Preconception Management of Hyperthyroidism and Thyroid Status in Subsequent Pregnancy: A Population-Based Cohort Study.
Preconception Management of Hyperthyroidism and Thyroid Status in Subsequent Pregnancy: A Population-Based Cohort Study.
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DOI：
10.1210/clinem/dgad276
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发表时间：
2023-10-18
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妊娠期最佳甲状腺状态对于降低不良结局风险至关重要。育龄妇女甲状腺功能亢进症的管理带来了独特的挑战，目前还不清楚孕前治疗策略如何影响随后怀孕的甲状腺状态。我们的目的是确定甲状腺功能亢进症在孕前和孕期的管理趋势，并评估不同的孕前治疗策略对母亲甲状腺状态的影响。我们利用临床实践研究数据链数据库评价了所有年龄在15-45岁之间、临床诊断为甲状腺功能亢进并随后怀孕的女性（2000年1月至2017年12月）。我们根据孕前治疗，即（1）抗甲状腺药物直到或超过妊娠发作，（2）在妊娠前甲状腺切除术或放射性碘的确定性治疗，（3）在妊娠发作时没有治疗，比较妊娠期间的甲状腺状态。我们的研究队列包括4712例妊娠。只有53.1%的孕妇进行了促甲状腺激素（TSH）检测，其中28.1%的孕妇显示甲状腺状态不佳（TSH >4.0 mU/L或TSH <0.1 mU/L + FT 4>参考范围）。与抗甲状腺药物治疗期间开始的妊娠相比，既往接受过确定性治疗的妊娠更可能出现甲状腺状态欠佳（比值比4.72，95% CI 3.50-6.36）。从2000年到2017年，怀孕前使用确定性治疗的人数稳步下降。三分之一（32.6%）的妊娠早期暴露于卡比马唑的孕妇改用丙基硫氧嘧啶，而6.0%的丙基硫氧嘧啶暴露的孕妇改用卡比马唑。妊娠期甲状腺功能亢进症妇女的管理是次优的，特别是在那些孕前明确治疗的妇女中，迫切需要改进。需要更好的甲状腺监测和产前咨询，以优化甲状腺状态，减少致畸药物暴露，并最终降低不良妊娠结局的风险。
Optimal thyroid status in pregnancy is essential in reducing the risk of adverse outcomes. The management of hyperthyroidism in women of reproductive age poses unique challenges and it is unclear how preconception treatment strategies impact on thyroid status in subsequent pregnancy. We aimed to determine trends in the management of hyperthyroidism before and during pregnancy and to assess the impact of different preconception treatment strategies on maternal thyroid status. We utilized the Clinical Practice Research Datalink database to evaluate all females aged 15-45 years with a clinical diagnosis of hyperthyroidism and a subsequent pregnancy (January 2000 to December 2017). We compared thyroid status in pregnancy according to preconception treatment, namely, (1) antithyroid drugs up to or beyond pregnancy onset, (2) definitive treatment with thyroidectomy or radioiodine before pregnancy, and (3) no treatment at pregnancy onset. Our study cohort comprised 4712 pregnancies. Thyrotropin (TSH) was measured in only 53.1% of pregnancies, of which 28.1% showed suboptimal thyroid status (TSH >4.0 mU/L or TSH <0.1 mU/L plus FT4 >reference range). Pregnancies with prior definitive treatment were more likely to have suboptimal thyroid status compared with pregnancies starting during antithyroid drug treatment (odds ratio 4.72, 95% CI 3.50-6.36). A steady decline in the use of definitive treatment before pregnancy was observed from 2000 to 2017. One-third (32.6%) of first trimester carbimazole-exposed pregnancies were switched to propylthiouracil while 6.0% of propylthiouracil-exposed pregnancies switched to carbimazole. The management of women with hyperthyroidism who become pregnant is suboptimal, particularly in those with preconception definitive treatment, and needs urgent improvement. Better thyroid monitoring and prenatal counseling are needed to optimize thyroid status, reduce teratogenic drug exposure, and ultimately reduce the risk of adverse pregnancy outcomes.
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