The impact of maternal hypothyroidism during pregnancy on neonatal outcomes: a systematic review and meta-analysis

The effects of maternal hypothyroidism on neonatal outcomes were not definitely confirmed. We conduct a systematic review of the literatures on the impact of maternal hypothyroidism on neonatal outcomes. We searched Pubmed, Embase and the Cochrane Controlled Trials Register databases complemented by manual searches in article references without language restrictions published from 1946 to April 2015. Nine trials are included. For preterm birth in pregnancies of hypothyroidism women, there is an increased tendency (RR 1.18; 95% CI 0.99 to 1.40; p?=?0.06). The same result is seen relating to the low birth weight (RR 1.31; 95% CI 1.00 to 1.72; p?=?0.05). Regarding small for gestational age there is no significant increase. Children who were born from mothers with hypothyroidism during pregnancy have increased birth weight (MD 32.35, 95% CI 7.46 to 57.24; p?=?0.01). The impact of maternal hypothyroidism shows a trend of reduced risk of large for gestational age (RR 1.17; 95% CI 0.99 to 1.38; p?=?0.06). Our review suggests that mothers with hypothyroidism during pregnancy are more likely to give birth to children with higher birth weight or LGA, and L-T4 supplementation should be recommended. The risk of preterm birth and low birth weight also tends to be higher in children with hypothyroidism mothers.     

Association between the clinical classification of hypothyroidism and reduced TSH in LT4 supplemental replacement treatment for pregnancy in China

The study was aimed to evaluate the effects of levothyroxine (LT4) supplemental replacement treatment for pregnancy and analyze the associations between the clinical classification of hypothyroidism and reduced thyroid-stimulating hormone (TSH) in LT4 therapy. Totally, 195 pregnant women with hypothyroidism receiving routine prenatal care were enrolled. They were categorized into three groups: overt hypothyroidism (OH), subclinical hypothyroidism (SCH) with negative thyroperoxidase antibody (TPOAb), and SCH with positive TPOAb. The association between the clinical classification and reduced TSH in LT4 supplemental replacement treatment was assessed. The results indicated that reduced TSH was significantly different among the groups according to the clinical classifications (p?=?0.043). The result was also significantly different between patients with OH and patients with SCH and negative TPOAb (p?=?0.036). Similar result was reported for the comparison between patients with OH and patients with SCH and positive TPOAb (p?=?0.016). Multiple variable analyses showed that LT4 supplementation, gestational age and the variable of clinical classifications were associated with reduced TSH independently. Our data suggested that the therapeutic effect of substitutive treatment with LT4 was significantly associated with different clinical classifications of hypothyroidism in pregnancy and the treatment should begin as soon as possible after diagnosis.     

The impact of elevated thyroid stimulating hormone on female subfertility

Purpose

Hypothyroidism is known to have a negative impact on female reproduction even in subclinical form, subclinical hypothyroidism (SH). This study aimed to investigate the association between elevated TSH level and reproductive outcome.

Methods

We retrospectively evaluated a total of 203 infertile women who first visited our infertility treatment division from January 1, 2009 to August 31, 2012, including 13 patients with TSH above 4.5 mIU/l (elevated-TSH patients), 11 of whom were diagnosed as SH, and 190 patients with normal TSH (normo-TSH patients). We evaluated them according to reproductive outcome, including clinical pregnancy, miscarriage, and live birth until April 31, 2014. We also aimed to redefine the upper limit of normal serum TSH level.

Results

Multivariate analysis showed significant influence of elevated TSH on clinical pregnancy, although miscarriage and live birth were not affected. In addition, we revealed that the rate of decreased ovarian reserve and unexplained infertility was increased in patients with elevated TSH levels.

Conclusions

We found an association between elevated TSH and the decreased rate of clinical pregnancy. This might be related to an ovulatory disorder and pathophysiology of unexplained infertility. These results may reinforce the usefulness of TSH screening in infertility population.

