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【医脉通指南频道】2014+ETA孕妇和儿童亚临床甲减的管理指南

【医脉通指南频道】2014+ETA孕妇和儿童亚临床甲减的管理指南

E-Mail karger@http://www.wendangku.net/doc/790f0d572f60ddccda38a0d6.html G uidel ines

E ur Thyroid J 2014;3:76–94 D OI:

【医脉通指南频道】2014+ETA孕妇和儿童亚临床甲减的管理指南

10.1159/000362597

2014 European Thyroid Association

Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children

J ohn Lazarus a Rosalind S. Brown c Chantal Daumerie d

Alicja Hubalewska-Dydejczyk e Roberto Negro f Bijay Vaidya b

a T hyroid Research Group, Institute of Molecular Medicine, Cardiff University, University Hospital of Wales, C ardiff ,

and b D epartment of Endocrinology, Royal Devon and Exeter Hospital and University of Exeter Medical School,

E xeter,UK;c C linical Trials Research Division of Endocrinology, Children’s Hospital Boston, Harvard Medical School,

B oston, Mass. , USA; d E ndocrinologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain,

B russels,Belgium;e D epartment of Endocrinology, Jagiellonian University Medical College, K rakow , Poland;

f D ivision of Endocrinology, V. Fazzi Hospital, L ecce , Italy

there is no evidence that maternal levothyroxine therapy im-

proves this outcome. Targeted antenatal screening for thy-

roid function will miss a substantial percentage of women

with thyroid dysfunction. In children SCH (serum TSH con-

centration >5.5–10 mU/l) normalizes in >70% and persists in

the majority of the remaining patients over the subsequent

5 years, but rarely worsens. There is a lack of studies examin-

ing the impact of SCH on the neuropsychological develop-

ment of children under the age of 3 years. In older children,

the evidence for an association between SCH and impaired

neuropsychological development is inconsistent. Good qual-

ity studies examining the effect of treatment of SCH in chil-

dren are lacking. © 2014 European Thyroid Association

Published by S. Karger AG, Basel

I ntroduction

S ubclinical hypothyroidism (SCH) in pregnancy is de-

fined by a serum thyroid-stimulating hormone (TSH)

concentration higher than the upper limit of the pregnan-

cy-related reference range associated with a normal se-

K ey Words

P regnancy · Hypothyroidism · Subclinical · Child ·

Screening · Iodine · Management

A bstract

T his guideline has been produced as the official statement

of the European Thyroid Association guideline committee.

Subclinical hypothyroidism (SCH) in pregnancy is defined as

a thyroid-stimulating hormone (TSH) level above the preg-

nancy-related reference range with a normal serum thyrox-

ine concentration. Isolated hypothyroxinaemia (defined as a

thyroxine level below the 2.5th centile of the pregnancy-re-

lated reference range with a normal TSH level) is also recog-

nized in pregnancy. In the majority of SCH the cause is auto-

immune thyroiditis but may also be due to iodine deficiency.

The cause of isolated hypothyroxinaemia is usually not ap-

parent, but iodine deficiency may be a factor. SCH and iso-

lated hypothyroxinaemia are both associated with adverse

obstetric outcomes. Levothyroxine therapy may ameliorate

some of these with SCH but not in isolated hypothyroxin-

aemia. SCH and isolated hypothyroxinaemia are both associ-

ated with neuro-intellectual impairment of the child, but

R eceived: February 13, 2014

A ccepted after revision: April 1, 2014

P ublished online: June 7, 2014

J ohn Lazarus

T hyroid Research Group, Institute of Molecular Medicine, Cardiff University

University Hospital of Wales

H eath Park, C ardiff CF14 4XN (UK)

E-Mail Lazarus @ c f.ac.uk

© 2014 European Thyroid Association

Published by S. Karger AG, Basel

2235–0640/14/0032–0076$39.50/0

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