88例甲状腺功能亢进症131I治疗后妊娠患者的甲状腺功能分析及治疗策略  

Thyroid function analysis and treatment in 88 cases of pregnancy after 131I treatment of hyperthyroidism

作　　者：陶志嵩 牟琦 冯雪凤[1] Tao Zhisong;Mu Qi;Feng Xuefeng(Department of Nuclear Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Nuclear Medicine,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院核医学科,南京210008 [2]东南大学附属中大医院核医学科,南京210009

出　　处：《中华核医学与分子影像杂志》2024年第6期355-358,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：南京市医学科技发展项目(YKK13063)。

摘　　要：目的:探讨甲状腺功能亢进症(简称甲亢)131I治疗后的妊娠期女性甲状腺功能(简称甲功)状态及左甲状腺素(L-T_(4))替代治疗策略。方法:回顾性分析2005年1月至2019年12月在南京鼓楼医院行甲亢131I治疗后至少半年、甲功正常后妊娠并顺利分娩的88例患者,治疗时年龄为(27.3±3.7)岁。分别检测患者妊娠前1~3个月、妊娠期(4~7周、8~12周、13~22周、23~28周、29周后)、产后(6周、3个月和6个月)的3项甲功指标:促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4)),按2011年美国甲状腺协会指南血清TSH水平推荐标准,进行L-T_(4)替代治疗以维持甲功正常。采用重复测量方差分析、最小显著差异t检验分析数据。结果:妊娠前、妊娠期及产后各时间段的TSH、FT_(3)、FT_(4)和L-T_(4)差异有统计学意义(F值:5.94、3.32、3.49、9.63,均P<0.05)。为维持妊娠各时间段甲功正常,同妊娠前1~3个月L-T_(4)替代治疗剂量(64.52±34.32)μg相比,妊娠4~7周L-T_(4)替代治疗剂量增加至(82.33±35.06)μg,妊娠8~12周持续增加至(100.75±36.77)μg(t值:7.33、10.44,均P<0.001),妊娠13周后L-T_(4)剂量增加趋缓,妊娠晚期(29周后)较妊娠前增幅达76.69%。同妊娠晚期[TSH:(2.99±1.42)mU/L,FT_(3):(3.90±0.55)pmol/L,FT_(4):(15.37±2.29)pmol/L]相比,产后6周TSH[(1.21±1.08)mU/L]下降(t=-2.48,P=0.017),FT_(3)[(5.23±1.07)pmol/L]和FT_(4)[(21.29±4.96)pmol/L]明显升高(t值:6.05、5.88,均P<0.001),L-T_(4)替代治疗剂量明显减少(t=-6.85,P<0.001),但产后6周、3个月和6个月L-T_(4)替代治疗剂量仍高于妊娠前(t值:4.67~4.71,均P<0.001)。结论:甲亢131I治疗后从妊娠前的1~3个月、妊娠期到产后6周要定期监测TSH、FT_(3)和FT_(4),依血清TSH水平尽早调整L-T_(4)替代治疗剂量。Objective To investigate the thyroid function status and levothyroxine(L-T_(4))replacement therapy strategy in pregnant women after 131I treatment of hyperthyroidism.Methods From January 2005 to December 2019,88 patients(age:(27.3±3.7)years)who received 131I treatment in Nanjing Drum Tower Hospital were retrospectively analyzed.They became pregnant at least half a year after 131I treatment with normal thyroid function and delivered successfully.Thyroid stimulating hormone(TSH),free triiodothyronine(FT_(3))and free thyroxine(FT_(4))were respectively detected at 1-3 months before pregnancy,4-7,8-12,13-22,23-28,≥29 weeks of pregnancy,and 6 weeks,3 months,6 months of postpartum.According to the 2011 American Thyroid Association guidelines,L-T_(4) replacement therapy was performed to maintain normal thyroid function.Repeated measures analysis of variance and the least significant difference t test were used to analyze data.Results There were significant differences in TSH,FT_(3),FT_(4) and L-T_(4) among different time periods before pregnancy,pregnancy and postpartum(F values:5.94,3.32,3.49,9.63,all P<0.05).In order to maintain normal thyroid function in each period of pregnancy,the doses of L-T_(4) replacement therapy were increased to(82.33±35.06)μg and(100.75±36.77)μg at 4-7,8-12 weeks of pregnancy compared with the dose((64.52±34.32)μg)before pregnancy(t values:7.33,10.44,both P<0.001).The doses of L-T_(4) were increased slowly after 13 weeks of pregnancy.In the third trimester(≥29 weeks),the dose was 76.69%higher than that before pregnancy.There were significant changes of TSH,FT_(3) and FT_(4) at 6 weeks of postpartum compared with those in the third trimester(TSH:(1.21±1.08)vs(2.99±1.42)mU/L,FT_(3):(5.23±1.07)vs(3.90±0.55)pmol/L,FT_(4):(21.29±4.96)vs(15.37±2.29)pmol/L,t values:-2.48,6.05,5.88,P values:0.017,<0.001,<0.001).Compared with that in the third trimester,the dose of L-T_(4) was decreased significantly at 6 weeks of postpartum(t=-6.85,P<0.001),but doses of L-T_(4) at 6 weeks,3 months an

关 键 词：甲状腺功能亢进症 放射疗法 碘放射性同位素 妊娠 甲状腺功能试验 

分 类 号：R714.256[医药卫生—妇产科学]