目的 探讨妊娠早期甲状腺功能(甲状腺功能)异常的筛查方案, 制定北京市海淀区妊娠早期特异性血清TSH正常参考值。方法 (1)2011-10至2012-10在武警总医院就诊的妊娠早期(8～12周)单胎孕妇1400例, 年龄18～35岁, 测定血清TSH水平, 对TSH>2.5 mU/L者, 测FT₃、FT₄、TPOAb、TGAb;对TSH<0.1 mU/L者, 测FT₃、FT₄、TRAb, 按ATA指南标准统计甲状腺功能异常的发病率。(2)随机选取无甲状腺疾病病史、无甲状腺疾病家族史, 无其他自身免疫性疾病史的妊娠早期(8～12周)的单胎孕妇360例, 测定血清TSH、TPOAb、TGAb, 排除TPOAb、TGAb阳性病例, 制定北京市海淀区妊娠早期TSH的95%正常参考值, 并按此标准统计甲状腺功能减退症(甲减)的发病率。结果 (1)1400例孕妇中, 妊娠期甲减发病率为9.0%, 其中亚临床甲减和临床甲减分别为7.36%和1.64%;在妊娠期甲减患者中, 存在桥本甲状腺炎者46.03%;妊娠期甲状腺毒症发病率为3.5%, 其中亚临床甲状腺功能亢进症(甲亢)和临床甲亢分别为3.14%和0.36%;在妊娠期甲状腺毒症中, 妊娠甲亢综合征(gestational hyperthyroidism syndrome, GHS)占94%, 妊娠Graves占6%。(2) 360例孕妇去除56例TPOAb、TGAb阳性病例, 剩余304例抗体阴性孕妇, 计算妊娠早期血清TSH的95%正常参考值为0.1～3.6 mU/L;按TSH 0.1～3.6 mU/L计算, 则1400例孕妇中亚临床甲减发病率为3.86%。结论 妊娠期甲减的主要病因是桥本甲状腺炎, 妊娠甲状腺毒症中大部分为GHS。妊娠早期孕妇常规检测TSH, 并以本地区妊娠特异性TSH参考值为准, 对TSH异常者进一步检查FT₃、FT₄及甲状腺自身抗体, 是一项经济、有效的妊娠期甲状腺疾病筛查方法。

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.