期刊
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
卷 98, 期 12, 页码 E1941-E1945出版社
ENDOCRINE SOC
DOI: 10.1210/jc.2013-2768
关键词
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资金
- Endocrine Research Fund
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula
- NIHR
- CLAHRC for the South West Peninsula
- National Institute for Health Research [NF-SI-0611-10219] Funding Source: researchfish
Context: Increasing numbers of women are being treated with L-thyroxine in pregnancy for mild thyroid dysfunction because of its association with impaired neuropsychological development in their offspring and other adverse obstetric outcomes. However, there are limited data to indicate whether treatment should be continued outside of pregnancy. Objectives: We aimed to determine whether subclinical hypothyroidism and maternal hypothyroxinemia resolve postdelivery. Design, Setting, and Participants: A total of 523 pregnant healthy women with no known thyroid disorders were recruited during routine antenatal care and provided blood samples at 28 weeks of pregnancy and at a mean of 4.9 years postpregnancy. Main Outcome Measures: TSH, free T-4, free T-3, and thyroid peroxidase antibody levels were measured in serum taken in pregnancy and at follow-up. Results: Subclinical hypothyroidism in pregnancy (TSH >3 mIU/L) was present in 65 of 523 (12.4%) women. Of these, 49(75.4%) women had normal thyroid function post pregnancy; 16 of 65(24.6%) had persistent high TSH (TSH >4.5 mIU/L postpregnancy) with 3 women receiving L-thyroxine treatment. A total of 44 of 523 (8.4%) women had isolated maternal hypothyroxinemia in pregnancy (free T-4 <10th centile and TSH <= 3 mIU/L). Only 2 of 44 (4.5%) had TSH >4.5 mIU/L outside pregnancy. Of the women with subclinical hypothyroidism in pregnancy with antibody measurements available, those with thyroid peroxidase antibodies in pregnancy were more likely to have persistently elevated TSH or be receiving L-thyroxine replacement after pregnancy (6 of 7 [86%] vs 10 of 57 [18%], P < .001). Conclusions: The majority of cases of subclinical hypothyroidism in pregnancy are transient, so treatment with L-thyroxine in these patients should be reviewed because it may not be warranted after pregnancy.
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