     

帕金森病非运动症状临床特点研究

目的:全面评估帕金森病(Parkinson disease,PD)患者非运动症状,总结男性和女性PD患者、青年型和老年型PD患者非运动症状临床特征的异同。方法:应用统一PD评定量表第三部分和H-Y分级评估PD患者的运动功能和疾病严重程度;应用非运动症状评定量表全面评估PD患者各项非运动症状的发生率。结果:本研究纳入38例为青年型PD,62例为老年型PD。女性PD患者更易出现紧张、疼痛等症状,而男性更易出现注意力缺乏及忘记做事情等症状;泌尿系统症状等非运动症状在男性PD患者更常见。老年型PD患者胃肠道症状及泌尿系统症状发生率明显高于青年型PD患者,且吞咽困难、便秘、夜尿增多、嗅觉减退等症状在老年型PD患者更常见。结论:非运动症状在PD患者中十分常见,男女PD患者合并不同的非运动症状,老年型PD患者合并更多的非运动症状。     

原发性甲状腺功能减退症患者血清25-羟基维生素D的测定及意义

目的探讨原发性甲状腺功能减退症患者血清中25-羟基维生素D[25-（OH）D]变化及临床意义。方法用电化学发光法检测86例原发性甲状腺功能减退症患者与56例健康人群（正常对照组）血清25-（OH）D水平,用化学发光法检测上述人群血清三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）、甲状腺素（T4）、游离甲状腺素（FT4）、促甲状腺激素（TSH）及甲状旁腺激素（PTH）水平,用邻甲酚酞络合酮分光光度法检测两组人群血清总钙。结果原发性甲状腺功能减退症患者血清25-（OH）D和总钙水平明显低于正常对照组（P＜0.05）,两组间PTH差异无统计学意义（P＞0.05）。原发性甲状腺功能减退症患者组中,25-（OH）D正常和缺乏者的FT4和TSH比较,差异均有统计学意义（均P＜0.05）。结论原发性甲状腺功能减退症患者的维生素D和总钙水平较低,需及时检测并补充维生素D。     

新生儿及母亲临床特征对先天性甲状腺功能 减退症筛查的影响

目的 探讨新生儿及母亲临床特征对先天性甲状腺功能减退症（CH）筛查的影响,为避免漏诊CH提供依 据。方法 收集2016年1月—2017年11月足跟血促甲状腺激素（TSH）初筛阳性的新生儿206例,同期1∶1随机抽取 TSH初筛阴性的新生儿206例作为正常对照组,分析2组新生儿性别、胎龄、体质量和母亲合并疾病对CH初筛及确 诊的影响。结果 TSH初筛阳性的新生儿体质量低于初筛正常的新生儿（P＜0.05）,而2组新生儿的性别、胎龄,以 及早产、足月产和过期产比例差异无统计学意义。与TSH初筛正常组相比,初筛阳性组的母亲合并甲状腺功能减退 症比例和TSH水平更高,FT3和FT4水平更低（P＜0.05）,而2组母亲合并贫血、妊娠糖尿病、亚临床甲状腺功能减退 症及甲状腺功能亢进症的比例,以及血红蛋白、空腹血糖水平差异无统计学意义。与复查为正常的新生儿（198例） 相比,确诊为CH的新生儿（8例）体质量更低,其母亲合并甲状腺功能减退症比例和TSH水平更高,FT3和FT4水平更 低（P＜0.05）,而CH组与复查正常组的性别、胎龄、母亲合并亚临床甲状腺功能减退症和甲状腺功能亢进症的比例差 异无统计学意义。结论 新生儿低体质量及母亲合并甲状腺功能减退症影响CH的初筛和确诊,筛查CH时应特别 注意,以避免漏诊。     

山东地区汉族儿童先天性甲状腺功能减低症NNT基因突变筛查研究

目的 探讨山东地区汉族儿童先天性甲状腺功能减低症(CH)烟酰胺核苷酸转氢酶(NNT)基因突变情况及其与CH的关系,为CH的诊断提供理论依据。方法 对50例来自山东地区的汉族CH患儿进行NNT基因编码区筛查。提取血液基因组DNA,PCR扩增NNT基因全部编码区后进行Sanger测序,将测序结果与NCBI中NNT基因编码区原序列(NM_012343.3)进行比对,检测这些患儿是否携带NNT基因突变并对发现的突变进行生物信息学分析。结果 2例患儿中发现了NNT基因c.1475C＞T(p.A492V)突变,1例患儿中发现NNT基因c.2704C＞A(p.P902T)突变,Polyphen值显示前者几乎无蛋白危害性,可能不是致病突变,而后者蛋白危害性较大,应为致病突变。结论 NNT基因突变可能不是山东汉族人群CH的主要病因,仍需扩大样本量进行研究。     

