妊娠期甲状腺功能减退症的诊治进展

Update in diagnosis and management of hypothyroidism during pregnancy

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.

Hypothyroidism including overt hypothyroidism(OH) and subclinical hypothyroidism(SCH) is the mostfrequent 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 levothyroxinedosage should be taken in pregnant women with OH diagnosed before pregnancy, whereas, pregnant women with newlydiagnosed OH should immediately start on levothyroxine(L-T4) therapy to ensure that TSH reaches the target value as soonas possible. As for pregnant women with SCH, there has been a controversy regarding the benefit of L- T4 therapy inpreventing adverse pregnancy-related outcome and the suggestion in national and international guidelines. However, recentstudies have recommended L-T4 replacement in all SCH women during pregnancy regardless of whether TPO antibodies arepositive or negative. This paper reviews the research status of OH and SCH related diagnosis and treatment in pregnancy.