1. Insufficient thyroid function: the "invisible killer" on the road to pregnancy preparation
Hypothyroidism (hypothyroidism) is a common endocrine disease in women of childbearing age. The prevalence of hypothyroidism during pregnancy in my country is as high as 5%-10. Thyroid hormones directly regulate reproductive system functions. Elevated TSH (thyroid-stimulating hormone) levels in patients with hypothyroidism can interfere with follicular development, inhibit ovulation, and lead to menstrual disorders (such as reduced menstrual volume, prolonged cycles) and even amenorrhea.
Clinical case: 28-year-old Ms. Li visited the hospital for repeated miscarriages. The examination found that TSH was as high as 6.8 mIU/L (normal range 0.35-4.94 mIU/L), and she was diagnosed with subclinical hypothyroidism.
:28,TSH6.8 mIU/L(0.35-4.94 mIU/L),.After treatment with levothyroxine, TSH dropped below 2.5 mIU/L, and a healthy baby was successfully born the following year.
2. Hypothyroidism poses a dual threat to pregnancy
1.
1. Natural conception stage
·Ovulation disorders: Patients with hypothyroidism have a threefold increased risk of follicular arrest and a 40% reduction in ovulation cycles
·Pregnancy complications: abortion rate increased by 1.6 times, risk of preterm labor increased by 30%, and incidence of gestational hypertension increased by 25%
·Fetal risk: Fetal brain development in the first 3 months of pregnancy relies on maternal thyroid hormone. Hypothyroidism can reduce the intelligence score of the offspring by 7-10 points and even cause stupidity
2. IVF cycle
·Reduced egg quality: Mitochondrial function in oocytes of patients with hypothyroidism is abnormal, and the rate of chromosomal aneuploidy in embryos increases by 20%
·Decrease: Decrease in endometrial receptivity
3. Scientific intervention: getting thyroid function back on track
1. Screening must be done before pregnancy
TSH test: All women planning to conceive should have their thyroid function checked 8 weeks before pregnancy, and TSH should be controlled below 2.5 mIU/L
Antibodytesting: Those with positive thyroid peroxidase antibody (TPOAb) have a twofold increased risk of abortion, and strengthened monitoring is needed
2. Standardize treatment plan
Drugintervention: Levothyroxine (Uthyrox) is the first choice. The dose in the first trimester needs to be increased by 20%-30%, and adjusted every 4-6 weeks
Combinationtreatment: Patients with insulin resistance or polycystic ovary syndrome need to use metformin simultaneously to improve metabolism
3. Test tube cycle management
Individualizedovulation: Low-dose GnRH antagonist regimen to reduce risk of ovarian hyperstimulation
Embryoscreening: PGT-A technology is recommended to screen chromosomes normal embryos and reduce abortion rate to less than 10%
IV. Expert Appeal: Early Screening and Early Treatment is the Key
"Thyroid dysfunction is preventable and controllable, but the golden intervention period needs to be seized." Professor Ma Liangkun, an expert in the Department of Obstetrics and Gynecology at Peking Union Medical College Hospital, emphasized,"It is recommended that all women planning to get pregnant include thyroid function tests as a mandatory pre-pregnancy test, and patients who are diagnosed should start a pregnancy plan after reaching the TSH standard.