The incidence of subclinical hypothyroidism and its effect on pregnancy outcomeunder different diagnostic criteria
不同诊断标准下亚临床甲状腺功能减退症发病率及对妊娠结局的影响

摘要

目的 探析不同诊断标准下亚临床甲状腺功能减退症（SCH）发病率及对妊娠结局的影响。方法 2023年1月~2024年1月，取我院产科门诊4310例建档孕妇，以国内2012年拟定的相关标准，创建本地不同孕期TSH（促甲状腺激素）参考范围，国内标准组（以TSH的95%为上限），即FT4（血清游离甲状腺素）正常、TSH>5.360mIU/L的妊娠伴亚甲减孕妇；分别对比美国ATA（甲状腺学会）2011年、2017年推荐标准，对妊娠期发生亚甲减几率的影响展开分析，探究诊断不同标准影响妊娠结局情况。结果 国外旧标准组共计700例亚甲减孕妇，占比16.24%，国内标准组共计104例，占比2.41%，组间发生亚甲减几率（P<0.05）。国外标准组共计146例亚甲减孕妇，占比3.39%，对比国内标准组（P>0.05）。对比对照组，国外新标准、国内标准组（P<0.05），而国外旧标准组（P>0.05）。结论 妊娠期孕妇发生亚甲减的几率较高，可增加妊娠不良结局；以2012年我国标准，诊断标准取本地区参考区间与本地区地域特点更为适合，也与新国际2017年诊断标准符合，以免治疗过度，可减少妊娠不良结局决，以国际旧诊断标准对亚甲减实施诊断，管理太过宽泛，患者心理压力、经济负担增加，于孕期管理不利。

Abstract

Objective To investigate the incidence of subclinical hypothyroidism (SCH) and its influence on pregnancy outcome under different diagnostic criteria.
Methods From January 2023 to January 2024, 4310 pregnant women enrolled in the obstetric outpatient department of our hospital were selected, and the local reference range of TSH (thyroid stimulating hormone) during different pregnancy was established according to the relevant standards formulated in 2012 in China, and the domestic standard group (with 95% of TSH as the upper limit). That is, pregnant women with subhypothyroidism with normal FT4 (serum free thyroxine) and TSH>5.360mIU/L; Compared with the American ATA (Thyroid Society) recommended standards in 2011 and 2017, the influence of the incidence of subthyroidism during pregnancy was analyzed, and the influence of different diagnostic criteria on pregnancy outcomes was explored.
Results There were 700 cases of subhypothyroidism in the old standard group abroad, accounting for 16.24%, and 104 cases in the domestic standard group, accounting for 2.41%. The incidence of subhypothyroidism between groups was P<0.05. There were 146 pregnant women with subhypothyroidism in the foreign standard group, accounting for 3.39%, compared with the domestic standard group (P>0.05). Compared with the control group, the foreign new standard group, the domestic standard group (P<0.05), and the foreign old standard group (P>0.05).
Conclusion   The incidence of subhypothyroidism in pregnant women during pregnancy is higher, which may increase the adverse outcome of pregnancy. According to the 2012 Chinese standard, the diagnostic criteria are more suitable for the regional reference range and the regional characteristics of the region, and are also in line with the new international diagnostic standards in 2017, so as to avoid excessive treatment and reduce adverse pregnancy outcomes. The diagnosis of subthyroidism based on the old international diagnostic standards is too broad, and the psychological pressure and economic burden of patients are increased, which is not conducive to the management of pregnancy.