The Effects Of The Remedy For Subclinical Hypothyroidism During Pregnancy On The Fetus And Their Mothers

Objective： Cure those who were screened out of subclinical hypothyroidism duringpregnancy with sinistral thyroxine to select the effects of the intervention on sugar metabolismand pregnancy outcomes.Methods:(1)To Select those pregnant women who have antenatal care in shenzhen people’shospital during2009.4-2013.2and eligible for screening before the20week.The patients whoseinitial screening TSH>2.5mIU/L or <0.1mIU/L were reviewed at once and taken furthermeasurement of TT4、TT3、FT4、FT3and TPOAb、TRAb. Make a statistical analysis of TSHscreening results and maternal age、gestational age and fasting blood-glucose.（SPSS13.0software）(2)In the results of the review，if those whose2.5mIU/L>TSH>0.1mIU/L and thefurther measurement were normal were divide as the control group. if those whose10mIU/L>TSH>2.5mIU/L，TT4、TT3、FT4、FT3normal and no whether combined with TPOAbpostive were diagnosised as subclinical hypothyroidism. Other types of thyroid dysfunction weretransferred to endocrine clinic.(3)The patients whose were diagnosised as subclinicalhypothyroidistm were given L-thyroxine tablets(L-T4) therapy and divide as the experimentalgroup. If TSH>2.5mIU/L, the patients were initiated treatment with an initial dose of50μg/d; IfTSH>8.0mIU/L, the patients were initiated treatment with an initial dose of75μg/d. The patientswho combined with TPOAb unormal were added25μg/d to the conventional therapy. Thepatients were reviewed once every two weeks ante partum.(4)The experimental group werepaied a return visit by telephone for their treatments. According to the treatment situation, todivide them as the no regular treatment group(including irregular cure, etc),the treatment ofcompliance with the standard group,the treatment of compliance without the standard group.(5)Compare the pregnancy OGTT results of the experimental group and the control group.Compare the OGTT results between the three groups(the no regular treatment group, thetreatment of compliance with the standard group, the treatment of compliance without thestandard group). Use repeated measures design analysis of variance.(6)Compare the pregnancyoutcomes between the experimental group and the control group. SPSS13.0software was usedfor statistical analysis(Measurement data with two independent sample t test; Count data by chi-square test)Results:(1)10323pregnant women were undergoing the early screening of thyroidfunction.The number in the early stages of pregnancy(13+6weeks or less) is2836，the numberof initial TSH abnormal among them is718. The number in mid stage of pregnancy (14~20weeks) is7487，the number of initial TSH abnormal among them is1625. The initial screeningTSH value（1.85±1.65mU/L） in mid stage of pregnancy is higher than（1.28±1.086mU/L）inthe early stages of pregnancy（P<0.05）.(2)In the types of thyroid dysfunction in Pregnancy, thesubclinical hypothyroidism is the main type（4.11%）,which is higher in mid stage of pregnancy（4.54%） than in the early stages of pregnancy（3.0%，P<0.05）.Thyrotoaricosis is inferior tothe front（0.80%）. All kinds of thyroid function abnormalities are combined with TPOAbpositive easily. Clinical hypothyroidism combined with TPOAb positive（60.2%） is morecommon than Subclinical hypothyroidism（32.3%）.(3) It is no relationship between initialscreening TSH and fasting glucose（P>0.05）.(4) OGTT1hours of blood sugar（7.86±2.17mmol/L）of the experimental group is higher than the control group（7.48±1.44mmol/L）(P <0.05).(5)In the experimental group，if the three groups(the no regular treatment group, thetreatment of compliance with the standard group, the treatment of compliance without thestandard group) use TSH=2.5mIU/L as the Standard treatment, the second group is more proneto have OGTT1h,2h results higher than the others（P<0.05）. While the TSH=3.0mIU/L as theStandard treatment,there is no different between them（P>0.05）.(6) The incidence ofPreeclampsia,Hypohemia, Fetal growth restriction, cesarean delivery of the experimental groupis higher than the control group（P<0.05). The incidence of Preterm birth, cholestasis disease,gestational diabetes (GDM), fetal intrauterine distress is no different between the experimentalgroup and the control group（P>0.05）.(7)The incidence of postpartum blood loss, postpartumblood pressure; postpartum diastolic pressure and birth weight, Apgar score is no differentbetween the experimental group and the control group（P>0.05）.Conclusions:(1)All kinds of thyroid dysfunction during pregnancy is given priority to thesubclinical hypothyroidism, and which in the mid pregnancy is higher than which in the earlypregnancy, that prompt that thyroid function screening during pregnancy is of great significance. Due to the high incidence of positive TPOAb, monitoring of pregnancy should be strengthened.(2)Those pregnancy women whose were diagnosised as subclinical hypothyroidistm after beengiven L-thyroxine tablets(L-T4) therapy is more prone to have the higher1hour blood glucosein the OGTT results than the normal ones. It is prompt a further discuss of the therapeuticschedule of Subclinical hypothyroidism during gestation period.(3)The pregnancy women withthe subclinical hypothyroidism which had the TSH control <2.5mIU/L is prone to have1h and2h higher OGTT result than the others. While as the Standard treatment as3.0mIU/L, there is nodifferent between them It is nessary to establish specific thyroid hormone normal rang indifferent term.(4)Due to the incidence of Preeclampsia,Hypohemia, Fetal growth restriction andcesarean delivery of those pregnancy women whose were diagnosised as subclinicalhypothyroidistm before being given L-thyroxine tablets(L-T4) as the therapy is higher than thenormal ones, it is prompt that thyroid hormone deficiency may not be the main factors that affectthose abnormal occurs.(5)Due to the incidence of postpartum blood loss, postpartum bloodpressure; postpartum diastolic pressure and birth weight, score is no different between thosewomen, it is prompt that treatment of subclinical hypothyroidism during pregnancy is of positivemeaning.