Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum
Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum
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DOI：
10.1089/thy.2011.0087
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发表时间：
2011-10-01
期刊：
影响因子：
6.6
通讯作者：
Wiersinga, Wilmar
中科院分区：
文献类型：
--
作者：
Stagnaro-Green, Alex;Abalovich, Marcos;Wiersinga, Wilmar
怀孕对甲状腺和甲状腺功能有深远的影响。在碘充足的国家，怀孕期间腺体的大小增加10%，在碘缺乏的地区增加20%-40%。甲状腺素（T4）和三碘甲状腺原氨酸（T3）的产生增加50%，沿着每日碘需求量增加50%。这些生理变化可能会导致甲状腺功能减退症在怀孕后期的碘缺乏妇女谁是甲状腺功能正常的前三个月。在胎盘人绒毛膜促性腺激素（hCG）的影响下，促甲状腺激素（TSH）的范围在整个妊娠期间降低，妊娠早期正常TSH水平下限定义不清，上限为2.5 mIU/L。10%至20%的怀孕妇女在怀孕的头三个月是甲状腺过氧化物酶（TPO）或甲状腺球蛋白（Tg）抗体阳性和甲状腺功能正常。孕早期甲状腺功能正常且TPO或Tg抗体阳性的妇女，有16%在孕晚期发生TSH> 4.0mIU/L，孕早期TPO或Tg抗体阳性的妇女，有33%~ 50%发生产后甲状腺炎。从本质上讲，妊娠是甲状腺的应激试验，在甲状腺储备不足或碘缺乏的女性中，会发生甲状腺功能减退，在妊娠前甲状腺功能正常的桥本氏病患者中，也会发生产后甲状腺炎。直到最近，2.5 mIU/L的TSH才被接受为妊娠早期TSH正常值的上限。这对文献的解释以及甲状腺功能减退症的临床诊断具有重要意义。虽然显性甲状腺功能减退和显性甲状腺功能亢进对妊娠有有害影响是公认的，但目前的研究主要集中在亚临床甲状腺功能减退和亚临床甲状腺功能亢进对孕产妇和胎儿健康的潜在影响、TPO和/或Tg抗体阳性的甲状腺功能正常妇女的流产和早产之间的关联以及产后甲状腺炎的患病率和长期影响。最近完成的前瞻性随机研究已经开始产生急需的数据，关于治疗甲状腺疾病对母亲，胎儿和未出生婴儿未来智力的影响。正是在这种情况下，美国甲状腺协会（ATA）委托一个工作组制定妊娠期和产后甲状腺疾病诊断和治疗的临床指南。工作队由甲状腺疾病和怀孕领域的国际专家组成，包括来自ATA、亚洲和大洋洲甲状腺协会、拉丁美洲甲状腺协会、美国妇产科医师学会和北美助产士联盟的代表。将甲状腺学家、产科医生和助产士纳入任务
Pregnancy has a profound impact on the thyroid gland and thyroid function. The gland increases 10% in size during pregnancy in iodine-replete countries and by 20%–40% in areas of iodine deficiency. Production of thyroxine (T4) and triiodothyronine (T3) increases by 50%, along with a 50% increase in the daily iodine requirement. These physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester. The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decreased throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxidase (TPO) or thyroglobulin (Tg) antibody positive and euthyroid. Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%–50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto’s disease who were euthyroid prior to conception.Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism. Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of subclinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid disease on the mother, fetus, and the future intellect of the unborn child. It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives on the task