孕妇尿碘及甲状腺功能监测

目的　探讨不同孕周、不同碘营养状况下孕妇尿碘水平及孕妇、新生儿甲状腺功能 ,分析孕妇碘营养状况及药物治疗的必要性。方法　于 1997年 7月～ 2 0 0 3年 3月期间 ,收集在我院就诊及分娩的孕产妇尿标本 185 2 8例次 ,按照是否补充“金典”分为A组 (未补碘 )及B组 (补碘 ) ,按照孕周分为 :孕早期 1组 ,孕中期 2组 ,孕晚期 3组 ;另随机抽取 2 4 6例孕产妇 ,并分组 :早孕未补充“金典”者 81例为JA1组 ,孕足月未补充“金典”者 86例为JA3组 ,孕足月补充“金典”者 79例为JB3组 ,对该组孕妇其及分娩的新生儿脐带血进行甲状腺功能的检测。结果　①本组孕产妇尿碘中位数为 2 31μg L ,尿碘值 <5 0 μg L、 <10 0 μg L、 <2 0 0 μg L的发生率分别为 2 4 %、 13 9%及 4 3 4 % ;②孕早、中、晚期未补充“金典” (及补充“金典”)组尿碘值中位数分别为 :16 2 μg L (377μg L)、 193μg L (2 86 μg L)、 2 6 0 μg L (382 μg L) ,前者尿碘值均低于后者 ,其差异有显著性 (P =0 0 0 0 ) ;随着孕周的增加 ,未补充“金典”组尿碘值依次升高 ,差异有显著性 (P =0 0 0 0 ) ;③三组孕妇甲状腺功能检测值的中位数均在正常范围内 ,除TG一项外 ,FT3、FT4 、TSH、TM等几项差异均有统计学意义(P =0 0 0 0 ) ;④足月     

不同孕期孕妇尿碘水平的监测及分析

目的调查不同孕期孕妇的尿碘水平,探讨尿碘筛查的最佳时机,为科学指导碘摄入提供理论依据。方法利用碘催化砷铈反应原理,采用冷消解快速尿碘定量检测方法测定623例孕妇随意尿的尿碘含量。结果 623例孕妇尿碘中位数是183μg/L,其中尿碘≤100μg/L的比率为18.61%,尿碘50μg/L的比率为4.01%。而孕早、中、晚期孕妇尿碘中位数分别是143μg/L、149μg/L、312μg/L,其中尿碘150μg/L的比率分别为60.19%、50.26%、25.31%,尿碘≤100μg/L的比率分别为20.37%、24.10%、14.69%,尿碘50μg/L的比率分别为0%、6.15%、4.06%,孕早、中期尿碘水平低于孕晚期(P0.01),低尿碘率高于孕晚期(P0.01)。低尿碘组中孕晚期的尿碘水平低于孕早、中期(P0.05),高尿碘组中孕晚期的尿碘水平高于孕早、中期(P0.05)。结论本研究中的孕妇人群虽不存在碘缺乏,但孕早、中期孕妇尿碘水平偏低,因此孕早、中期是尿碘筛查、及时纠正碘营养状况的最佳时机,孕晚期孕妇碘的需求应随个体不同的碘营养状况而调整。     

孕妇碘营养水平与新生儿甲状腺功能及体格发育的相关性研究

目的为了解孕妇不同碘营养水平对胎儿甲状腺功能和体格发育的影响,并对昆明市市区孕妇碘营养状况作出初步评估,以便为临床是否需针对性补碘提供理论依据.方法本研究测定220例正常孕足月孕妇尿碘浓度,并对比分析孕妇相应新生儿的甲状腺功能和体格发育状况.结果①昆明市市区正常孕妇大部分已处于较好的碘营养状况,但仍有部分孕妇存在缺碘或碘摄入过量情况.②孕妇尿碘水平在一定的浓度范围内与新生儿脐血TSH值呈明显负相关,提示孕妇碘营养越好时,胎儿、新生儿甲状腺功能越完善.③碘影响新生儿体格发育,摄入过少或过多均可使低体重儿数目增多.④与剖宫产相比,阴道产可使新生儿脐血TSH值升高.     

