Subclinical hypothyroidism and pregnancy
Subclinical hypothyroidism and pregnancy
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DOI：
10.1097/01.ogx.0000223331.51424.9b
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发表时间：
2006-06-01
影响因子：
6.2
通讯作者：
Casey, BM
中科院分区：
文献类型：
--
作者：
Casey, BM
妊娠对甲状腺的稳态有相当大的影响，使甲状腺功能减退症的诊断复杂化。明显甲状腺功能减退的孕妇有明显的孕产妇发病率以及围产期发病率和死亡率。对这些妇女的治疗已被证明可以改善这些结果。关于识别和治疗亚临床甲状腺功能减退症妇女的重要性的争议爆发后，几份报告将不同定义的甲状腺功能减退症与胎儿神经发育受损联系起来。通常，这些报告被错误地认为是确定亚临床甲状腺功能减退症的妇女，而事实上，这些研究都没有特别确定这样的妇女。到目前为止，还没有一个良好的对照，长期的研究，对后代的孕妇亚临床甲状腺功能减退症作为同时代的定义。此外，这些报告还导致多个国家实体就是否所有孕妇都应接受甲状腺功能减退症筛查以及对发现患有亚临床甲状腺功能减退症的孕妇进行治疗的问题发表了相互矛盾和令人困惑的立场声明。重要的是，也没有发表的干预试验专门评估这种治疗对改善亚临床甲状腺功能减退症女性后代神经发育结局的疗效。人们承认，产科医生面临越来越大的压力，筛查和治疗亚临床甲状腺功能减退症的孕妇，尽管不确定他们的后代是否会从治疗中受益。推荐这种筛查和治疗的国家内分泌组织强调，需要进行大型临床试验来解决这些问题。在这些研究完成之前，对妊娠期亚临床甲状腺功能减退症的常规筛查和治疗是没有必要的，应该被认为是实验性的。
Pregnancy has a considerable impact on thyroid homeostasis that complicates the diagnosis of hypothyroidism. Pregnant women with overt hypothyroidism have appreciable maternal morbidity as well as perinatal morbidity and mortality. Treatment of such women has been shown to improve these outcomes. Controversy regarding the importance of identifying and treating women with subclinical hypothyroidism erupted after several reports have linked variously defined hypothyroidism with impaired neurodevelopment of the fetus. Frequently, these reports are erroneously considered as identifying women with subclinical hypothyroidism, when in fact, none of these studies specifically identified such women. To date, there have been no well-controlled, long-term studies on offspring of pregnant women with subclinical hypothyroidism as contemporaneously defined. Furthermore, these reports have led to conflicting and confusing position statements from several national entities as to whether all pregnant women should be screened for hypothyroidism and treatment prescribed for those found to have subclinical hypothyroidism. Importantly, there are also no published intervention trials specifically assessing the efficacy of such treatment to improve neurodevelopmental outcomes in offspring of women with subclinical hypothyroidism. It is acknowledged that obstetricians are under increasing pressure to screen for and treat pregnant women with subclinical hypothyroidism despite uncertainty that their offspring would benefit from therapy. National endocrine groups recommending such screening and treatment have emphasized that there is a need for large clinical trials to address these issues. Until such studies are completed, routine screening for and treatment of subclinical hypothyroidism during pregnancy is unwarranted and should be considered experimental.