甲状腺功能减退症妇女子代的甲状腺功能、智力和身体发育的研究

目的探讨甲状腺功能减退症妇女对其子代甲状腺功能、智力发育和身体发育情况的影响。方法将2004年7月-2006年1月在笔者所在医院就诊的60例甲状腺功能减退症（甲减）妇女及30例健康妇女的子代分别作为研究组及对照组。甲减妇女确诊后均给予甲状腺激素（优甲乐或甲状腺片）替代治疗。动态测定（至少每月1次）60例甲减母亲妊娠期间的甲功三项（FT3、FT4、TSH），根据母亲的甲功三项水平将婴儿分为甲减控制良好组（甲功三项控制在正常水平、TPOAb阴性）、甲减控制不佳组（妊娠期间甲功三项有任何异常或TPOAb阳性）。测定三组母亲的婴儿在0、12、24、36个月时的甲状腺功能（FT3、FT4、TSH）、发育商、语言和功能构成、身高及体重等指标。比较三组的甲状腺功能和智力、身体发育有无差异。结果新生儿期甲减控制不佳组的TSH显著高于甲减控制良好组及对照组，血清FT4、FT3、水平显著低于甲减控制良好组及对照组（P〈0．05）。12个月、24个月、36个月三组的TSH、FT4、FT3水平差异无统计学意义（P〉0．05）。甲减控制不佳组的发育商在新生儿期、12个月、24个月、36个月均明显低于甲减控制良好组及对照组（P〈0．05）。甲减控制不佳组的体格发育在新生儿期、12个月、24个月、36个月均滞后于甲减控制良好组及对照组（P〈0．05）。结论甲状腺功能减退症妇女经合理、规范治疗后，在妊娠期间维持甲状腺功能在正常水平（TSH〈2．5mlU／L，TPOAb阴性），其子代的甲状腺功能、智力及体格发育与健康妇女的子代差异无统计学意义。仍存在甲减或亚临床甲减的妇女其子代可出现短暂的甲状腺功能异常，并较长时间表现有智力和运动、体格发育滞后。提示筛查和积极治疗妊娠早、中期甲状腺功能异常，对优生优育十分必要，加强对患甲状腺疾病母亲及其孩子的管理有重要意义。

The study of the thyroid function, intelligence and physical development in future generations of maternal hypothyroidism

Objective To investigate how to hypothyroidism impact such female patients＇ offspring＇s thyroid function, intellectual development and body development. Methods A total of 60 children whose mothers were hypothyroidism patients in Xinyi people＇s Hospital from July 2004 to January 2006 were enrolled. Additional 30 children whose mothers were non -hypothyroidism（normal） women were also collected as control group. All maternal patients were administered levo thyroxine 4 （euthyrox） replacement therapy after hypothyroidism di- agnosed. According to thyroid function（ FT3 , FT4 , and TSH） results of the pregnant women, 60 children were divided into two groups： hy- pothyroidism well -controlled group （Group I） and hypothyroidism poorly -controlled group （Group II）. We respectively determinated all 90 children＇s thyroid function, intelligent quotient, language development, height and weight when children were born, 12, 24, 36 months old. Thyroid function, intelligence and physical development of two groups were compared with control group. Results TSH level when children were newborn in Group II was the highest among the three groups, Serum FT4 and FT3 levels was lower than the control group（ P 〈 0. 05 ）. However, TSH, FT4 and FT3 levels when children were 12, 24, 36 months among the three groups were no significant difference（ P 〉0. 05 ）. Intelligence in Group II was significantly lower than Group I and control group respectively when children were 0, 12, 24 and 36 month （ P 〈 0. 05 ）. Physical development in Group II was lag behind Group I and control group （ P 〈 0. 05 ）. Conclusion After reasonable and standard treatment, the thyroid function of hypothyroidism women could maintain at normal level （TSH 〈 2.5 mIU/L, TPOAb negative） during pregnancy. Thyroid functions, intellectual and physical development of their offspring, compared with the healthy women, were no significantly different. The offspring of hypothyroidism or subclinical hypothyroidism women may occur temporarily abnormal thyroid function, and a long period motion, intelligence and physical development delay, which suggests that screening and active treatment of thyroid dysfunction at early and medium stage of pregnancy was of necessity for the aristogenesis. Therefore, it is important to strengthen the management of thyroid disease mothers and their children.