Variation researches of thyroid hormone therapy for patients with hypothyroidism before, during pregnancy and postpartum / 中国综合临床

ABSTRACT

Objective To investigate the variation of thyroid hormone therapy in patients with hypothyroidism before,during and postpartum pregnancy.Methods Thirty-eight patients who suffered from hypothyroidism and had successful pregnancy were collected.Among them,15 cases of hypothyroidism were caused by autoimmune thyroiditis caused,11 cases were induced by thyroid surgery; in 131I treatment induced hypothyroidism were 5 cases,7 patients had unclear reason pregnancy clinical thyroid dysfunctions.Thirty-eight cases of non-pregnant patients with hypothyroidism were also collected as the control group.They achieved efficacy standards by levothyroxine (L-T4) treatment and dose variation of L-T4 was statistically analyzed.Results There was a significant difference before pregnancy,postpartum and different periods of pregnancy.L-T4 dose had a significant increase after pregnancy.At 10-12 weeks,16-18 weeks,22-24 weeks,26-30 weeks,34-36 weeks respectively,L-T4 dose was significantly increasing compared with before pregnancy and postpartum 3 months((110.51 ± 10.42),(113.81 ± 21.04),(108.32 ± 21.01),(105.58 ±21.54),(105.89±10.24),(84.42 ±10.45) and (86.43 ±10.29) μg/L,F=15.631,P＜0.001),but between before and pregnancy postpartum,there was not significantly difference (P ＞ 0.05).Among the various stages of pregnancy,there was also no significant difference; In the patients with hypothyroidism due to thyroid surgery and 131I therapy,L-T4 dose were significantly higher than autoimmune thyroiditis and patients with no clear reason(before,during and after pregnancy,F =4.98,5.15,5.04,P ＜ 0.001).Conclusion Patients with hypothyroidism during pregnancy should increased therapeutic dose of thyroid hormone with average about 30％-40％ of the original dose,and in postpartum,levels before pregnancy could resume.High doses of L-T4 treatment should be taken in patients with hypothyroidism after 131I therapy and after thyroid surgeries.