妊娠合并亚临床甲状腺功能减退患者甲状腺素剂量调整的临床观察

Clinical observation of thyroxine dose adjustment of pregnancy with subclinical hypothyroidism

目的 观察妊娠期亚临床甲状腺功能减退（简称亚临床甲减）患者甲状腺素剂量调整的时机和规律,实施早期治疗,达到优生优育的目的.方法 选择孕32 ～51 d的亚临床甲减患者90例,其中45例妊娠前已知甲状腺功能减退（孕前甲减组）,45例早孕检查时初发亚临床甲减（妊娠甲减组）,观察两组患者治疗期间药物剂量调整及开始药物替代治疗前后甲状腺素和生化指标变化规律,及时予以补充替代治疗.结果 两组患者甲状腺激素治疗剂量不同,孕前甲减组所需的剂量高于妊娠甲减组.孕前甲减组入组时血清游离甲状腺素（FT4）为（13.7±4.4） pmol/L,孕3月为（21.6±4.4） pmol/L;妊娠甲减组入组时FT4值为（14.4±3.7） pmol/L,孕3月为（22.3±5.6） pmol/L,两组患者入组前后FT4值比较,差异有统计学意义（t值分别为3.65,4.15;P ＜0.01）.两组患者的FT4水平随着孕月逐渐升高,孕3月时达到早孕要求目标值.两组患者妊娠期间促甲状腺激素（TSH）变化规律一致,随着甲状腺激素剂量的增加,孕前甲减组和妊娠甲减组入组时TSH分别为（36.70±4.31）,（29.90±6.79） mIU/L,在孕3月时已降至目标值,分别为（0.57±0.32）,（0.62±0.41）mIU/L,两组比较,差异无统计学意义（t值分别为18.61,17.52;P ＞0.05）.结论 妊娠早期应尽快明确甲状腺功能,对亚临床甲减患者应尽快补充甲状腺激素,确保孕3月时可达标,有效消除甲状腺激素减退导致的妊娠不良结局和后代智力受损.

Objective To observe the time and pattern of thyroxine dose adjustment in pregnancy women with subclinical hypothyroidism,so as to implement the early treatment and achieve the purpose of birth.Methods Between January 2010 and June 2012,90 cases with the pregnancy of 32-51 days were divided into pre-pregnancy hypothyroidism group （n =45） that diagnosed with hypothyroidism before pregnancy,and pregnancy hypothyroidism group （n =45） that diagnosed with primary subclinical hypothyroidism after pregnancy.The drug dosage adjustment during treatment,and the changes of thyroxine and biochemical before and after the initiation of drug substitution treatment were observed and timely replacement therapy was performed.Results Treatment doses of thyroid hormone of two groups were different,pre-pregnancy hypothyroidism group was higher than pregnancy hypothyroidism group.Significant difference was found in the FT4 when the study began and 3 months of pregnancy,respectively were [（13.7 ± 4.4） vs （14.4 ± 3.7） pmol/L,t =3.65,P 〈 0.01] and [（21.6 ± 4.4） vs （22.3 ± 5.6） pmol / L,t =4.15,P 〈 0.01] between two groups.The change rule of thyroid stimulating hormone （TSH） between two groups was consistent,and it increased with the doses of thyroid hormone increase.No significant difference was found between two groups in the TSH when the study began [（36.7 ± 4.31） vs （29.9 ± 6.79） mIU/L,t =18.61,P 〉 0.05] and 3 months of pregnancy [（0.57±0.32） vs （0.62 ±0.41）mIU/L,t =17.52,P〉0.05].Conclusions Thyroid function of early pregnancy should be made clear as soon as possible,and for patients with subclinical hypothyroidism,thyroid hormone supplementation therapy should be performed early.It can effectively decrease the adverse pregnancy outcomes and offspring mental impairment.