干预治疗对TPOAb阴性亚甲减孕妇妊娠结局的影响

目的:探讨干预治疗对不同TSH水平的妊娠期亚临床甲减合并甲状腺过氧化物酶(TPOAb)阴性孕妇妊娠结局的影响。方法:回顾性分析2016年1月1日至2016年12月31日在青岛大学附属医院产科分娩孕妇诊断为亚临床甲减且TPOAb阴性的孕妇不良妊娠结局的发生率,根据2011年(S1标准)及2017年(S2标准)美国甲状腺协会(ATA)指南对妊娠合并亚临床甲减推荐诊断的TSH水平不同分组,A组(4 m IU/LTSH10.0 m IU/L)131例,B组(TSH4 m IU/L,在T1期TSH2.5 m IU/L,T2、T3期TSH3.0 m IU/L)326例,根据是否接受左甲状腺素钠片(商品名:优甲乐)治疗,分为治疗组(295例)、未治疗组(194例),同时选取TPOAb阴性且甲状腺功能正常的孕妇(306例)作为对照组。结果:(1)依据S1、S2诊断标准,妊娠合并亚临床甲减的发生率分别为13.57%、3.6%,治疗率分别为39.67%、51.34%,不同诊断标准间比较差异具有统计学意义(P0.05)。(2)A组孕妇中,未治疗组妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血、流产、早产、胎儿窘迫的发生率均高于治疗组及对照组,差异具有统计学意义(P0.05),而治疗组与对照组比较差异无统计学意义(P0.05)。未治疗组胎盘早剥、胎膜早破、胎儿畸形、低体重儿的发生率虽高于治疗组及对照组,但两两比较差异均无统计学意义(P0.05)。(3)B组孕妇未治疗组妊娠期高血压疾病、妊娠期糖尿病、妊娠期贫血、流产、早产、胎儿窘迫、胎盘早剥、胎膜早破、胎儿畸形、低体重儿的发生率虽高于治疗组及对照组,三组及两两比较差异无统计学意义(P0.05)。结论:对于青岛地区TPOAb阴性的妊娠期亚临床甲减孕妇,4.0 m IU/LTSH10.0 m IU/L时,左甲状腺素钠片治疗能明显改善其不良妊娠结局。     

妊娠期糖尿病患者糖化血红蛋白水平与甲状腺激素水平及不良妊娠结局的关系分析

目的:分析妊娠期糖尿病(GDM)患者糖化血红蛋白(HbAlc)水平与甲状腺激素水平及不良妊娠结局的关系。方法:选取2017年2月～2018年5月期间延安大学附属医院接收的GDM患者118例作为观察组,其中血清HbAlc水平≤6.5%55例,6.5%63例。另外选取同期来我院接受孕检的110例非GDM孕妇作为对照组,比较对照组、观察组血清HbAlc、甲状腺激素水平以及不良妊娠结局,比较观察组中不同HbAlc水平患者不良妊娠结局情况,采用Pearson相关性分析HbAlc水平与甲状腺激素水平的关系。结果:观察组初次测量、二次测量时的血清HbAlc水平均高于对照组(P0.05)。观察组血清三碘甲状腺原氨酸(T_3)、游离甲状腺原氨酸(FT_3)、总甲状腺素(T_4)、游离甲状腺素(FT_4)水平均低于对照组(P0.05)。观察组羊水过多、胎儿窘迫、新生儿低血糖、早产、巨大儿的发生率均高于对照组(P0.05)。HbAlc水平6.5%的患者羊水过多、胎儿窘迫、新生儿低血糖、早产、巨大儿的发生率均高于HbAlc水平≤6.5%的患者(P0.05)。Pearson相关性分析结果可知,HbAlc与T_3、T_4、FT_4、促甲状腺素(TSH)无相关性(P0.05),而与FT_3呈负相关(P0.05)。结论:血清HbAlc水平可较好地预测GDM患者不良妊娠结局,GDM患者多处于甲状腺激素水平较低状态,且HbAlc与甲状腺功能指标FT_3密切相关。     

