桥甲炎患者产后替代治疗剂量变化分析

Therapeutic Dose of Postpartum Thyroxine Replacement in Hashimoto's Thyroiditis

目的研究桥本氏甲状腺炎(桥甲炎)对妊娠的影响,探讨产后患者左旋甲状腺素(L-T4)替代治疗剂量变化原因。方法选取某医院2011年1月至2013年12月794例桥本氏甲状腺炎所致甲状腺功能减退(桥甲炎性甲减)的患者进行回顾性研究。经筛选,确诊桥甲炎性甲减妊娠妇女34例作为研究组,非妊娠32例女性患者为对照组。研究组观察孕前9个月、妊娠期和产后9个月,对照组观察三个连续9个月,分析L-T4摄入量与促甲状腺素(TSH)水平之间的关系。研究组患者妊娠期间,分析患者资料,该院医师随机采用两种方案补充L-T4:方案1,11例患者孕期(妊娠早期T1,妊娠中期T2,妊娠晚期T3)不改变L-T4剂量(T1=T2=T3);方案2,23例患者孕期逐渐加大L-T4剂量(T1<T2<T3)。结果与方案1的TSH值比较,方案2的TSH值显著不同(分别为2.8±0.5m IU/L;1.3±0.1m IU/L。P<0.003)。以孕前L-T4的补充剂量为基准线,产后3个月,方案2的女性比方案1高出基线至少20%以上(P=0.04)。结论由于甲状腺储备功能不同及产后进行性自身免疫性功能损害程度存在差异,50%以上的桥甲炎性甲减的女性患者,产后需要补充的L-T4比产前剂量增多。

Objective To explore the impact of Hashimoto＇ s thyroiditis on pregnancy and the therapeutic doses of levothyroxine requirements after pregnancy. Methods 794 cases with Hashimoto＇ s thyroiditis were recruited in our hospital for four years, and 34 cases in pregnancy were selected as the study group, the 32 non-pregnant women were served as the control group, the relationship of levothyroxine dose and TSH level were analyzed. The levothyroxine intake and serum thyrotropin （TSH） levels of observed patients were detected before, during, and after pregnancy, each time point last for 9 months, but this detection were last for only three consecutive 9- month in patients of control group. There were two ways of levothyroxine supplementation adopted in this study. Patten No. 1 （ n = 11 ） ： no change on levothyroxine dose with no subsequent change in each trimester（T1=T2=T3 ） Patten No. 2 （n = 23 ）, multistep levothyroxine dose throughout pregnancy（Tl〈T2〈T3 ） to maintain the TSH levels to meet the standards of American Thyroid Association （ATA）. Results The value of TSH in Pattern No. 2 showed significant difference as compared with Patten No. 1 （2.8 ± 0.5mIU/L and 1.3 ± 0. lmIU/L, respectively, P 〈 0. 003 ）. According to the supplement baseline of L-T4, Pattern No. 2 showed a more increase above 20% than the Pattern No. 1 at 3 months postpartum （P =0.04）. Conclusion More than 50% of hypothyroid women with Hashimoto＇ s thyroiditis need an increase in levothyroxine requirements in the postpartum because of the different storage of hypothyroid as well the function of auto-immune injury