Evaluating the progression to abnormal thyrotropin in euthyroid preconception women: a population-based study.

IF 1.9 Q3 ENDOCRINOLOGY & METABOLISM Thyroid Research Pub Date : 2024-03-11 DOI:10.1186/s13044-024-00192-w
Rili Gao, Xinyi Lyu, Ying Yang, Jinrong Fu, Chuanyu Zhao, Haixia Guan, Xu Ma
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引用次数: 0

Abstract

Background: Abnormal preconception thyrotropin levels were associated with fecundability and adverse fetomaternal outcomes, however, little is known regarding the natural change of serum thyrotropin in euthyroid preconception women. Thus, we performed a population-based study to evaluate the progression to abnormal thyrotropin in euthyroid preconception women.

Methods: This retrospective cohort study used data from the National Free Prepregnancy Checkups Project (NFPCP) collected between 2010 and 2020. Female Han Chinese participants aged 20-49 years who had two repeated NFPCP participations with a time interval of 1.5-3.0 years, confirmed non-pregnant status within this duration, and normal thyrotropin levels during their first participation were included for the analysis of thyrotropin abnormalities during the second NFPCP examination. Data were analyzed between June 1 and October 1, 2023.

Results: This study included 186,095 euthyroid women of reproductive age (mean ± SD, 26.72 ± 4.70 years) whose preconception thyrotropin levels were between 0.37 and 4.87 mIU/L. The median follow-up time was 2.13 (IQR, 1.85-2.54) years. A total of 8,497 (4.57%) women developed abnormal thyrotropin, including 4,118 (2.21%) subnormal thyrotropin and 4,379 (2.35%) supranormal thyrotropin. Compared with the reference group (thyrotropin 1.01-2.00 mIU/L), the lower baseline thyrotropin group had greater risk of developing subnormal thyrotropin, and the higher baseline thyrotropin group had greater risk of developing supranormal thyrotropin. Moreover, the restricted cubic spline analysis revealed a U-shaped dose-response association of baseline thyrotropin levels or thyrotropin multiples of the median (MOM) levels against risk of subnormal thyrotropin in the follow-up, and a J-shaped dose-response association against risk of supranormal thyrotropin levels in the follow-up. We further found that baseline thyrotropin outside of 1.43-1.93 mIU/L or baseline thyrotropin MOM outside 0.59-1.36 would hava a higher risk of developing of abnormal thyrotropin.

Conclusions: Both low and high baseline thyrotropin were associated with a significantly increased risk of developing abnormal thyrotropin outcomes. The optimal preconception baseline thyrotropin levels may be between 1.43 mIU/L and 1.93 mIU/L or baseline thyrotropin MoM between 0.59 and 1.36 to minimize progression toward abnormal thyrotropin after 1.5-3.0 years. These findings may help with counseling of preconception thyroid function monitoring.

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评估甲状腺功能正常的孕前妇女甲状腺素异常的进展情况:一项基于人群的研究。
背景:孕前甲状腺素水平异常与受孕率和不良的胎儿-产妇结局有关,但人们对甲状腺功能正常的孕前妇女血清甲状腺素的自然变化知之甚少。因此,我们进行了一项基于人群的研究,以评估甲状腺功能正常的孕前妇女甲状腺素异常的进展情况:这项回顾性队列研究使用了 2010 年至 2020 年间收集的国家免费孕前检查项目(NFPCP)数据。研究纳入了年龄在20-49岁之间、两次重复参加国家免费孕前优生健康检查且间隔时间在1.5-3.0年之间、在此期间确认未孕且在第一次参加时甲状腺素水平正常的汉族女性参与者,以分析她们在第二次参加国家免费孕前优生健康检查时的甲状腺素异常情况。数据分析时间为 2023 年 6 月 1 日至 10 月 1 日:该研究共纳入了 186,095 名甲状腺功能正常的育龄妇女(平均 ± SD,26.72 ± 4.70 岁),她们的孕前促甲状腺素水平在 0.37 至 4.87 mIU/L 之间。随访时间中位数为 2.13 年(IQR,1.85-2.54)。共有8,497名(4.57%)妇女出现甲状腺素异常,其中4,118名(2.21%)妇女甲状腺素亚正常,4,379名(2.35%)妇女甲状腺素超常。与参照组(甲状腺素 1.01-2.00 mIU/L)相比,基线甲状腺素较低的一组出现甲状腺素亚正常的风险更高,而基线甲状腺素较高的一组出现甲状腺素超常的风险更高。此外,限制性立方样条分析显示,基线甲状腺素水平或甲状腺素中位数倍数(MOM)水平与随访期间甲状腺素亚正常风险呈 "U "形剂量-反应关系,而与随访期间甲状腺素超正常风险呈 "J "形剂量-反应关系。我们还发现,基线甲状腺素在1.43-1.93 mIU/L之外或基线甲状腺素MOM在0.59-1.36之外的人,甲状腺素异常的发病风险较高:结论:甲状腺素基线过低和过高都会显著增加甲状腺素异常的风险。最佳的孕前促甲状腺激素基线水平可能介于 1.43 mIU/L 和 1.93 mIU/L 之间,或基线促甲状腺激素摩尔值介于 0.59 和 1.36 之间,以尽量减少 1.5-3.0 年后促甲状腺激素异常的进展。这些发现可能有助于为孕前甲状腺功能监测提供咨询。
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来源期刊
Thyroid Research
Thyroid Research Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
3.10
自引率
4.50%
发文量
21
审稿时长
8 weeks
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