CAJ | 학술논문

目的研究妊娠早期甲状腺毒症发病率及妊娠期一过性甲状腺毒症(GTT)与Graves病在甲状腺功能变化情况、妊娠早期临床表现等方面的区别.方法研究对象来自于2011年至2013年参与《妊娠早期妇女碘铁营养缺乏、亚临床甲状腺激素缺乏:筛查与干预》项目的妊娠12周前妇女(8 105名),均在妊娠早期(1 ～12周)进行问卷调查、体格检查并检测血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb)、尿碘及甲状腺超声,甲状腺毒症患者加测血清游离三碘甲状腺原氨酸(FT3)、促甲状腺激素受体抗体(TRAb).对71例GTT患者、32例Graves病患者和与之年龄匹配的219名甲状腺功能正常妊娠妇女(对照组)分别在妊娠中期(13 ～27周)、妊娠晚期(≥28周)进行随访.结果 (1)8 105名妊娠妇女中甲状腺毒症患者共109名,甲状腺毒症发病率为1.34％,GTT和Graves病发病率分别为0.90％和0.44％.(2)Graves病患者出现严重甲状腺功能亢进体征的频率显著高于GTT患者(P＜0.05).GTT和Graves病妊娠早期妇女的甲状腺体积、体重指数与对照组妊娠妇女存在显著差异(P＜0.05).(3)妊娠各期Graves病患者的TSH、FT4、TRAb、TPOAb与GTT患者存在显著差异(P＜0.05).妊娠早期Graves病患者FT3显著高于GTT患者(P＜0.05).Graves病患者在妊娠早、中、晚期TSH、FT4与对照组相比存在显著差异(P＜0.01).GTT患者妊娠早期、中期TSH、FT4与对照组妇女相比存在显著差异(P＜0.01),而妊娠晚期FT4与对照组差异无统计学意义.结论妊娠早期甲状腺毒症以GTT为主,GTT患者甲状腺功能及临床表现与Graves病患者存在显著差异.妊娠中、晚期,GTT患者甲状腺功能均恢复正常,而Graves病患者仍多存在FT4升高,TSH降低.
목적 연구임신조기갑상선독증발병솔급임신기일과성갑상선독증(GTT)여Graves병재갑상선공능변화정황、임신조기림상표현등방면적구별.방법 연구대상래자우2011년지2013년삼여《임신조기부녀전철영양결핍、아림상갑상선격소결핍:사사여간예》항목적임신12주전부녀(8 105명),균재임신조기(1 ～12주)진행문권조사、체격검사병검측혈청촉갑상선격소(TSH)、유리갑상선소(FT4)、갑상선과양화물매항체(TPOAb)、뇨전급갑상선초성,갑상선독증환자가측혈청유리삼전갑상선원안산(FT3)、촉갑상선격소수체항체(TRAb).대71례GTT환자、32례Graves병환자화여지년령필배적219명갑상선공능정상임신부녀(대조조)분별재임신중기(13 ～27주)、임신만기(≥28주)진행수방.결과 (1)8 105명임신부녀중갑상선독증환자공109명,갑상선독증발병솔위1.34％,GTT화Graves병발병솔분별위0.90％화0.44％.(2)Graves병환자출현엄중갑상선공능항진체정적빈솔현저고우GTT환자(P＜0.05).GTT화Graves병임신조기부녀적갑상선체적、체중지수여대조조임신부녀존재현저차이(P＜0.05).(3)임신각기Graves병환자적TSH、FT4、TRAb、TPOAb여GTT환자존재현저차이(P＜0.05).임신조기Graves병환자FT3현저고우GTT환자(P＜0.05).Graves병환자재임신조、중、만기TSH、FT4여대조조상비존재현저차이(P＜0.01).GTT환자임신조기、중기TSH、FT4여대조조부녀상비존재현저차이(P＜0.01),이임신만기FT4여대조조차이무통계학의의.결론 임신조기갑상선독증이GTT위주,GTT환자갑상선공능급림상표현여Graves병환자존재현저차이.임신중、만기,GTT환자갑상선공능균회복정상,이Graves병환자잉다존재FT4승고,TSH강저.
Objective To study the incidence of maternal thyrotoxicosis in the first trimester and compare thyroid function,clinical manifestations in the first trimester between gestational transient thyrotoxicosis (GTT) and Graves' disease.Methods The subjects were selected from 8 105 pregnant women who had participated in the study of "Subclinical Hypothyroid during Early Pregnancy" from 2011 to 2013.All subjects received questionnaires,physical examination,and thyroid stimulating hormone (TSH),free T4 (FT4),thyroid peroxidase antibody (TPOAb),urinary iodine measurement,and thyroid ultrasonography during the first trimester (1-12 weeks).Patients with thyrotoxicosis were measured for free T3 (FT3) and thyrotropin receptor antibody (TRAb).71 patients with GTT,32 patients with Graves' disease,and 219 age-matched pregnant women with normal thyroid function in the control group have been followed up during the second trimester(13-27 weeks) and the third trimester(≥28 weeks).Results (1) The incidences of maternal thyrotoxicosis in the first trimester was 1.34％.GTT 0.90％,and Graves' disease 0.44％.(2) The frequency of severe hyperthyroidism signs of patients with Graves' disease was significantly higher than that of patients with GTT(P＜0.05).There were significant difference of body mass index and thyroid volume between GTT or patients with Graves' disease and control group.The thyroid volume and body mass index of patients with GTT and patients with Graves' disease were significantly different with that of control group (P＜0.01).(3) TSH of patients with Graves' disease was significantly lower than that of patients with GTT during pregnancy,while FT4,TRAb,TPOAb of patients with Graves' disease were significantly higher than that of patients with GTT during pregnancy(P＜0.01).FT3 of patients with Graves' disease was significantly higher than that of patients with GTT during the first trimester(P＜0.05).TSH and FT4 of patients with Graves' disease had significantly statistical difference with those of control group during pregnancy (P＜0.01).TSH and FT4 of patients with GTT had significantly statistical difference with those of control group during the first trimester and the second trimester(P＜0.01),but TSH of patients with GTT was significantly lower than that of control group (P＜0.05),and FT4 of patients with GTT had no significantly statistical difference with that of control group during the third trimester.Conclusions GTT is the main causes of thyrotoxicosis in the first trimester.The thyroid function and clinical symptoms of GTT patients and Graves' disease were significant different.During the second and third trimesters the thyroid function of GTT patients returned to normal,but still,most of patients with Graves' disease had increased FT4 and decreased TSH.