孕产妇碘营养状况调查

目的探索不同孕期、哺乳期妇女和新生儿是否存在碘缺乏和碘缺乏病（iodinedeficiencydisorder,IDD）,为妊娠期和哺乳期是否需要补碘提供依据。方法对孕产妇尿碘水平及孕母、新生儿甲状腺功能进行测定。结果孕产妇缺碘发生率达24．48％,明显高于非妊娠妇女（714％）,且多集中于34孕周后及哺乳期。缺碘孕妇血清TSH、脐血清TSH、T4水平均有改变,其中脐血清TSH≥10mU／L,提示甲状腺功能处于代偿性状态。结论上海杨浦地区孕产妇存在一定缺碘状况,因此孕期有必要作尿碘筛查,低者及时补碘,避免碘缺乏给母儿带来不良影响。     

妊娠期甲状腺功能保护

甲状腺疾病可以导致母儿不良妊娠结局,由于妊娠期甲状腺功能发生特异性变化,用非妊娠妇女的诊断标准评估妊娠期甲状腺功能可导致妊娠期甲状腺功能减退症漏诊、甲状腺功能亢进症误诊和药物治疗剂量不足。只有正确诊断妊娠期甲状腺疾病,合理保护妊娠期甲状腺功能,才能避免不良妊娠结局的发生和减少对新生儿远期生存质量的影响,对实现我国优生优育的国策具有非常重要的意义。     

锦州地区妊娠早期女性甲状腺功能的临床分析及参考值的建立#br#

目的分析锦州地区妊娠早期女性甲状腺功能的临床特点及建立参考值。方法选择辽宁省锦州地区150例妊娠早期女性作为研究组,同时选择150例健康非妊娠期女性作为对照组,通过罗氏检验平台检测血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺球蛋白抗体(Tg Ab)以及甲状腺过氧化物酶抗体(TPOAb)水平,随访并记录所有妊娠女性的妊娠结局。结果研究组血清TSH水平低于对照组,血清FT3、FT4、Tg Ab和TPOAb水平均高于对照组(P<0.05)。TSH参考值为(0.07~2.49)m IU/L、FT4参考值为(13.30~20.65)pmol/L。对所有妊娠女性跟踪随访中位数为32周,150例妊娠女性均为活产,其中140例(93.33%)顺产,仅出现早产1例(0.67%)、胎儿宫内窘迫1例(0.67%)、胎儿生长受限2例(1.33%),新生儿出生时体质量为(3212.97±276.75)g,Apgar评分为(9.65±0.22)分。结论锦州地区妊娠早期女性血清TSH水平明显降低,血清FT3、FT4、Tg Ab和TPOAb水平则明显升高,当地需建立妊娠妇女早孕期甲状腺激素正常参考值。     

不同剂量左甲状腺素治疗妊娠合并甲状腺功能减退症的疗效

目的 探讨不同剂量左甲状腺素治疗妊娠合并甲状腺功能减退症患者的疗效。方法 选取60例妊娠合并甲状腺功能减退症患者,根据随机数字表法将患者分为两组,每组30例。对照组采用小剂量左甲状腺素治疗,观察组采用大剂量左甲状腺素治疗。比较两组治疗前后甲状腺激素水平、血脂指标及妊娠结局。结果 治疗后观察组游离甲状腺素(FT₄)水平高于对照组,血清促甲状腺激素(TSH)、甲状腺过氧化物酶抗体(TPOAb)水平均低于对照组(P<0.05)。观察组治疗后血清甘油三酯(TG)、总胆固醇(TC)及高密度脂蛋白-胆固醇(HDL-C)指标低于对照组,低密度脂蛋白-胆固醇(LDL-C)指标高于对照组(P<0.05)。对照组不良妊娠结局发生率为13.33%,观察组不良妊娠结局发生率为16.67%,比较差异无统计学意义(P>0.05)。结论 妊娠合并甲状腺功能减退症患者应用大剂量左甲状腺素可明显改善甲状腺功能及血脂指标。     

妊娠和甲状腺功能减退症

妊娠合并甲状腺功能减退症(简称甲减)的发生率约为1/1 600～2 000,慢性自身免疫性甲状腺疾病为其常见原因.仅根据临床表现很难对妊娠中的甲减及早诊断,因此,常规筛选显得十分必要,尤其是一些高危人群.血清TSH水平为甲减筛选的敏感指标.妊娠过程中若甲减未能及时控制,可引起多种并发症.母亲甲减对胎儿智力发育的影响正日益受到重视.L-T4为治疗甲减的首选药物.孕期应监测甲状腺功能,并据此调整治疗剂量.     