妊娠合并甲状腺功能减退症26例妊娠结局分析

目的：对妊娠合并甲状腺功能减退症进行分析,探讨其对母儿的影响,及孕期筛查甲状腺功能有无意义。方法：对我院26例妊娠合并甲减的临床资料进行回顾性统计分析。结果：26例妊娠合并甲减病例中有1例早产（孕33周）,其余25例患者维持至足月妊娠,其中剖宫产17例（65.38%）,合并妊娠期高血压疾病5例（19.23%）,妊娠期糖尿病3例（11.53%）,羊水胎粪污染3例（11.54%）,新生儿无先天性甲减。经过治疗后甲状腺功能减退孕妇的剖宫产率,糖尿病发生率、高血压疾病发生率、羊水粪染的发生率较对照组增加;但两组妊娠结局差异无统计学意义（P〉0.05）。结论：妊娠合并甲状腺功能减退症孕妇多种妊娠并发症的发病率高于正常孕妇,应加强对妊娠甲减的早期筛查及治疗,可有效降低不良妊娠结局,减少先天性甲低的出生。     

妊娠期妇女甲状腺功能的筛查情况及相关影响因素分析

摘要 目的：了解妊娠期妇女甲状腺功能的筛查情况及相关影响因素。方法：以2016年1月~2017年1月在我院接受产前检查的400例孕妇为研究对象,其中早期妊娠78例、中期妊娠146例、晚期妊娠176例,同期健康体检合格妇女120例为对照组。比较妊娠妇女和对照组促甲状腺激素（TSH）、游离T3（FT3）及游离T4（FT4）水平,并分析妊娠合并甲状腺功能异常者妊娠不良结局发生情况,并分析妊娠合并甲状腺功能异常的影响因素。结果：400例孕妇中,亚临床甲减62例、临床甲减5例、亚临床甲亢16例、临床甲亢2例,甲状腺疾病合计85例。孕早期TSH低于孕中期及孕晚期,FT3浓度高于孕中期及孕晚期,FT4浓度高于孕中期及孕晚期,孕中期及孕晚期TSH水平高于对照组,孕中期及孕晚期FT3、FT4浓度低于对照组,差异有统计学意义（P<0.05）。不同年龄、流产次数、碘摄入量、吸烟组妊娠合并甲状腺功能异常率差异比较有统计学意义（P<0.05）。Logistic回归分析,年龄≥30岁、流产次数≥2次、碘摄入量≥150 μg/d为妊娠合并甲状腺功能异常发生的独立危险因素。妊娠合并甲状腺功能异常组妊娠不良结局合计率高于妊娠合并甲状腺功能正常组（P<0.05）。结论：加强对妊娠期妇女甲状腺功能的筛查和高危因素的管理能够预防不良妊娠结局,达到优生优育。     

左旋甲状腺素对甲状腺功能减退症孕妇临床指标的影响

探讨左旋甲状腺素治疗对甲状腺功能减退症孕妇血脂水平以及甲状腺球蛋白抗体(TG-Ab)、抗甲状腺过氧化物酶抗体(TPO-Ab)、促甲状腺激素受体抗体(TRAb)的影响。选取甲减和亚甲减孕妇各71例为研究对象,均给予左旋甲状腺素替代治疗,另选取产前检查同期且正常分娩的孕妇165例作为对照组,对这三组孕妇的甲状腺功能、血脂水平以及甲状腺自身抗体状况进行比较。结果显示,甲减孕妇治疗前血清中促甲状腺素(TSH)明显高于正常对照组,总甲状腺素(TT4)、游离甲状腺素(FT4)水平明显低于正常对照组(t=8.456~45.367,p0.05),甲减组TSH明显高于亚甲减组,TT4、FT4水平明显低于亚甲减组(t=2.712~5.835,p0.05),治疗后甲减组与亚甲减组TSH明显降低,TT4、FT4明显升高(t=3.326~8.568,p0.05),甲减组与亚甲减组比较,差异无统计学意义(t=0.098~0.368,p0.05);甲减孕妇治疗前TPO-Ab、TG-Ab、TR-Ab均明显高于正常对照组(t=6.254~18.125,p0.05),甲减组TPO-Ab、TG-Ab、TR-Ab明显高于亚甲减组(t=2.321~4.365,p0.05),治疗后甲减组与亚甲减组TPO-Ab、TG-Ab、TR-Ab均明显降低(t=5.742~9.321,p0.05),两组比较差异无统计学意义(t=0.125~0.432,p0.05);甲减孕妇治疗前,甲减组与亚甲减组TC、TG、LDL-C均明显高于正常对照组,HDL-C明显低于正常对照组(t=4.084~20.192,p0.05),甲减组TC、TG、LDL-C明显高于亚甲减组,HDL-C明显低于亚甲减组,差异有统计学意义(t=2.453~7.658,p0.05),治疗后,三组比较差异无统计学意义(t=0.103~0.527,p0.05)。甲状腺功能减退孕妇存在TSH、TPO-Ab、TG-Ab、TR-Ab高表达,TT4、FT4低表达。早期应用左甲状腺素替代治疗有助于改善甲状腺功能,降低甲状腺自身抗体水平,改善血脂水平。     

