Discussion On The Relationship Between Subclinical Hypothyroidism And Simple Hypothyroidemia With Negative TPO-Ab In The Range Of Accurate Reference Value And Adverse Pregnancy Outcome

Objective: To test the thyroid function of pregnant women during regular checkups in our hospital,including total triiodothyronine(TT3),total thyroxine(TT4),thyrotropin(TSH),and free triiodothyronine Acid(FT3),free thyroxine(FT4),and thyroid peroxidase antibody(TPOAb)levels,analyze and further refine the grouping,screen out the most valuable detection indicators,and establish precise and specific thyroid glands in women at all stages of pregnancy Function reference range.To investigate the subclinical value of thyroid peroxidase antibody(TPO-Ab)negative in the second trimester(12-28 weeks)and third trimester(?28 weeks)of pregnancy under the precise reference range of thyroid function during pregnancy.Relationship between Hypothyroidism and Hypothyroxinemia and Adverse Pregnancy Outcomes.Method: According to the value of the conventional reference value range stipulated in the 2017 ATA guidelines,after excluding the influencing factors,a total of 1212 pregnant women in 2018 were included,which were divided into 403 cases in the first stage of pregnancy(T1 stage)and 403 cases in the second stage of pregnancy(T2 stage))409 cases,400 cases in the third stage of pregnancy(T3 stage),the reference value range of thyroid function in each stage of pregnancy was obtained,and the various indicators were analyzed to screen out the valuable detection indexes TSH and FT4;further research was conducted from 2016 to 2018 The TSH and FT4 levels in the blood of 1,219 pregnant women who came to our hospital for prenatal examination during the first trimester of pregnancy,and clarified the changes in TSH and FT4 during different gestational weeks.The first trimester was divided into T1-A stages.(<7 weeks)and T1-B(?7 weeks),the precise reference value range of thyroid function during pregnancy was established.On the basis of the above,a retrospective analysis of the blood thyroid hormone levels of 19,884 pregnant women who came to our hospital for prenatal examination from 2016 to 2018,excluded the relevant influencing factors,and the detection indicators were TPOAb positive Patients,according to the range of thyroid hormone specific reference values during pregnancy in this hospital,women in the first and second trimesters of pregnancy were divided into normal thyroid function group and simple hypothyroxinemia group(IMH),TPO-Ab negative subclinical hypothyroidismgroup(SCH / TPO-),and then analyze and compare the incidence of adverse pregnancy outcomes in different groups.Results: The accurate reference values for TSH during pregnancy are 0.44-4.35 mIU / L,0.07-3.63 mIU / L,0.48-3.91 mIU / L,and 0.42-for T1-A,T1-B,T2,and T3,respectively.4.33 mIU / L and FT4 are 7.02-11.75 ng / L,6.73-21.13 ng / L,5.09-8.03 ng / L and 5.15-8.32 ng / L respectively;under the precise range of thyroid function during pregnancy,in pregnancy TPO-Ab-negative subclinical hypothyroidism in the second and third trimesters has no significant difference in adverse pregnancy outcomes between pregnant women and fetuses compared with the normal group(P> 0.05);Incidence of gestational diabetes mellitus(GDM)was significantly higher than that of the normal group and TPO-Ab negative subclinical hypothyroidism(P < 0.05);postpartum hemorrhage and premature rupture of membranes occurred in simple hypothyroxin in the second trimester The incidence rate was significantly higher than that of the normal group and TPO-Ab negative subclinical hypothyroidism group during the same pregnancy period(P <0.05).Conclusion: It is necessary to establish a precise reference range of thyroid function during pregnancy.In the first trimester,accurate grouping is performed with the 7th week of pregnancy as the boundary,and then TSH and FT4 are selected as two indicators to formulate a precise range of thyroid function-specific reference values during pregnancy.Helping clinicians to understand the status of thyroid function during pregnancy has a very positive significance in guiding clinical work properly.There was no significant correlation between TPO-Ab negative subclinical hypothyroidism and adverse pregnancy outcomes in the second or third trimester of pregnancy;independent hypothyroxinemia and GDM in the second or third trimester of pregnancy Closely related,and suggest that hypothyroidism and GDM may be related to low FT4 rather than high TSH;independent hypothyroxinemia in the second stage of pregnancy is also related to large children,postpartum hemorrhage and premature rupture of membranes.These adverse pregnancy outcomes exist independently of each other.