反覆流產之病患需篩檢是否輕微甲狀腺低下

反覆流產之病患需篩檢是否輕微甲狀腺低下([TSH] >2.5 mIU/L with a normal free thyroxine or free thyroxine index)

高達19%是因為輕微甲狀腺低下引發反覆流產

http://www.sciencedirect.com/science/article/pii/S0015028213027611

Impact of subclinical hypothyroidism in women with recurrent early pregnancy loss

• Lia A. Bernardi, M.D.^a, b, 
• Ronald N. Cohen, M.D.^c, 
• Mary D. Stephenson, M.D., M.Sc.^a, b, , 

• ^a University of Chicago Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
• ^b Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois
• ^c Department of Internal Medicine, University of Chicago, Chicago, Illinois

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Objective

To assess the impact of subclinical hypothyroidism (SCH) in women with recurrent early pregnancy loss (REPL).

Design

Observational cohort study.

Setting

REPL program in an academic medical center.

Patient(s)

286 women with a history of ≥2 pregnancy losses <10 weeks.

Intervention(s)

From 2004–2007, no treatment for women with SCH (thyroid-stimulating hormone [TSH] >2.5 mIU/L with a normal free thyroxine or free thyroxine index); from 2008 onward, levothyroxine treatment prepregnancy to maintain TSH ≤2.5 mIU/L.

Main Outcome Measure(s)

Live-birth rate (LBR).

Result(s)

The prevalence of SCH was 55 (19%) of 286 in this REPL cohort. The cumulative LBR was 27 (69%) of 39 for women with SCH versus 104 (74%) of 141 for euthyroid women. The per-pregnancy LBR was 34 (49%) of 69 for SCH versus 129 (58%) of 221 for euthyroid women. When the LBR was compared between treated and untreated SCH, the cumulative LBR was 17 (71%) of 24 versus 10 (67%) of 15, respectively. The per-pregnancy LBR for SCH treated versus untreated women was 22 (48%) of 46 versus 12 (52%) of 23, respectively.

Conclusion(s)

Although there was a high prevalence of SCH in the REPL cohort, there was no statistically significant difference in the subsequent live-birth rate when comparing women with SCH and euthyroid women, or treated and untreated SCH.