亚临床甲状腺功能减退与动脉粥样硬化的相关性研究

目的:探讨亚临床甲状腺功能减退与动脉粥样硬化的相关性.方法:选择2010年3月至2012年3月我院收治的46例亚临床甲状腺功能减退患者为亚临床甲减组,另选取46例甲状腺功能正常的同期门诊老年体检者为对照组,分析亚临床甲状腺功能减退与动脉粥样硬化的相关性.结果:亚临床甲减组患者的甘油三酯(TC)、低密度脂蛋白胆固醇(LDL-C)水平和颈动脉粥样斑块的发生率均显著高于对照组,差异有统计学意义(P＜0.05).多元线性逐步回归分析结果显示颈动脉内膜中层厚度(IMT)与TC、LDL-C及促甲状腺激素(TSH)水平独立相关;FT3、FT4与血脂水平均存在不同程度的负相关,TSH与血脂水平均存在不同程度的正相关(P＜0.05).结论:亚临床甲状腺功能减退时动脉粥样硬化的发生可能与脂代谢异常有关.     

甲状腺功能5 项检测在妊娠期妇女中的应用

目的:分析甲状腺功能5项检测在妊娠期妇女中的应用价值,为制定妊娠期妇女的甲状腺功能指标的参考值范围提供依据。方法:选取2013年8月~2014年12月我院收治的826例健康妊娠妇女(实验组)与794例非妊娠育龄妇女(对照组)为研究对象。采用电化学发光法检测甲状腺功能5项指标,即三碘甲腺原氨酸(TT3)、甲状腺素(TT4)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4),比较两组甲状腺功能异常率,并比较5项指标在妊娠早、中、晚期妇女与对照组中的差异。结果:(1)实验组甲状腺功能异常的发生率(39.10%)显著高于对照组(17.63%),差异有统计学意义(P0.05);(2)实验组FT4、TT4水平随着妊娠期的进展逐渐降低,TSH水平逐渐升高,且均低于对照组水平,差异有统计学意义(P0.05);而各妊娠期FT3、TT3水平比较差异无统计学意义,但均略低于对照组(P0.05)。结论:甲状腺功能5项指标检测应作为妊娠期妇女的孕期必查项目之一,且制定早、中、晚期妊娠期妇女的甲状腺功能5项指标参考值范围十分必要。     

不同剂量左旋甲状腺素对妊娠合并甲减患者胎儿发育的影响

目的:探讨不同剂量左旋甲状腺素对妊娠合并甲减患者胎儿发育的影响。方法:选择2012年5月至2016年6月在我院诊治的妊娠合并甲减孕妇72例作为研究对象,根据随机数字表法抽签分为观察组与对照组各36例,两组都给予左旋甲状腺素治疗,对照组应用剂量为低剂量,观察组应用剂量为高剂量,两组均治疗观察3个月,对比两组的临床疗效、治疗前后游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、血清促甲状腺激素(TSH)水平的变化及并发症的发生情况。结果:治疗后,观察组的总有效率[97.2%(35/36)]显著高于对照组[83.3%(30/36)](P0.05),两组TSH值显著低于治疗前(P0.05),FT3与FT4值均显著高于治疗前(P0.05),且观察组的FT3、FT4值均明显高于对照组(P0.05),而血清TSH值显著低于对照组(P0.05)。治疗期间,观察组的早产、产后出血、宫内窘迫、妊娠高血压等并发症发生率为11.1%,对照组为30.6%,观察组显著低于对照组(P0.05)。所有孕妇都顺利分娩,新生儿都存活,观察组新生儿的智力发育与精神运动发育评分都显著高于对照组(P0.05)。结论:高剂量左旋甲状腺素治疗妊娠合并甲减患者的临床效果明显高于低剂量左旋甲状腺素,其可有效促进甲状腺激素分泌平衡,减少妊娠并发症的发生,促进新生儿的发育。     

