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Autoimmune thyroid disease during pregnancy.
The Lancet ( IF 168.9 ) Pub Date : 2018-Jul-01 , DOI: 10.1016/s2213-8587(17)30402-3
Simone De Leo , Elizabeth N Pearce

Understanding of changes in thyroid function and the consequences of thyroid disease during pregnancy has rapidly grown in the past two decades, and revised American Thyroid Association guidelines on this topic were published in 2017. This Review explores the association between thyroid autoimmunity and complications during and after pregnancy. Thyroid autoimmunity refers to the presence of antibodies to thyroperoxidase or thyroglobulin, or thyroid-stimulating hormone receptor antibodies (TRAbs), or a combination of these, and is present in up to 18% of pregnant women. Thyroid antibodies in pregnant women with normal functioning thyroids (ie, euthyroid) have been associated with several complications, including miscarriage and premature delivery. Treatments to improve pregnancy outcomes are being studied. Whether thyroid antibodies are associated with infertility and assisted reproductive technology outcomes is unclear; although, treatment with low doses of levothyroxine, which is usually used to treat hypothyroidism, can be considered in such situations. Additionally, thyroid antibodies have been associated with other neonatal and maternal complications. All these associations require confirmation in larger prospective studies, and their pathogenic mechanisms need to be better understood. Post-partum thyroiditis is substantially more frequent in women who have thyroid antibodies during pregnancy than in those who do not have thyroid antibodies; however, whether treatment can prevent post-partum thyroiditis in women who are or have been antibody positive is unknown. Finally, TRAbs cross the placenta from the mother to the fetus and can cause fetal or neonatal hyperthyroidism. Therefore, women who are positive for TRAbs during pregnancy should be monitored.

中文翻译:

妊娠期间自身免疫性甲状腺疾病。

在过去的二十年中,对甲状腺功能变化和怀孕期间甲状腺疾病后果的了解迅速增长,有关该主题的美国甲状腺协会修订指南于2017年发布。该综述探讨了甲状腺自身免疫与并发症期间和之后的并发症之间的关系。怀孕。甲状腺自身免疫是指存在针对甲状腺过氧化物酶或甲状腺球蛋白的抗体,或促甲状腺激素受体抗体(TRAbs)或它们的组合,并且存在于多达18%的孕妇中。甲状腺功能正常的孕妇(即正常甲状腺)的甲状腺抗体与多种并发症有关,包括流产和早产。正在研究改善妊娠结局的疗法。尚不清楚甲状腺抗体是否与不孕症和辅助生殖技术结局有关;不过,在这种情况下,可以考虑使用通常用于治疗甲状腺功能减退的低剂量左甲状腺素治疗。另外,甲状腺抗体已与其他新生儿和产妇并发症相关。所有这些关联都需要在更大的前瞻性研究中得到证实,并且它们的致病机制需要更好地理解。与没有甲状腺抗体的妇女相比,怀孕期间具有甲状腺抗体的妇女的产后甲状腺炎的发生率要高得多。但是,对于抗体阳性或曾经抗体阳性的妇女,治疗是否可以预防产后甲状腺炎尚不清楚。最后,TRAbs从母亲到胎儿穿过胎盘,可引起胎儿或新生儿甲亢。因此,应监测怀孕期间TRAb阳性的妇女。
更新日期:2018-06-20
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