2010-2016年陕西省新生儿疾病筛查治疗及随访结果分析

目的 总结并分析2010-2016年陕西省新生儿疾病筛查中心高苯丙氨酸血症(HPA)、先天性甲状腺功能减低症(CH)的筛查及治疗、随访情况。方法 新生儿出生72 h后采集足跟血,制成干血滤纸片,采用荧光法检测滤纸干血斑中苯丙氨酸(Phe)、促甲状腺素(TSH)的水平,Phe ≥2.0 mg/dl、TSH ≥10 μU/ml为阳性,阳性病人召回复查,采用串联质谱法检测血Phe、酪氨酸(Tyr),化学发光免疫分析技术检测甲状腺功能五项(TSH、T₃、T₄、FT₃、FT₄)而确诊。结果 2010-2016年全省助产机构活产数共2 751 268例,接受筛查2 329 335例,筛查率84.67%;确诊轻度HPA 131例,发病率1/17 781;确诊苯丙酮尿症(PKU) 300例,发病率1/7 764; 确诊CH 966例,发病率1/2 411。确诊后即建立病历档案,分别给予低苯丙氨酸饮食及口服左旋甲状腺素片(L-T₄)替代治疗。通过Gesell发育量表监测发育情况,发现6月龄内开始接受治疗的PKU患儿智商(IQ)水平明显优于6月龄后开始治疗的患儿(P<0.01),筛查确诊后即坚持治疗随访的CH 患儿,其IQ与正常同龄儿无明显差异(P>0.05)。结论 全面开展新生儿疾病筛查,提高筛查覆盖率,尽早规范化开始治疗及长期随访监测,可使PKU、CH患儿避免体格和智力不可逆损害,对改善其预后和生存质量意义重大。     

亚临床甲状腺功能减退症对糖尿病心脏自主神经病变的影响研究

背景糖尿病心脏自主神经病变（DCAN）是糖尿病常见且严重的慢性并发症之一,但目前关于甲状腺功能与DCAN关系的研究报道较少。目的探讨亚临床甲状腺功能减退症（SCH）对DCAN的影响。方法选取2019年10月至2020年10月在首都医科大学附属北京友谊医院住院及门诊就诊的2型糖尿病患者564例。所有患者均完成Ewing试验。收集患者一般资料、体格检查结果、实验室检查结果,并依据Ewing试验评估并筛查DCAN。相关性分析采用Pearson相关分析和Spearman秩相关分析,采用多因素Logistic逐步回归分析探究2型糖尿病患者并发DCAN的影响因素。结果564例2型糖尿病患者中,129例并发DCAN（DCAN组）,435例未并发DCAN（对照组）,DCAN发生率为22.9%。2型糖尿病患者中合并SCH者84例（14.9%）,DCAN组患者中合并SCH者36例（28.0%）,对照组患者中合并SCH者48例（11.0%）,DCAN组患者合并SCH患病率高于对照组（χ2=22.346,P<0.001）。2型糖尿病并发DCAN患者Valsalva试验动作期间最大R-R间距与最小R-R间距比值（VAL R-R比值）与糖尿病病程、糖化血红蛋白（HbA1c）、空腹血糖（FBG）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TC）、超敏C反应蛋白（hs-CRP）、促甲状腺激素（TSH）、尿微量白蛋白/肌酐（UACR）呈负相关,与舒张压（DBP）呈正相关（P<0.05）。多因素Logistic逐步回归分析结果显示,SCH〔OR=1.717,95%CI（1.246,2.365）〕是2型糖尿病患者并发DCAN的独立影响因素（P<0.05）。结论2型糖尿病患者TSH水平与DCAN相关,且SCH是2型糖尿病患者并发DCAN的独立影响因素。     

Negative Association of Subclinical Hypothyroidism on Improvement in Patient-Reported Outcomes After Total Knee Arthroplasty

BackgroundThe purpose of this study is to analyze the potential influence of subclinical hypothyroidism (SCH) on improvement in patient-reported outcome measures following primary total knee arthroplasty.MethodsA prospective, comparative cohort study between 92 SCH and 90 euthyroid patients was performed. Patients were followed up to 5 postoperative years. Patient-reported outcome measure was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. The Knee Society Scores were used for functional evaluation, and 5-point Likert scale for patient satisfaction. The Hospital Anxiety and Depression scale was also used.ResultsAll outcome scores significantly improved from preoperative to final follow-up in both groups (P = .001). There were no significant differences between groups in Knee Society Scores (P = .057) at the final follow-up, but Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly lower in the SCH group (P = .015). Likewise, the patient satisfaction rate was significant lower in the SCH group (0.010).ConclusionSCH patients have a slower functional recovery than euthyroid patients, and trended toward lower improvements in patient-reported scores. Depression was the most important negative factor. The findings of this study can provide the surgeon with an important information for better counseling the SCH patients.