妊娠期甲状腺减退患者妊娠期间左旋甲状腺素钠替代剂量探讨

Levothyroxine replacement dose in patients with hypothyroidism during pregnancy

目的探讨妊娠甲状腺功能减退症（甲减）妊娠期间左旋甲状腺素钠替代剂量。方法 2014年3月至2015年3月入选在我院分娩的274例妊娠合并甲减孕妇,其中亚临床型甲减组（SHT）207例,临床型甲减组（HT）67例,以妊娠早期促甲状腺激素（TSH）〈2.5mU/L,妊娠中晚期TSH〈3.0mU/L为治疗目标,根据TSH及孕周变化予调整左旋甲状腺素钠治疗剂量。并根据TSH水平分为TSH1组,TSH 3~5 mU/L,TSH2组,TSH 5~8 mU/L,TSH3组,TSH 8~10 mU/L,TSH4组,TSH 10~15 mU/L,TSH5组,TSH 15~20 mU/L和TSH6组,TSH〉20mU/L。结果各组达治疗目标后,SHT组T1、T2和T3期,左旋甲状腺素钠剂量分别为：（52.26±19.43）μg、（56.69±20.58）μg和（56.76±19.99）μg;HT组在T1、T2和T3期,左旋甲状腺素钠剂量分别为：（64.58±50.26）μg、（66.67±47.64）μg和（65.91±34.06）μg;TSH1组-TSH6组左旋甲状腺素钠剂量分别为（45.65±16.08）μg、（72.32±14.85）μg、（75.00±13.06）μg、（112.5±53.03）μg、（137.5±23.18）μg和（150.00±23.13）μg;T1、T2和T3妊娠期TSH2、TSH3、TSH4和TSH5组左旋甲状腺素钠剂量高于TSH1组（P〈0.05）;TSH4、TSH5和TSH6组左旋甲状腺素钠片剂量高于TSH2组（P〈0.05）;TSH4、TSH5和TSH6组高于TSH3组（P〈0.05）;TSH5和TSH6组高于TSH4组（P〈0.05）;TSH6组高于TSH5组（P〈0.05）。结论妊娠期临床型甲减左旋甲状腺素钠剂量在T1、T2和T3妊娠期均高于亚临床型甲减（P〈0.05）。随着TSH水平增高,所需左旋甲状腺素钠明显增加（P〈0.05）。

Objective To explore the levothyroxine dose in patients with hypothyroidism during pregnancy.Methods A total of 274 pregnant subjects with hypothyroidism including 207 patients with subclinical hypothyroidism（SHT）and 67 patients with clinical hypothyroidism（HT）were enrolled in this study from March 2014 to March2015.According to thyrotrophic（TSH）levels,the levothyroxine dose was adjusted to reach the targets with the first trimester TSH ranging 0.1-2.5mU/L,the second trimester（T2）TSH ranging 0.2-3.0mU/L and the third trimester（T3）TSH ranging 0.3-3.0 mU/L.The subjects were divided into different groups on the basis of TSH levels,including TSH1 group：TSH 3-5 mU/L,TSH2 group：TSH 5-8 mU/L,TSH3 group：TSH 8-10 mU/L,TSH4group：TSH 10-15 mU/L,TSH5 group：TSH 15-20 mU/L and TSH6 group：TSH 〉20 mU/L.Results The levothyroxine doses were respectively（52.26±19.43）μg in T1 period,（56.69±20.58）μg in T2 period and（56.76±19.99）μg in T3 period in subclinical hypothyroidism,and respectively（64.58±50.26）μg in T1 period,（66.67±47.64）μg in T2 period and（65.91±34.06）μg in T3 period in clinical hypothyroidism.The doses of levothyroxine were（45.65±16.08）μg,（72.32±14.85）μg,（75.00±13.06）μg,（112.5±53.03）μg,（137.5±23.18）μg and（150.00±23.13）μg from TSH1 group to TSH6 group,respectively.The doses of levothyroxine in TSH2,TSH3,TSH4 and TSH5groups were significantly higher than that of TSH1 group during T1 to T3trimester（P〈0.05）.The doses of levothyroxine in TSH4,TSH5 and TSH6 groups were significantly higher than that of TSH2 group（P〈0.05）.The doses of levothyroxine in TSH4,TSH5 and TSH6 groups higher than TSH3 group（P〈0.05）;The doses of levothyroxine in TSH5 and TSH6 groups were significantly higher than that of TSH4group（P〈0.05）.The dose of levothyroxine in TSH6 group were significantly higher than that of TSH5 group（P〈0.05）.Conclusion The levothyroxine（LT4）dose in clinical hypothyroidism in T1,T2 and T3trimester were significantly higher than those in subclinical hypothyroidism（P〈0.05）.The dose of levothyroxine sodium increased significantly accompanied by the increased TSH level during pregnancy（P〈0.05）.