孕早期妇女血清25-羟维生素D水平的表达及与甲状腺功能的相关性研究

目的:探讨孕早期妇女血清25-羟维生素D[25(OH)D]水平及与甲状腺功能的相关性。方法:选取2015年12月至2016年12月期间来我院进行常规产前检查的孕早期(≤12周)妇女90例为观察组,根据妊娠时间将观察组分为A组(4-6周)、B组(7-9周)和C组(10-12周),另选取同期在我院进行健康体检的妇女30例为对照组。采用电化学发光免疫分析法测定所有研究对象血清中的25(OH)D、促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)水平,并分析观察组妇女血清25(OH)D水平与TSH、FT4、FT3之间的相关性。结果:A组、B组、C组出现维生素D缺乏的比例高于对照组,维生素D充足的比例低于对照组,C组出现维生素D不足的比例高于对照组,差异均有统计学意义(P0.05)。A组、B组、C组维生素D缺乏、维生素D不足、维生素D充足的比例之间差异无统计学意义(P0.05)。A组、B组、C组出现甲状腺功能异常的比例比较差异无统计学意义(P0.05)。三种甲状腺功能减退的患病率由低到高分别为临床甲减、亚临床甲减、低T4血症,且A组、B组、C组临床甲减、亚临床甲减及低T4血症组间整体比较差异无统计学意义(P0.05)。不同血清25(OH)D水平的观察组孕妇血清中TSH、FT4、FT3水平之间的差异无统计学意义(P0.05)。直线回归分析显示,观察组血清中25(OH)D水平与TSH、FT4无明显相关性(P0.05),与FT3呈正相关关系(P0.05),多元线性回归模型分析显示血清中25(OH)D水平与TSH、FT4、FT3均无相关性(P0.05)。结论:孕早期妇女普遍存在维生素D缺乏的现象,血清25(OH)D水平及与甲状腺功能无明显相关性,但仍应注意加强维生素D的补充。     

自身免疫性甲状腺功能紊乱孕妇血清TPOAb 检测的临床价值

目的:探讨血清甲状腺过氧化物酶抗体(TPOAb)对于患有自身免疫性甲状腺功能紊乱的孕妇的临床诊断价值。方法:筛选2009年9月至2013年1月我院收治的205例孕妇,其中甲状腺功能紊乱孕妇55例(紊乱组),非甲状腺功能紊乱孕妇150例(非紊乱组);非紊乱组中,年龄30岁的高龄孕妇50例(高龄组),年龄≤30岁的孕妇100例(正常组)。采用化学发光法,测定所有孕妇血清中游离甲状腺三碘原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)和TPOAb水平。结果:紊乱组患者血清中TSH、TPOAb及TPOAb阳性率水平显著高于非紊乱组,且存在统计学意义(均P0.05),而两组患者血清中FT3和FT4水平无统计学意义(均P0.05);高龄组和正常组血清中TSH、FT3、FT4及TPOAb水平均无统计学意义(均P0.05);与TSH正常组相比,TSH异常组中约有超过半数TPOAb表现为阳性,有统计学意义(P0.05);孕妇体内的TSH水平正常与否,均有出现TPOAb阳性的可能,在TSH水平较高(4.67 m IU/L)中,TPOAb阳性概率更高。结论:TSH、FT3、FT4水平正常而TPOAb呈阳性的孕妇依然存在自身免疫性甲状腺功能紊乱的可能性,监测TPOAb的水平对于妊娠期孕妇功能紊乱的诊断与治疗具有重要意义。     

Urinary iodine and thyroid function in a population of healthy pregnant women in the North of Spain