我国部分地区孕妇和哺乳妇女适宜的尿碘参考值范围的制定

目的:对我国部分地区正常孕妇和哺乳妇女的尿碘值进行测定,以期对尿碘值范围提供一定的参考.方法:收集我国6个地区孕妇和哺乳妇女的尿碘和甲状腺功能数据,对甲状腺功能正常的141例孕妇和170例哺乳妇女的尿碘值进行统计分析.结果:我国部分地区孕妇和哺乳妇女适宜的尿碘值范围分别为90～500 μg/L和70～450μg/L.结论:本研究为孕妇和哺乳妇女碘营养状况的个体诊断提供了一种思考方法.     

妊娠合并甲状腺功能亢进临床分析

目的 探讨甲状腺功能亢进(甲亢)患者孕前及妊娠期治疗是否能减少妊娠并发症、降低胎儿丢失率及改善母要结局.方法 回顾性分析我院1995年1月至2005年12月共11年间60例妊娠合并甲亢患者孕前及妊娠期治疗及母婴结局.60例患者分为三组:甲亢病史组(Ⅰ组):19例有甲亢病史,孕期监测甲状腺功能未复发组;治疗满意组(Ⅱ组):28例曾应用抗甲状腺药物治疗,终止妊娠时甲状腺功能正常;治疗不满意组(Ⅲ组):13例孕期未系统治疗,就诊时间晚、病情重,终止妊娠时甲状腺功能异常.结果 (1)妊娠合并甲亢进入围产期的发病率为2.25‰(52/23 104),因病情严重28周前终止妊娠8例,胎儿丢失率为11.8%(8/60);(2)Ⅰ组无妊娠并发症发生;(3)Ⅲ组与Ⅱ组相比,重度子(癎)前期(53.9%和10.7%)、甲亢性心脏病(38.5%和3.6%)、胎盘早剥(23.1%和3.6%)的发生率和胎儿丢失率(46.2%和7.1%)均有显著增加(P＜0.05);(4)Ⅲ组与Ⅱ组相比,并发重度子(癎)前期的OR=9.72(95%CI:1.53-71.21)、甲亢性心脏病OR=16.88(95%CI:1.45-826.42)、胎盘早剥OR=8.1(95% CI:0.54-440.44)、胎儿丢失OR=11.14(95%CI:1.45-126.39);(5)Ⅲ组新生儿平均体重明显低于Ⅱ组和Ⅰ组[(2550±573)g和(3211±717)g、(3186±492)g,P＜0.05];(6)Ⅲ组中有一例新生儿发生甲状腺功能减退;三组均无孕妇及围产儿死亡、无新生儿畸形.结论 重视甲亢的孕前及孕期治疗,能有效降低孕期并发症、减少胎儿丢失率及改善围产期母儿结局.     

Prevalence of thyroid disorders in pregnant women with mild iodine deficiency

To assess the prevalence of thyroid disorders in a region with mild iodine deficiency, this study was undertaken in a randomized sample of pregnant women during different gestational periods. Evaluations were performed in 215 women: thyroid ultrasound scanning, thyroid stimulating hormone (TSH), free thyroxine (T4) and thyroid peroxidase (TPO) antibodies. At the time of participation in the study, some women (90/215) had been receiving 150–200?µg iodine. Hypothyroidism was found in four women (1.86%). Positive TPO antibodies were seen in 34 of 215 women (15.8%), and TPO antibody level over 150?mU/l was found in 9.8% (21/215). There was no significant difference between TSH levels in women with positive or negative TPO antibodies. There were no differences in TSH level between the women receiving and those not receiving iodine prophylaxis. The prevalence of goiter in 211 euthyroid women was found to be 24.2% (51/211). In the group with iodine prophylaxis, thyroid volume was found to be significantly lower (t?=?2.5; p?=?0.02) than in women who had not received it, or had started it during the second trimester. By comparison of history data on the prevalence of aborted pregnancy between the group with positive (26.5%; 9/34) and the group with negative TPO antibodies (14.3%; 26/181), no significant differences were found. We conclude that, in mild iodine deficiency, pregnancy is related to a high risk of goiter, which can be prevented by iodine prophylaxis. TPO antibody carrier status in pregnant women is probably not associated with a significant risk of thyroid dysfunction or spontaneous abortion.     

