| Hypothyroidism is a common endocrine disease, thyroid hormone deficiency can affect the fetal nervous system and mental development, result in serious obstetric complications, impact seriously on human health and quality of life. Domestic and foreign study found that patients with hypothyroidism during pregnancy need to increase dose of thyroid hormone replacement therapy,now it has no detailed study about changes in thyroid hormone replacement therapy dose,so the treatment in patients with hypothyroidism during pregnancy is very meaningful.Objective:To study patients with hypothyroidism the regularity for change of thyroid hormone therapy dose before pregnancy,different stages of pregnancy,after delivery and different causes of hypothyroidism during pregnancy, provide evidence for treatment and reduce the incidence of hypothyroidism in patients with pregnancy complications and improve quality of life of the mother and fetus.Materials and methods:1. The subjects : Choose 38 non-pregnant female patients with hypothyroidism in outpatient department and inpatient of our hospital who apply thyroid hormone replacement therapy as the control group (including post-thyroiditis hypothyroidism 18 cases,hypothyroidism after thyroid surgery 10 cases, hypothyroidism after 131I treatment 10 cases) from January 2008 to August 2010, 40 pregnant women with hypothyroidism in endocrin and obstetric outpatient department and inpatient of our hospital who apply thyroid hormone replacement therapy as the observation group over the same period (including 18 cases of post-thyroiditis hypothyroidism,7 cases of hypothyroidism after thyroid surgery, 10 cases of hypothyroidism after 131I treatment), which was divided into three groups according to before pregnancy, during pregnancy(to study dose of levothyroxine in the ninth months of pregnancy) and 4 months after delivery.The age of the control group and observation group rangs from 40 to 60, body mass index (BMI) rangs from 16 to 27kg/m2.2. (1) Criteria of diagnosis:①signs and symptoms of hypothyroidism;②thyroid function tests thyroid stimulating hormone (TSH) increased, accompanied by free T4 (FT4) decreased, total T4 (TT4) normal or mild decline (Seventh Edition of textbook of medicine) (After application of levothyroxine replacement therapy, TSH, FT3, FT4 may become normal). All patients are an adequate supply of iodine, no serious heart and kidney disease affect pregnancy outcome.(2) Observation group cases selected: the group of patients must be met:①taking thyroid hormone replacement therapy,②pregnancy; All selected patients must apply levothyroxine replacement therapy and conceived after their thyroid function was normal for at least six months, pregnancy was determined by gynecologist,all singleton pregnancies,and the final delivery.The observation group cases gestational referenced limits of TSH was 0.3-2.5 mIU/L, before pregnancy and 4 months after delivery normal range of TSH was also 0.3-2.5 mIU / L.(3) Control group of cases selected: The group of patients must be met:①taking thyroid hormone replacement therapy,②non-pregnant female patients. Non-pregnancy was determined by gynecologist, At the end of the visit for six months not pregnant .The range of TSH is 0.3-2.5 mIU / L.3. Observing indexes: TSH, FT3, FT4 and L - T4 dose.4. Statistical methods: SPSS 16.0 statistics software was used for data processing. All measurement data was expressed by mean±standard deviation, mean comparison of multiple groups pairwise analysis use analysis of variance, P value<0.05 was considered to have statistical significance.Results:1. The observation group: L-T4 dose during pregnancy was higher than before pregnancy, there were significant differences between the two groups (p <0.01); L-T4 dose during pregnancy was higher than 4 months after delivery, the difference was statistically significant (p <0.01); L-T4 dose of 4 months after delivery had no significant difference with before pregnancy (p> 0.05).2. The observation group compared with the control group: L-T4 dose of the control group comparing with the observation group before pregnancy and 4 months after delivery has no statistically significance (p> 0.05); L-T4 dose of the observation group during pregnancy was higher than the control group, there were significant differences between the two (p <0.01).3. Different stages during pregnancy of L-T4 dosage compared with before pregnancy: L-T4 dosage of early trimester of pregnancy,mid trimester of pregnancy and late trimester of pregnancy compared with before pregnancy, the difference was statistically significant (p <0.05); Late trimester of pregnancy of L-T4 dosage was higher than early and mid-trimester of pregnancy, mid-trimester of pregnancy was higher than early trimester of pregnancy ,the difference was statistically significant (p <0.05).4. Different reasons with hypothyroidism of L-T4 dose increased percentage during pregnancy and after delivery compared with the dose before pregnancy: L-T4 dose of post-thyroiditis hypothyroidism during pregnancy increased 37.64%, 4 months after delivery increased 2.58%; L-T4 dose of hypothyroidism after 131I treatment during pregnancy increased 45.94%, 4 months after delivery increased 4.70%; L-T4 dose of hypothyroidism after thyroid surgery during pregnancy increased 44.20%, 4 months after delivery increased 1.88%.Conclusions:1. Hypothyroidism during pregnancy in patients with thyroid hormone replacement therapy need to increase the dose, the dose gradually decreased after birth ,4 months after delivery returned to the level before pregnancy.2. Patients with hypothyroidism during pregnancy of thyroid hormon replacement therapy dose comparing with non-pregnant has an increase, hypothyroidism of different reasons have different dose of replacement therapy.3. As gestational weeks increased,thyroid hormon dose was gradually increased, maximum dose is in late trimester of pregnancy,and it increased by approximately 40% than before pregnancy.4. Patients with hypothyroidism during pregnancy need strictly monitor thyroid function, adjust thyroid hormon dosage, which will effectively reduce obstetric complications and fetal abnormalities of the nervous system.
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