BackgroundIodine is an essential trace element for the synthesis of thyroid hormones, which are keys in maternal metabolism during pregnancy as well as in neurological development during fetal and postnatal life. This was a prospective study on iodine status and thyroid function in women during pregnancy in the Basque country to assess whether there was any relationship among maternal urinary iodine, maternal thyroid function and thyrotropin (TSH) in newborns, and to explore any difference in women experiencing miscarriages.MethodsWe analyzed TSH, free T₄ (FT₄), free T₃ (FT₃), thyroid peroxidase antibody (TPO-Ab) titers in serum and urinary iodine concentrations (UIC) in 2104 women in the first trimester of pregnancy and in 1322 of them in their second trimester. We obtained neonatal TSH levels in 1868 cases.ResultsIn the first (T1) and second trimesters (T2), the median UICs were 88.5 μg/L and 140 μg/L, respectively. No relationship was found between UIC and FT₄, or maternal and neonatal TSH. In T1 and T2, 9.7% and 7.5% of women were TPO-Ab positive, respectively. The total miscarriage rate was 10%. The percentage of miscarriages in healthy women was 8.9%, lower than in women with overt hypothyroidism (21.2%; p < 0.001) and than in women with subclinical hypothyroidism (15.6%; p < 0.025). The miscarriage rate was not higher in TPO-Ab-positive women.ConclusionsIn this study most women had iodine deficiency during pregnancy. Neonatal TSH is not correlated with maternal UIC during pregnancy. Pregnant women with hypothyroidism have a higher rate of miscarriages.     

孕早期亚临床甲状腺功能减退与流产发生的相关性

目的:探讨孕早期亚临床甲状腺功能减退与流产发生的相关性.方法:2017年2月至2019年选择在本院进行建档的孕早期孕妇120例,检测血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid stimulating ...     

Color-Flow Doppler Sonography in Patients with Subclinical Thyroid Dysfunction

ObjectiveTo assess the value of color-flow Doppler sonography (CFDS) in evaluating intrathyroidal blood flow and velocity in patients with subclinical thyroid dysfunction.MethodsIn this prospective study, patients with subclinical hypothyroidism, patients with subclinical hyperthyroidism, and euthyroid patients without known thyroid autoimmune disease who served as controls were included. Subclinical thyroid dysfunction was defined as normal serum free thyroxine (FT₄) and free triiodothyronine (FT₃) in the presence of high (subclinical hypothyroidism), or lowsuppressed (subclinical hyperthyroidism) serum thyrotropin (TSH) levels. Serum FT₄, FT₃, TSH, and antibodies to thyroid peroxidase and thyroglobulin were measured in all participants. In addition, TSH receptor antibody levels were determined in patients with subclinical hyperthyroidism. All participants underwent conventional sonography and CFDS. Mean peak systolic velocity (PSV) and resistive index were obtained from multiple extranodular thyroid parenchyma samplings and inferior thyroid artery measurements.ResultsThe study population included 27 patients with subclinical hypothyroidism, 15 patients with subclinical hyperthyroidism, and 20 euthyroid patients. Patients with subclinical hypothyroidism had significantly higher mean intrathyroidal PSV values than control patients (19.9 ± 5.6 cm/s vs 15.7 ± 4.4 cm/s; P = .008), whereas patients with subclinical hyperthyroidism had significantly higher mean PSV values than control patients at the inferior thyroid artery level (29.7 ± 10.7 cm/s vs 21.9 ± 6.8 cm/s; P = .014). Compared with control patients, a greater proportion of patients with subclinical hypothyroidism and patients with subclinical hyperthyroidism had marked CFDS patterns (78% vs 15% [P <.001] and 53% vs 15%; [P <.001], respectively). A significant association was found between positivity for thyroid autoantibodies and intense CFDS patterns. No correlation was found between TSH or thyroid hormone levels and CFDS pattern or blood flow velocity.ConclusionWe have demonstrated that significantly increased thyroid blood flow velocity and vascularity are already present in patients with mild thyroid dysfunction.(Endocr Pract. 2010;16:376-381)     

Associations of Thyroid-Stimulating Hormone and Free Thyroxine Concentrations with Health and Life Satisfaction in Elderly Adults

