A screening program for thyroid disease during early pregnancy in Haidian district in Beijing
XIA Yixin1, ZHENG Ying2, XU Chun2, LIU Hong1, SHEN Liyan1
1.Obstetrics and Gynecology Department, 2. Department of Endocrinology, General Hospital of Chinese People’s Armed Police Forces, Beijing 100039, China
Abstract：Objective To study the screening program of thyroid dysfunction during early pregnancy and develop an specific thyroid-stimulating hormone normal reference value during early pregnancy in Beijing. Methods One thousand four hundred cases of single-birth women were enrolled in this study between October 2011 and October 2012.Their age ranged from 18 to 35 years old and all of them were given a regular prenatal check in in the Armed Police General Hospital. By detecting the levels of thyroid stimulating hormone (TSH), we established two reference values as follows 1) TSH concentrations greater than 2.5 mU/L 2) TSH concentrations less than 0.1mU/L, for the group one we detected free thyroxine (FT3、FT4), TGAb and TPOAb, and detected free thyroxine (FT3、FT4)、TRAb for the group two .The incidences of thyroid dysfunction were calculated according to ATA treatment guideline.Additionally, 360 single-birth women during early pregnancy, (8-12 weeks) without a history of thyroid disease, family history of thyroid disease, no history of other autoimmune diseases were selected to detect the levels of thyroid stimulating hormone (TSH), TGAb and TPOAb, and those women who were positive for TPOAb and TGAb were excluded. Early pregnancy TSH normal reference value of 95% confidence interval in Beijing, and statistical incidence of hypothyroidism were developed according to this standard. Results (1)The incidence of hypothyroidism in the 1400 cases was 9.0%, of which pregnancy subclinical hypothyroidism and pregnancy clinical hypothyroidism were 7.36% and 1.64%, respectively. In patients with hypothyroidism during pregnancy, the incidence of Hashimoto’s thyroiditis accounted for 46.03%; the incidence of gestational thyrotoxicosis was 3.5%, of which clinical hyperthyroidism and subclinical hyperthyroidism constituted 3.14% and 0.36%, respectively.In gestational thyrotoxicosis, pregnancy with hyperthyroidism syndrome (GHS) accounted for 94%, pregnancy Graves disease accounted for 6%. (2)56 women who were positive for TPOAb and TGAb were excluded in the 360 pregnant women, the 95% normal serum TSH reference value of the remaining 304 pregnant women with negative antibody in early pregnancy was 0.1-3.6 mU/L; according to the standard TSH 0.1-3.6 mU/L .the incidence rate of subclinical hypothyroidism in the 1400 pregnant women was, 3.86%. Conclusions The incidences of hypothyroidism and thyrotoxicosis are high in early pregnancy and mostly subclinical. The main cause of hypothyroidism during pregnancy is Hashimoto’s thyroiditis. Most of thyrotoxicosis in pregnancy is GHS. TSH routine testing of pregnant women in early pregnancy, and further detecting free thyroxine (FT3、FT4) and thyroid autoantibodies if TSH is abnormal according to specific TSH reference values of pregnancy is an economical and effective screening method for thyroid disease during pregnancy.
夏义欣, 郑莹, 徐春, 刘红, 申利燕. 北京市海淀区妊娠早期甲状腺疾病筛查方案探讨[J]. 武警医学, 2015, 26(1): 26-28.
XIA Yixin, ZHENG Ying, XU Chun, LIU Hong, SHEN Liyan. A screening program for thyroid disease during early pregnancy in Haidian district in Beijing. Med. J. Chin. Peop. Armed Poli. Forc., 2015, 26(1): 26-28.
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Stricker R T, Echenard M, Ebehart R, et al.Evaluation of maternal thyroid function during pregnancy:the importance of using gestional age-specific referance intervals[J].Eur J Endocrinol, 2007, 157:509-514.
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Larsen T M.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J].Thyroid, 2011, 21:1081-1125.
Gilbert R M, Hadlow N C.Assessment of thyroid function during pregnancy:first-trimester(weeks9-13)reference intervals derived from Western Australian women[J].Med J Aust, 2009, 190(4):219-220.
[5]
Larsen T M.Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J].Thyroid, 2011, 21:1081-1125.
2015, Vol. 26 
