The Concentrations Changes Of Serum Thyroid Hormone In Maternal During Pregnancy

ObjectiveThe maternal endocrine system has the particular change during pregnancy. Evaluation of the thyroid function is obviously different with the unpregnancy healthy female.Respecting that the thyroid function is very important to the pregnancy process and the nervous system growth of the embryo, this study was designed to exam the blood serum thyroxin and the TSH levelof the early pregnant women(before 8weeks)and carry on following up in different time point during pregnancy and discuss the variation serum thyroid hormone during pregnancy, provide the clinical basis for the normal value of thyroid hormone concentrations during pregnancy.MethodsScreening objects: Early pregnant women,whose pregnancy is below 8 weeks, without thyroid disease history,and the non-local goiter ward life history, don't have the severe clinical history of present and past.Follow up object: The case group is the pregnant women whoseTSH≥2.5mIU/L after the first screening,and the level of the TSH is confirmed in the second screening.The control group is the pregnant woman whoseTSH＜2.5mIU/L without the history of the thyroid disease whose thyroid functionl level can be used to observe the variation of pregnancy serumThe request during the follow-up: (1)Ensurance of the accurance of the follow-up time point:the follow-up time is divided into nine points:the first day of the 8th,12th,16th,20th,24th,28th,32th,36th(before the delivery).(2)the contents of the follow-up: urine aliquot 5ml and venous blood 5ml which is collected during 8 to 11 o'clock in the morning at empty stomach.(3) Don't need to take any iodine or aliment containing the iodine whose level of the urine iodine is above 130μg/L during pregnant.(4)Don't take any medicine or aliment containing the medicine.Content of questionnaire: The name, the age,the natio, the address, the occupation, the times of pregnancy, the general condition (diploma and family month income of couple), the history of pregnant and accouchement (including natural abortion history, medicine miscarriage history, induced abortion history and unusual pregnancy history), family history of the thyroid disease,hypertension and diabetes situation in the first.Indicatrix: serum TSH,FT₃,FT₄,TT₃,TT₄,TPOAb,TGAb and urine iodine.Results1,The median of urine iodine during early pregnant women in shengyang is 185.5ug/L.Shengyang is the area of quantity iodine.2,The median of the serum of early pregnant women in Shenyang(before 8 weeks)is 1.28mIU/L.95% confidence intervals is 0.13～4.1mIU/L;FT4 is 18.23±2.87 pmol/L,95% confidence level is 12.6～23.86 pmol/L.3,The chang of the thyroxine level in different pregnant week.4,Incidence rate of the case group,which TSH≥2.5 mIU/L,TPOAb positive(＞50IU/ml) is23.08%(27/117);TPOAb positive rate of all the screening pregnancy wemen is11.66% (67/573). Defference is obvious(X²=9.196, P=0.002).5,Relation between TSH and TPOAb: whose serum TSH≥2.5mIU/L TPOAb positive percentage is obviously higher than those,which TSH is between 0.3-2.5mIU/L(28.74%比9.82% X2=34.52,P＜0.005).RR value is3.35, which reveals that TPOAb positive pregnancy wemen's TSH abnormity is 3.35 times than TPOAb negative.Conclusions1,Shenyang is the idodine right amount area.2,The normal value of the blood serum in the early pregnant females is lower than the generals.It's about 51%.3,The low limit of FT4 is about 40% higher than the generals during the whole pregnance.4,Follow-up investigation indicates that there is a peak of TSH before 8 Week.Then it drops gradually latter and reach the lowest until the 12th week.Then steps up slightly but not surpass the value of the 8th week and maintains the steady level to the childbirth.TT₃ is lowest in the 4th week during the pregnant, latter elevates gradually, and maintain the high level after the 20th week, and 32 reach the peak in the 32th week.And TT₄ reach the peak in the 12th week, latter reduces fast,and keeps the low level until 32 weeks.Then step up to the level of the 4th month of the pregnance.The FT₃ maintains a high level during entire gestation period,and higher than the the normal value upper limit of common crowd.FT4 is highest at week 4, drop slowly later to 24 weeks and maintenance to 36 weeks.5,TPOAb positive is the risk factor of Subclinical hypothyroidism during pregnancy.