妊娠早期合并亚临床型甲状腺功能异常的超声表现

Ultrasound Manifestations of Subclinical Thyroid Dysfunction in Early Pregnancy

目的 探讨妊娠早期甲状腺血清学异常患者甲状腺超声表现特点.方法 选择2018年1月-2019年1月在深圳市龙岗区人民医院就诊的53例孕妇进行甲状腺超声检查.入组孕妇在孕早期检测血清促甲状腺激素(TSH)、血清游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPoAb)水平并首次发现甲状腺功能或血清TPoAb 抗体水平异常.比较血清TPoAb≥45 IU/mL和血清TPoAb<45 IU/mL孕妇甲状腺回声异常发生率及腺体血流增多发生率差异.结果 53例孕妇当中其中有41例为亚临床型甲状腺功能亢进,5例为亚临床型甲状腺功能减低,7例为单纯TPoAb水平的增高.41例亚临床型甲状腺功能亢进孕妇中,35例不伴有TPoAb 水平升高的孕妇甲状腺超声表现未见明确异常,而其余有TPoAb水平升高的6例孕妇当中有2例孕妇(33.3%)甲状腺实质回声有弥漫性的改变;5例亚临床型甲状腺功能减低的孕妇当中,其中3例不伴有TPoAb水平升高的孕妇甲状腺实质回声出现弥漫性的改变,而2例伴有TPoAb水平升高的孕妇中1例(50.0%)出现甲状腺实质回声弥漫性改变;7例单纯TPoAb 水平升高的孕妇中,其中4例孕妇(57.1%)甲状腺实质回声出现弥漫性改变.在所有血清TPoAb水平升高的15例孕妇中,10例孕妇血清TPoAb≥45 IU/mL,5例孕妇血清TPoAb<45 IU/mL.血清TPoAb≥45 IU/mL的孕妇甲状腺回声异常发生率高于血清TPoAb<45 IU/mL的孕妇(7/10 vs 0/5);血清TPoAb≥45 IU/mL的孕妇甲状腺血流增多发生率高于血清TPoAb<45 I U/m L的孕妇(4/1 0 vs 1/5).结论 妊娠期具有甲状腺血清学检测指标异常的患者当中,可以出现不同的超声影像学表现,但超声影像学表现与血清学检测结果 并不完全一致.

Objective To explore the characteristics of thyroid ultrasonography in patients with thyroid serologic abnormality in early pregnancy.Methods Choice From January 2018 to January 2019,53 pregnant women in Longgang District People's Hospital of Shenzhen City were examined by thyroid ultrasound.Serum TSH,FT4 and TPOAb were detected in the first trimester of pregnancy,and abnormal thyroid function or TPOAb antibody was found for the first time.The incidence of abnormal thyroid echo and increased glandular blood flow in pregnant women with serum TPOAb≥45 IU/mL and serum TPOAb<45 IU/mL were compared.Results Among 53 pregnant women,41 cases were subclinical hyperthyroidism,5 cases were subclinical hypothyroidism,and 7 cases were simple increase of TPOAb level.Among 41 cases of subclinical hyperthyroidism,35 cases of pregnant women without elevated TPOAb level showed no definite abnormality,Among the other six pregnant women with elevated TPOAb level,2(33.3%)had diffuse changes in thyroid parenchyma echo;Among 5 cases of subclinical hypothyroidism,3 cases did not show diffuse thyroid changes,In 2 cases of pregnant women with elevated TPOAb level,1 case(50.0%)showed diffuse thyroid changes;in 7 cases of pregnant women with elevated TPOAb level,4 cases(57.1%)showed diffuse thyroid changes.Of the 15 pregnant women with elevated serum TPOAb,10 had a serum TPOAb≥45 IU/mL,and 5 had a serum TPOAb<45 IU/mL.The incidence of abnormal thyroid echo in the pregnant women with serum TPOAb≥45 IU/mL was higher than that in the pregnant women with serum TPOAb<45 IU/mL(7/10 vs 0/5);the incidence of increased thyroid blood flow in the pregnant women with serum TPOAb≥45 IU/mL was higher than that in the pregnant women with serum TPOAb<45 IU/mL(4/10 vs 1/5).Conclusion Patients with abnormal thyroid serological indicators in pregnancy may have different ultrasonic manifestations,which are not completely consistent with the serological manifestations.