ObjectiveTo analyze associations between thyroid-stimulating hormone (TSH) and free thyroxine (FT₄) concentrations and life satisfaction, symptoms, self-rated health, and common neuropsychiatric diseases (depression or dementia) in a community-dwelling elderly population to provide evidence whether to decrease the upper reference limit for TSH or the optimal TSH target in levothyroxine treatment in older adults.MethodsIn this cross-sectional study, we determined TSH and FT₄ concentrations in a thyroid disease-free population of 502 men (median age, 71 years) and 584 women (median age, 73 years) and in a patient group of 49 women (median age, 75 years) with primary hypothyroidism who were stable users of thyroxine treatment. Life satisfaction, self-rated health, depression, and dementia were assessed with Specific questions and with tools such as the Self-report Depression Scale and the Mini-Mental State Examination. Independent variables were dichotomized, and associations of these variables with TSH and FT₄ levels were assessed in the thyroid disease-free population. Levels of TSH and FT₄ in thyroid disease-free women and in women treated with thyroxine were also compared.ResultsAfter age adjustment, there were no associations between TSH levels and self-rated health, life satisfaction, or most symptoms in the thyroid disease-free population. No associations were found between diagnosed depression or Mini-Mental State Examination results and levels of TSH and FT₄. Dementia was associated with higher FT₄ concentration in men. Although women treated with thyroxine had TSH levels that were higher than thyroid disease-free women, there were no statistically significant differences in independent variables between these 2 groups.ConclusionOur results do not support the need to decrease the upper reference limit for TSH or to lower the optimal TSH target in levothyroxine treatment in older adults, as recommended in recent guidelines. (Endocr Pract. 2007;13:451-457)     

Association of First-Trimester Thyroid Function Test Values with Thyroperoxidase Antibody Status,Smoking, and Multivitamin Use

ObjectiveTo determine first-trimester thyroid function values and associations with thyroperoxidase antibody (TPO-Ab) status, smoking, emesis, and iodine-containing multivitamin use.MethodsWe collected information by interview, questionnaire, and blood draw at the initial obstetric visit in 668 pregnant women without known thyroid disease. We compared thyroid-stimulating hormone (TSH), total thyroxine (T₄), and free T₄ index (FT₄I) values by TPO-Ab status. Multiple regression was used to identify characteristics associated with thyroid function values.ResultsThe following median (range containing 95% of the data points) thyroid function test values were obtained in 585 TPO-Ab–negative women: TSH, 1.1 mIU/L (0.04-3.6); FT₄I, 2.1 (1.5-2.9); and T₄, 9.9 μg/dL (7.0-14.0). The following median (range containing 95% of the data points) thyroid function test values were obtained in 83 TPO-Ab–positive women: TSH, 1.8 mIU/L (0.3-6.4) (P < .001); FT₄I, 2.0 (1.4-2.7) (P = .06); and T₄, 9.3 μg/dL (6.8-13.0) (P = .03) (P values denote statistically significant differences between TPO-Ab–positive and negative participants). Among TPO-Ab–negative participants, TSH level was not associated with use of iodine-containing multivitamins, smoking, or race. TSH increased 0.03 mIU/L for every year of maternal age (P = .03) and decreased by 0.3 mIU/L for every increase in parity (P < .001). T₄ decreased 0.04 μg/dL for every year of maternal age (P = .04). Mean FT₄I was 2.05 in smokers and 2.20 in nonsmokers (P < .01). There were no relationships between T₄ or FT₄I and parity, race, or iodine-containing multivitamin use.ConclusionTPO-Ab status of pregnant women should be considered when constructing trimester-specific reference ranges because elevated serum TPO-Ab levels are associated with higher TSH and lower T₄ values. (Endocr Pract. 2008;14:33-39)     

Impact of Thyroid Function on Serum Cystatin C and Estimated Glomerular Filtration Rate: A Cross-Sectional Study

ObjectiveTo determine the relationship between thyroid-stimulating hormone (TSH) and cystatin C (CysC) and estimated glomerular filtration rate calculated by Cys^C (e^GFRCysC).MethodsWe conducted a cross-sectional study including 8,126 male participants. Serum creatinine (Cr), CysC, eGFR calculated by Cr (eGFR_Cr), and eGFR_CysC were determined and compared in euthyroid and subclinical thyroid dysfunction patients. Relationships between TSH and Cr, cystatin C, eGFR_Cr, and eGFR_CysC were assessed by linear and quadratic trend analyses. Odds ratios (ORs) of chronic kidney disease (CKD; eGFR<60 mL/min/1.73m²) were calculated according to categories of thyroid function using TSH values of 2.01-3.00 mIU/L as a reference.ResultsSerum CysC level was significantly elevated, and eGFR_CysC was significantly reduced in both sub-clinical hypothyroidism and subclinical hyperthyroidism. TSH was negatively and linearly associated with Cr and eGFR_Cr (P<.001). Quadratic trends were found between TSH and cystatin C or eGFR_CysC (P<.001). Compared with individuals with TSH of 2.01-3.00 mIU/L, the prevalence of CKD_CysC was significantly higher in subjects with TSH<0.40 mIU/L, 3.01-4.00 mIU/L, and 4.01-7.00 mIU/L, while the prevalence of CKD_Cr was only significantly higher in subjects with TSH>7.0 mIU/L.ConclusionDespite only studying male subjects and using eGFR rather than standard GFR, we conclude that thyroid function differentially affects serum CysC and Cr concentrations. Subclinical hypothyroidism and subclinical hyperthyroidism are both associated with elevated CysC, reduced eGFR_CysC, and higher prevalence of CKD_CysC. Assessment of renal function with CysC should be avoided in patients with thyroid dysfunction. (Endocr Pract. 2013;19:397-403)     

