甲状腺功能减退患者妊娠前、妊娠期及产后甲状腺激素治疗剂量的变化规律研究  

Variation researches of thyroid hormone therapy for patients with hypothyroidism before, during pregnancy and postpartum

作　　者：钮玉洁[1] 

机构地区：[1]复旦大学附属妇产科医院妇产科,200090

出　　处：《中国综合临床》2013年第5期455-458,共4页Clinical Medicine of China

摘　　要：目的探讨甲状腺功能减退患者妊娠前、妊娠期及产后甲状腺激素治疗剂量的变化规律。方法选择孕前患甲状腺功能减退且成功妊娠分娩的患者38例，其中自身免疫性甲状腺炎致甲状腺功能减退者15例，甲状腺手术引起甲状腺功能减退者11例，131I治疗致甲状腺功能减退者5例，未知明确原因的妊娠期临床甲状腺功能减退患者7例；分别匹配未妊娠患者38例为妊娠前的对照组。均予左旋甲状腺素片（L—T4）治疗达到疗效标准，统计L—T4用药剂量的变化规律。结果妊娠前后及妊娠的不同时期L—T4剂量比较差异有统计学意义，妊娠后用药剂量显著增加，妊娠10～12周、16—18周、22—24周、26～30周、34～36周较妊娠前及产后3个月显著增加[（110．51±10．42）、（113．81±21．04）、（108．32±21．01）、（105．58±21．54）、（105．89±10．24）、（84．42±10．45）、（86．43±10．29）μg/L，F=15．631，P〈0．001]，而妊娠前与产后3个月相比差异无统计学意义，且妊娠时各阶段之间比较差异亦无统计学意义（P均〉0．05）；甲状腺手术后和131I治疗后甲状腺功能减退患者整个治疗期间L—T4剂量均显著高于自身免疫性甲状腺炎与未明确原因的患者（妊娠前、妊娠中期、产后F值分别为4．98、5．15、5．04，P均〈0．001）。结论甲状腺功能减退患者妊娠期间甲状腺激素治疗剂量增加，平均增加原剂量的30％～40％，而产后3个月又可恢复妊娠前的水平，甲状腺手术后和131I治疗后甲状腺功能减退患者L-T4治疗剂量较高。Objective To investigate the variation of thyroid hormone therapy in patients with hypothyroidism before, during and postpartum pregnancy. Methods Thirty-eight patients who suffered from hypothyroidism and had successful pregnancy were collected. Among them, 15 cases of hypothyroidism were caused by autoimmune thyroiditis caused, 11 cases were induced by thyroid surgery;in 131I treatment induced hypothyroidism were 5 cases,7 patients had unclear reason pregnancy clinical thyroid dysfunctions. Thirty-eight cases of non-pregnant patients with hypothyroidism were also collected as the control group. They achieved efficacy standards by levothyroxine （L-T4） treatment and dose variation of L-T4 was statistically analyzed. Results There was a significant difference before pregnancy, postpartum and different periods of pregnancy. L-T4 dose had a significant increase after pregnancy. At 10 - 12 weeks, 16 - 18 weeks, 22 -24 weeks ,26- 30 weeks ,34 -36 weeks respectively, L-T4 dose was significantly increasing compared with before pregnancy and postpartum 3 months （ （ 110. 51 ± 10. 42 ）, （ 113.81 ± 21.04 ）, （ 108.32 ± 21.01 ）, （ 105.58 ± 21.54）,（105.89±10.24）,（84.42 ±10.45） and （86.43 ±10.29） μg/L,F=15.631,P〈0.001）,but between before and pregnancy postpartum, there was not significantly difference （ P 〉 0.05 ）. Among the various stages of pregnancy ,there was also no significant difference;In the patients with hypothyroidism due to thyroid surgery and 131I therapy, L-T4 dose were significantly higher than autoimmune thyroiditis and patients with no clear reason（before,during and after pregnancy,F =4.98,5.15,5.04,P 〈0. 001）. Conclusion Patients with hypothyroidism during pregnancy should increased therapeutic dose of thyroid hormone with average about 30% -40% of the original dose, and in postpartum, levels before pregnancy could resume. High doses of L-T4 treatment should be taken in patients with hypothyroidism after 131I therapy and after thyroid surgeries.

关 键 词：妊娠期 甲状腺 治疗 左旋甲状腺素片 

分 类 号：R581.2[医药卫生—内分泌]