When pregnant mothers encounter hypothyroidism, where should I go?Do you know this key value?

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Wu Dan, Shen Huan Peking University People’s Hospital

During the pre -pregnancy examination

More and more doctors suggest patients

Examination of thyroid function

Because of pregnancy and postpartum thyroid disease

It is the endocrinology community in the past ten years

One of the hot research fields in the medical community

Thyroid function abnormalities

Effect on pregnancy and fetus

It has been confirmed by many research reports

In the late 1980s

Dutch scholar Vulsma and others first discovered

Thyroid hormone synthesis disorder

In the umbilical cord blood of nail -shaped gland newborn

Existence of thyroid hormone

As a result, the maternal thyroid hormone

Can’t pass the traditional view of the placenta

Basic research confirms the maternal thyroid hormone

In the first half of the fetal brain development

(1-20 weeks of pregnancy)

Important role

2018 Chinese Medical Association Endocrinology Society

Experts of the Society of Medical Society of the Chinese Medical Association and the Scientific Research Institute of the Health and Health Commission

On the basis of the 2012 version of the China pregnancy guide

Combined with American thyroid society

(ATA) promulgated in 2017

"Guidelines for Diagnosis and Management of Pitchus Diseases of pregnancy and postpartum"

Modify the guide to form a new version

"Guidelines for the diagnosis and treatment of thyroid disease during pregnancy and postpartum"

This version guide not only updated the pregnancy period

Diagnostic indicators of hypothyroidism

Also joined

"Auxiliary reproductive and thyroid disease"

This new chapter

Let’s explain in detail below

Part of the thyroid dysfunction in this guide

In a new guide

TSH (thyroid hormone) in early pregnancy (thyroid hormone)

The incision point of the upper limit has changed

TSH has different reference range in different periods of pregnancy

In early pregnancy, choricular gonadotropin due to chorionic membrane

Increasing concentration stimulates TSH receptor

As a result

Then cause TSH level to reduce

In my country

"Guidelines for the diagnosis and treatment of thyroid disease during pregnancy and postpartum gland disease (2018 revised edition)"

Clinically adopted

2011 ATA Guide Recommendation Standard

That is, early pregnancy TSH> 2.5 miu/L

Come to diagnose early sub -clinical hypothyroidism (SCH) in early pregnancy

But from the global exceeding

Research data of 50,000 pregnancy women indicate

The upper limit of the TSH reference value of most countries and regions

Both higher than 2.5m IU/L

Early pregnancy

Use TSH> 2.5MIU/L.

It will lead to excessive diagnosis of sub -clinical hypothyroidism

Based on new research evidence

New Guide Recommendation

Consider the 4.0miu/l

As the upper limit of the TSH reference value during pregnancy

Pregnancy sub -clinical hypothyroidism treatment strategies are more detailed

Clinical hypothyroidism during pregnancy

Can lead to a variety of bad pregnancy endings

The risk of damage to future nerve intellectual development is increased

Suggestion of the 2012 version guide:

TSH is higher than the normal upper limit

(2.5miu/L) and TPOAB

(Pitchus peroxidase antibody)

Positive sub -clinical hypothyroidism women

It is recommended to give L-T4 (left thyroxine) treatment

For TSH> 2.5miu/L

And TPOAB negative sub -clinical hypothyroidism

Not recommended nor against L-T4 treatment

The new guidelines will be sub -clinical in pregnancy

Treatment strategies are more detailed in layers

And to TSH> 4.0miu/L

And TPOAB negative sub -clinical hypothyroidism patients

Recommended recommendations for L-T4 treatment are given

The new guidelines also to the starting dose of L-T4

Make layered recommendation (see Table)

Infertility and auxiliary reproductive and thyroid disease

A survey research results show

Among the 171 cases of hypothetical women

23.4 % have menstrual disorders

Far higher than the normal thyroid function (8.4 %)

An one who is based on 149 infertile women

Horizontal surface research shows

4.6 % of patients serum

TSH level> 4.5MU/ L

Although the current research data is not yet perfect

However, most data supports the risk of infertility will increase infertility

Anti -hypothyroid drug safety

So to infertile women

Perform thyroid function screening and treatment

It is reasonable to adjust its thyroid function to normal level

So recommend all women who treat infertility

Monitor serum TSH level

For sub -clinical nails of the thyroid antibody -negative

Infertile women (uncomfortable auxiliary reproduction)

Insufficient evidence of L-T4 treatment increases conception rate

But applying L-T4 can prevent after pregnancy

The development of Sch to clinical hypothyroidism

And low-dose L-T4

Low treatment risk

Recommended infertility with Sch

Preparation for pregnant women give L-T4 treatment

The starting dose is 25 ~ 50 μg/d

A clinical random control study selected to accept

In vitro fertilization-embryo transplantation (IVF-ET)

Sch women

Among them, the test group LT4 treatment

(50 ~ 100 μg / d)

TSH control target <2.5 MU/ L

The results of the control group are displayed

The test group has a high clinical pregnancy rate than the placebo group

Lower abortion rate and high live yield rate

Sch may be a way to depend on dosage

Affects assisted reproduction

The risk of failure in pregnancy increases with the concentration of TSH


Accept auxiliary reproduction

SCH (TSH> 2.5 MU/ L)

Women should be treated

TSH treatment target should be controlled

Below 2.5MU / L

*References: "Guidelines for diagnosis and treatment of thyroid disease in pregnancy and postpartum (2nd Edition)", China Endocrine Magazine, 2019, 35 (8)

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