Relationship between mild iodine deficiency in pregnant women and thyroid function: A meta-analysis

BackgroundPregnant women are among the key groups in iodine nutrition evaluation. The purpose of the present study was to summarize the evidence supporting the relationship between mild iodine deficiency (UIC: 100–150 μg/L) in pregnant women and levels of thyroid function tests.MethodsThis review follows the guidelines for systematic reviews (PRISMA 2020). Three electronic databases (PubMed, Medline, and Embase) were searched for relevant publications in English on the association between mild iodine deficiency in pregnant women and thyroid function. Articles published in Chinese were searched in China’s electronic databases (CNKI, WanFang, CBM, and WeiPu). Pooled effects were presented as standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) using fixed or random effect models, respectively. This meta-analysis was registered at www.crd.york.ac.uk/prospero as CRD42019128120.ResultsWe summarized the results from 7 articles with 8261 participants. The overall pooled results showed that the levels of FT₃, FT4, and abnormal TgAb (the antibody levels exceeded the upper limit of the reference range) were significantly increased in pregnant women with mild iodine deficiency compared to pregnant women with adequate iodine status (FT₃: SMD=0.854, 95% CI: 0.188, 1.520; FT₄: SMD=0.550, 95% CI: 0.050, 1.051; TgAb: OR=1.292, 95% CI: 1.095; 1.524). Subgroup analysis was carried out on the sample size, ethnicity, country, and gestation of FT₃, FT_4, and TSH, but no plausible factor was found. Egger’s tests indicated no publication bias.The increase in FT₃ and FT_4, as well as TgAb levels, in pregnant women is associated with mild iodine deficiency.ConclusionMild iodine deficiency is associated with an increase in FT_3,FT₄ and TgAb levels in pregnant women. Mild iodine deficiency may increase the risk of thyroid dysfunction in pregnant women.     

Management of Hypothyroidism and Hypothyroxinemia During Pregnancy

ObjectiveTo review the diagnosis and management of hypothyroidism during pregnancy, in the preconception period, and in the postpartum period.MethodsA literature review of English-language papers published between 1982 and 2022, focusing on the most recent literature.ResultsDuring pregnancy, thyroid function laboratory tests need to be interpreted with regard to gestational age. Overt hypothyroidism, regardless of the thyroid-stimulating hormone (TSH) level, should always be promptly treated when it is diagnosed before conception or during pregnancy or lactation. Most women with pre-existing treated hypothyroidism require an increase in levothyroxine (LT4) dosing to maintain euthyroidism during gestation. LT4-treated pregnant patients need close monitoring of their serum TSH levels to avoid overtreatment or undertreatment. There is no consensus about whether to initiate LT4 in women with mild forms of gestational thyroid hypofunction. However, in light of current evidence, it is reasonable to treat women with subclinical hypothyroidism with LT4, particularly if the TSH level is >10 mIU/L or thyroperoxidase antibodies are present. Women who are not treated need to be followed up to ensure that treatment is initiated promptly if thyroid failure progresses. Additional studies are needed to better understand the effects of the initiation of LT4 in early gestation in women with subclinical hypothyroidism and hypothyroxinemia and determine optimal strategies for thyroid function screening in the preconception period and during pregnancy.ConclusionThe diagnosis and management of hypothyroidism in the peripregnancy period present specific challenges. While making management decisions, it is essential to weigh the risks and benefits of treatments for not just the mother but also the fetus.