Thyroid function in pregnant women: iodine deficiency after iodine enrichment program

Abstract

Objective: Significant changes in thyroid function occur during pregnancy which can complicate the interpretation of thyroid function tests. Therefore, normative gestational related reference ranges for thyroid hormones tests are required. The aim of this study was to determine the reference ranges for free triiodothyronine (FT3), free thyroxin (FT4) and thyroid stimulating hormone (TSH) in Iranian pregnant women.

Methods: This study was a cross-sectional observational study conducted in the Obstetrics and Gynecology department, Akbarabadi University Hospital. A single blood sample from 584 pregnant women was analyzed for thyroid function. Serum levels of TSH, FT4, FT3, total T4 (TT4), T3 resin uptake (T3RU) and anti-thyroid peroxidase antibody (TPO Ab) were measured. Urinary iodine was determined in some cases. Reference intervals based on 2.5th and 97.5th percentiles were calculated.

Results: The composition of reference population comprising 584 women included 162 in first trimester and 422 in the third trimester. The 2.5th and 97.5th percentiles values were used to determine the reference ranges for FT3, FT4, TT4, T3RU and TSH. These values were T3 1.4 and 2.9?pmol/L, FT4 7.1 and 18?pmol/L, TT4 7.2 and 13.5?µg/dL and TSH 0.5 and 3.9?µg/L, respectively. The level of urinary iodine in 80.5% of the subjects was less than normal.

Conclusions: Serum levels of thyroid hormones are different in Iranian population that could be due to racial differences or differences in iodine intake.     

Prevalence of thyroid disorders in pregnant women with mild iodine deficiency.

To assess the prevalence of thyroid disorders in a region with mild iodine deficiency, this study was undertaken in a randomized sample of pregnant women during different gestational periods. Evaluations were performed in 215 women: thyroid ultrasound scanning, thyroid stimulating hormone (TSH), free thyroxine (T4) and thyroid peroxidase (TPO) antibodies. At the time of participation in the study, some women (90/215) had been receiving 150-200 micrograms iodine. Hypothyroidism was found in four women (1.86%). Positive TPO antibodies were seen in 34 of 215 women (15.8%), and TPO antibody level over 150 mU/l was found in 9.8% (21/215). There was no significant difference between TSH levels in women with positive or negative TPO antibodies. There were no differences in TSH level between the women receiving and those not receiving iodine prophylaxis. The prevalence of goiter in 211 euthyroid women was found to be 24.2% (51/211). in the group with iodine prophylaxis, thyroid volume was found to be significantly lower (t = 2.5; p = 0.02) than in women who had not received it, or had started it during the second trimester. By comparison of history data on the prevalence of aborted pregnancy between the group with positive (26.5%; 9/34) and the group with negative TPO antibodies (14.3%; 26/181), no significant differences were found. We conclude that, in mild iodine deficiency, pregnancy is related to a high risk of goiter, which can be prevented by iodine prophylaxis. TPO antibody carrier status in pregnant women is probably not associated with a significant risk of thyroid dysfunction or spontaneous abortion.     

Serum thyroid hormone levels among Chinese pregnant women

Aim: The aim of this study is to examine gestational serum thyroid hormone levels and influencing factors among Chinese pregnant women with high dietary iodine intake.

Methods: The study was conducted from 2011 and 2013 in Zhoushan Women &; Children’s Hospital, Zhejiang, China. A total of 1991 pregnant women were enrolled and their serum levels of free thyroid hormones (FT₄, FT₃, and TSH) were detected by chemiluminescence method.

Results: Gestational serum FT₄ and FT₃ decreased with gestational week while TSH increased. Furthermore, the prevalence rate of subclinical hypothyroid increased with gestational stages, especially in the third trimester. Women aged more than 30?years had lower FT₄ and FT₃ in the first trimester and lower FT₄ in the second trimester. No significant difference was found in the association of gestational serum thyroid hormones with maternal height and the gender of fetuses.

Conclusion: Gestational serum thyroid hormones significantly changed with gestational week and were associated with the age of women. Specific normal range of thyroid hormones might be modified so as to better evaluate the thyroid hormone levels of pregnant women during pregnancy.     

