한국여성에서 임신 초기 갑상선기능의 평가 = Maternal Thyroid Function during the First Trimester of Pregnancy in Korean Women

다국어 초록 (Multilingual Abstract)

Background and Objectives: Thyroid dysfunction during pregnancy can result in many complications for both mother and infant. Due to the physiologic changes in thyroid stimulating hormone (TSH) level during early pregnancy, it is recommend to use trimester-specific reference ranges for every population. We obtained the reference range of TSH during the first trimester in Korean women according to gestational week. Materials and Methods: The study population consisted of pregnant women who had undergone a TSH screening during the first trimester of pregnancy (n=8365) and nonpregnant women (n=1835). Results: Median concentration of serum TSH decreased significantly from the 5th to 8th week of gestation (median TSH concentration: 2.00 mIU/L for 5 weeks; 1.70 mIU/L for 6 weeks; 1.40 mIU/L for 7 weeks; 1.05 mIU/L for 8 weeks). However, there was no significant difference in median concentration of serum TSH from the 8th to 12th weeks of gestation. Using the fixed cut-off value of TSH ＞3.66 mIU/L, the diagnosis rate of subclinical hypothyroidism was 15.0% for 5 weeks, 10.0% for 6 weeks, 5.9% for 7 weeks, and 3.6% for 8-12 weeks. Conclusion: When interpreting the TSH test for pregnancy (maternal thyroid function), we should consider that the TSH level decreases significantly during the early first trimester.

참고문헌 (Reference)

1 Negro R, "Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy" 95 (95): 1699-1707, 2010

2 Horacek J, "Universal screening detects two-times more thyroid disorders in early pregnancy than targeted high-risk case finding" 163 (163): 645-650, 2010

3 Glinoer D., "Thyroid hyperfunction during pregnancy" 8 (8): 859-864, 1998

4 Medici M, "Thyroid function in pregnancy: what is normal?" 61 (61): 704-713, 2015

5 Casey BM, "Thyroid disease in pregnancy" 108 (108): 1283-1292, 2006

6 Glinoer D, "The regulation of thyroid function in pregnancy:pathways of endocrine adaptation from physiology to pathology" 18 (18): 404-433, 1997

7 Maraka S, "Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis" 26 (26): 580-590, 2016

8 Casey BM, "Subclinical hypothyroidism and pregnancy outcomes" 105 (105): 239-245, 2005

9 Rosario PW, "Should pregnant women older than 30 years without risk factors be investigated for thyroid dysfunction?" 22 (22): 445-446, 2012

10 Glinoer D, "Serum TSH determinations in pregnancy: how, when and why?" 6 (6): 526-529, 2010

11 McNeil AR, "Reporting thyroid function tests in pregnancy" 36 (36): 109-126, 2015

12 Zhang X, "Reference intervals of thyroid function during pregnancy:self-sequential longitudinal study versus cross-sectional study" 26 (26): 1786-1793, 2016

13 Klein RZ, "Prevalence of thyroid deficiency in pregnant women" 35 (35): 41-46, 1991

14 Ballabio M, "Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid" 73 (73): 824-831, 1991

15 Stagnaro-Green A., "Postpartum management of women begun on levothyroxine during pregnancy" 6 : 183-, 2015

16 Stagnaro-Green A., "Overt hyperthyroidism and hypothyroidism during pregnancy" 54 (54): 478-487, 2011

17 Blatt AJ, "National status of testing for hypothyroidism during pregnancy and postpartum" 97 (97): 777-784, 2012

18 Su PY, "Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China" 96 (96): 3234-3241, 2011

19 De Groot L, "Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline" 97 (97): 2543-2565, 2012

20 Alexander EK, "Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum" 27 (27): 315-389, 2017

21 Stagnaro-Green A, "Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum" 21 (21): 1081-1125, 2011

22 김혜성, "Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy" 대한의학회 30 (30): 1308-1312, 2015

23 Laurberg P, "Dynamics and predictors of serum TSH and fT4 reference limits in early pregnancy: a study within the Danish National Birth Cohort" 101 (101): 2484-2492, 2016

24 Vaidya B, "Detection of thyroid dysfunction in early pregnancy: Universal screening or targeted high-risk case finding?" 92 (92): 203-207, 2007

25 Li C, "Assessment of thyroid function during first-trimester pregnancy:what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women?" 99 (99): 73-79, 2014

26 Bryant SN, "An analysis of population-based prenatal screening for overt hypothyroidism" 213 (213): 565 e1-565 e6, 2015

27 Li Y, "Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30months" 72 (72): 825-829, 2010

28 Lazarus J, "2014 European Thyroid Association guidelines for the management of subclinical hypothyroidism in pregnancy and in children" 3 (3): 76-94, 2014