Thyroid and Fertility: Recent Advances
Thyroid and Fertility: Recent Advances
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DOI：
10.1089/thy.2019.0382
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发表时间：
2020-02-04
期刊：
影响因子：
6.6
通讯作者：
Dosiou, Chrysoula
中科院分区：
文献类型：
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作者：
Dosiou, Chrysoula
背景：甲状腺疾病在育龄妇女中很常见，而不孕症在甲状腺功能障碍的妇女中很常见。在这项研究中，我们回顾了自2017年美国甲状腺协会怀孕指南发布以来，甲状腺和生育力领域的最新进展。摘要：最近的研究证实，促甲状腺激素(TSH)升高和/或甲状腺自身免疫与女性亚群中的不孕症和卵巢储备不足有关，并有助于更好地理解甲状腺自身免疫与不孕症的发病机制。尽管治疗TSH>；4MIU/L患者的益处已经在一项大型回顾队列研究中得到证实，但两项大型随机对照试验未能显示出甲状腺激素对甲状腺自身免疫功能正常女性的产科结局的益处。基于放射性碘对卵巢储备和精子染色体异常的影响，有关放射性碘(RAI)潜在性腺毒性的新数据出现。结论：继续有证据支持甲状腺激素在多个水平上调节生殖组织的重要作用。最近的随机试验未能确定甲状腺激素对甲状腺自身免疫功能正常的女性的益处。需要在这一领域进行进一步的研究，以更全面地描述相关途径，并确定哪些妇女可能从左旋甲状腺素治疗中受益。RAI对生育力的影响也值得进一步研究。
Background: Thyroid disease is prevalent in women of reproductive age, while infertility is common in women with thyroid dysfunction. In this study, we review the recent advances in the field of thyroid and fertility since the publication of the 2017 American Thyroid Association pregnancy guidelines.Summary: Recent studies have confirmed associations of thyrotropin (TSH) elevation and/or thyroid autoimmunity with infertility and low ovarian reserve in subsets of women, and have led to a better understanding of the pathogenesis linking thyroid autoimmunity with infertility. Even though the benefit of treating patients with TSH >4 mIU/L has been confirmed in a large retrospective cohort study, two large randomized controlled trials have failed to show benefit of thyroid hormone on obstetrical outcomes in euthyroid women with thyroid autoimmunity. New data have emerged regarding the potential gonadal toxicity of radioactive iodine (RAI), based on its impact on ovarian reserve and sperm chromosomal abnormalities.Conclusions: There is continued evidence supporting an important role of thyroid hormone in regulation of reproductive tissues at many levels. Recent randomized trials have failed to identify a benefit of thyroid hormone in euthyroid women with thyroid autoimmunity. Further research in the field is needed to more completely delineate the relevant pathways and identify women who may benefit from levothyroxine treatment. The impact of RAI on fertility also merits further investigation.