Endemic goiter in pregnant women: utility of the simplified classification of thyroid size by palpation and urinary iodine as screening tests

Objective To validate urinary iodine (I) excretion and the simplified classification of goiter by palpation, comparing them with ultrasound of the thyroid gland as the gold standard, to identify endemic goiter in pregnant women.
Population and setting 300 pregnant women identified in referral hospitals, in three geographic regions.
Methods Two endocrinologists, previously trained, evaluated thyroid size by palpation and by ultrasound. Urinary iodine excretion in a sample of urine was determined. Thyroid size below the 90th centile by ultrasound was considered normal.
Results Mean age of study women was 23 years old. The prevalence of low weight for gestational age was 39% and of anaemia 47%. Our sample distribution showed that 120 μg I/L was the best cut off for low urinary iodine excretion to identify endemic goiter in pregnant women (sensitivity 57% and specificity 70%, likelihood ratio of 1.4). The prevalence of goiter was 10% using ultrasound. Palpation had a sensitivity of identification goiter of 94% (95% CI 89–99%), a specificity of 80% (95% CI 75–85%), a likelihood ratio of 4.7, positive post-test probability of 36.5% and negative post-test probability of 99%.
Conclusions Low urinary iodine excretion identified up to 46% of women with goiter. This test by itself is not useful as a screening tool to identify pregnant women at risk of goiter. Identification of thyroid size by palpation was a better screening test. However, when both tests were combined in parallel, up to 100% of women with goiter were correctly identified. Our results suggest that the commonly used cut off point of 100 μg I/L to identify low urinary iodine excretion may under-estimate the prevalence of iodine deficiency disorders when used during pregnancy.     

Urinary iodine excretion and thyroid function in pregnant women of Bydgoszcz District prior to and after the introduction of iodized salt

INTRODUCTION: Before the introduction of the kitchen iodized salt in 1997 Poland was an area of mild and moderate iodine deficiency. AIM: The aim of the study was to determine the degree of iodine deficiency and thyroid function in pregnant women prior to and after the introduction of iodized salt. MATERIAL AND METHODS: Iodine urinary excretion and serum levels of TSH, fT3 and fT4 were determined in pregnant women divided into the two groups--with and without iodine supplementation. RESULTS: Before the introduction of the kitchen iodized salt iodine urinary excretion in pregnant women was 70.46 +/- 43.99 micrograms/l. The introduction of kitchen iodized salt increased iodine urinary excretion to 92.23 +/- 42.14 micrograms/l (p < 0.01). In pregnant women with iodine supplementation serum levels of TSH and fT3 were reduced. CONCLUSIONS: 1. There was a mild iodine deficiency in pregnant women before the introduction of the kitchen iodized salt programme. 2. The kitchen iodized salt increased iodine urinary excretion rates, 3. Reduced levels of serum TSH and fT3 after the introduction of iodized salt indicate diminished thyroid stimulation in pregnant women with higher iodine intake.     

汕头地区孕妇甲状腺功能参考值的建立及甲状腺功能异常的筛查

目的建立汕头地区妊娠妇女甲状腺激素功能指标的参考值范围,并依据该参考值了解本地区妊娠妇女甲状腺功能异常的发生情况。 方法对2013年1月至2015年12月期间在汕头大学医学院第二附属医院妇产科门诊就诊的837名妊娠妇女,进行血清甲状腺激素和甲状腺自身抗体检测。其中,2013年1月至2014年6月符合入组标准的367名妊娠妇女的甲状腺功能资料,用于建立本研究妊娠各期血清促甲状腺激素(Thyroid stimulating hormone, TSH)、游离甲状腺素(Free thyroxine, FT₄)的参考值。根据本研究初步建立的参考值,对2014年7月至2015年12月在汕头大学医学院第二附属医院妇产科门诊就诊的470名妊娠妇女进行甲状腺功能异常的筛查。 结果(1)初步建立的汕头地区妊娠妇女孕早、中和晚期血清TSH的正常参考范围分别为：0.07～5.34 mIU/L、0.09～4.96 mIU/L、0.05～6.59 mIU/L,血清FT₄的正常参考范围分别为：8.71～15.53 pmol/L、5.58～11.84 pmol/L、5.57～21.91 pmol/L;(2)本院就诊孕妇甲状腺功能异常的发生率：临床甲亢为1.91%(9/470)、亚临床甲亢为0.64%(3/470)、临床甲减为0、亚临床甲减为1.06%(5/470)。 结论建立汕头地区妊娠妇女甲状腺功能的参考值有利于本地区妊娠妇女甲状腺功能疾病的及时诊断和早期干预,从而减少疾病对孕妇及胎儿造成的影响。