancy period（P0.01）.The doses of both groups of patients after childbirth were lower than the groups in the 3rd trimester（P〈0.05）.Conclusions The doses of Levothyroxine in both groups of patients are increasing in the 2rd and 3rd trimester.All mothers with thyroid disease get adequate treatment in time and remain thyroid function normal,the adverse influence may be reduced to the least.So serial monitoring and therapeutic intervention may be necessary for the prevention of undesirable obstetric outcomes.