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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
therefore
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)
Beijing Obstetrics and Gynecology Society
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