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在生育治疗前进行甲状腺功能检测:我们是否会同意?
Sade Dunbar1, Rima Dhillon-Smith2, Abha Maheshwari3
1Department of Obstetrics & Gynaecology, University Hospital of the West Indies, Kingston, Jamaica.
Human reproduction (Oxford, England)
|April 25, 2025
概括
亚临床甲状腺功能低下症 (SCH),通常无症状,影响生育能力和怀孕结果. 目前的指导方针在寻求生育治疗的妇女的常规甲状腺查上有所不同,原因是TSH水平建议的差异.
科学领域:
- 内分泌学 在内分泌学.
- 生殖医学 生殖医学
- 妇女健康 妇女健康
背景情况:
- 甲状腺疾病,特别是甲状腺功能低下症,在女性中非常普遍,影响生育能力和怀孕.
- 亚临床甲状腺功能低下症 (SCH),以高甲状腺刺激激素 (TSH) 与正常甲状腺激素水平为特征,通常呈现无症状,但具有不良结果的风险.
- 甲状腺自身免疫 (TAI) 可以与SCH并存,并可能影响其进展,特别是在怀孕期间.
研究的目的:
- 审查当前的话语和关于常规甲状腺功能测试在女性经历不孕症的各种建议.
- 要突出诊断和管理SCH在这个特定的人群的临床指南的不一致性.
主要方法:
- 从主要的国际甲状腺和产科/妇科协会,对现有的临床指南进行文献审查和分析.
- 检查SCH的诊断标准,重点是缺乏对正常TSH上限的共识.
- 讨论这些变异对生育环境中的常规查方案的影响.
主要成果:
- 在知名的卫生组织 (如ATA,ETA,RCOG与NICE,ASRM) 之间,对于不孕期妇女的常规甲状腺查存在显著差异.
- 一些指导方针建议使用或不使用抗体检测进行TSH查,而另一些指导方针则不支持常规检测.
- 缺乏统一的TSH值有助于诊断和治疗不一致.
结论:
- 有一个显著的缺乏对常规的甲状腺功能测试对不育妇女的共识,导致不同的临床实践.
- 预计美国甲状腺协会的更新指南将包括不孕症,并获得国际认可,预计将解决这些差异.
- 澄清查建议对于优化生育结果和管理与亚临床甲状腺功能障碍相关的风险至关重要.
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