甲状腺疾病与女性生殖
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摘要
正常的甲状腺功能状态是维持女性生殖能力的一个重要因素;甲状腺激素直接或间接参与调节女性生殖功能。甲状腺机能障碍会影响性激素结合球蛋白(SHBG)和催乳素(PRL)水平,从而改变类固醇激素代谢和下丘脑-垂体-卵巢轴的功能,导致凝血功能障碍和各种生殖问题,如月经紊乱、排卵障碍、不孕、流产、早产等。甲状腺机能障碍通过适当的临床干预可能恢复正常的月经周期,并改善生殖功能。
Normal thyroid function is essential to maintain the female reproductive ability. Thyroid hormones are directly and indirectly involved in the regulation of female reproductive function. Thyroid dysfunction affects sex hormone binding globulin(SHBG) and prolactin(PRL) levels, alteres the metabolism of steroid hormones and the function of hypothalamic-pituitary-ovary axis, and causes coagulation dysfunction, which result in various reproductive problems such as menstrual disorders, ovulation disorder, infertility, abortion, premature birth, etc. Proper clinical intervention may restore the normal menstrual cycle, and improve fertility and the outcome of pregnancy.
Normal thyroid function is essential to maintain the female reproductive ability. Thyroid hormones are directly and indirectly involved in the regulation of female reproductive function. Thyroid dysfunction affects sex hormone binding globulin(SHBG) and prolactin(PRL) levels, alteres the metabolism of steroid hormones and the function of hypothalamic-pituitary-ovary axis, and causes coagulation dysfunction, which result in various reproductive problems such as menstrual disorders, ovulation disorder, infertility, abortion, premature birth, etc. Proper clinical intervention may restore the normal menstrual cycle, and improve fertility and the outcome of pregnancy.
引文
[1]Kim NY,Cho HJ,Kim HY,et al.Thyroid autoimmunity and its association with cellular and humoral immunity in women with reproductive failures.Am J Reprod Immunol,2011,65(1):78-87.
[2]Stavreus Evers A.Paracrine interactions of thyroid hormones and thyroid stimulation hormone in the female reproductive tract have an impact on female fertility.Front Endocrinol,2012,3:50.
[3]Aghajanova L,Lindeberg M,Carlsson IB,et al.Receptors for thyroid-stimulating hormone and thyroid hormones in human ovarian tissue.Reprod Biomed Online,2009,18(3):337-47.
[4]Aghajanova L,Stavreus-Evers A,Lindeberg M,et al.Thyroidstimulating hormone receptor and thyroid hormone receptors are involved in human endometrial physiology.Fertil Steril,2011,95(1):230-7.
[5]Earl R,Crowther CA,Middleton P.Interventions for preventing and treating hyperthyroidism in pregnancy.Cochrane Database Syst Rev,2010,8(9):CD008633.
[6]Joshi JV,Bhandarkar SD,Chadha M,et al.Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre.J Postgrad Med,1993,39(3):137-41.
[7]Krassas GE,Pontikides N,Kaltsas T,et al.Menstrual disturbances in thyrotoxicosis.Clin Endocrinol(Oxf),1994,40(5):641-4.
[8]Kakuno Y,Amino N,Kanoh M,et al.Menstrual disturbances in various thyroid diseases.Endocr J,2010,57(12):1017-22.
[9]Poppe K,Glinoer D,van Steirteghem A,et al.Thyroid dysfunction and autoimmunity in infertile women.Thyroid,2002,12(11):997-1001.
[10]Akande EO,Hockaday TD.Plasma oestrogen and luteinizing hormone concentrations in thyrotoxic menstrual disturbance.Proc R Soc Med,1972,65(9):789-90.
[11]Akande EO,Hockaday TD.Plasma luteinizing hormone levels in women with thyrotoxicosis.J Endocrinol,1972,53(1):173-4.
[12]Pontikides N,Kaltsas Th,Krassas GE.The hypothalamicpituitary-gonadal axis in hyperthyroid female patients before and after treatment.J Endocrinol Invest,1990,13(2 Suppl):203.
[13]Z?hringer S,Tomova A,von Werder K,et al.The influence of hyperthyroidism on the hypothalamic-pituitary-gonadal axis.Exp Clin Endocrinol Diabetes,2000,108(4):282-9.
[14]Tanaka T,Tamai H,Kuma K,et al.Gonadotropin response to luteinizing hormone releasing hormone in hyperthyroid patients with menstrual disturbances.Metabolism,1981,30(4):323-6.
[15]Vissenberg R,van den Boogaard E,van Wely M,et al.Treatment of thyroid disorders before conception and in early pregnancy:a systematic review.Hum Reprod Update,2012,18(4):360-73.
[16]De Groot L,Abalovich M,Alexander EK,et al.Management of thyroid dysfunction during pregnancy and postpartum:an endocrine society clinical practice guideline.J Clin Endocrinol Metab,2012,97(8):2543-65.
[17]Bjoro T,Holmen J,Kruger O,et al.Prevalence of thyroid disease,thyroid dysfunction and thyroid peroxidase antibodies in a large unselected population.Eur J Endocrinol,2000,143(5):639-47.
[18]陈立立,刘超.甲状腺疾病对女性生殖功能的影响.国际内科学杂志,2009,36(5):298-304.
[19]Goldsmith RE,Sturgis SH,Jacob L,et al.The menstrual pattern in thyroid disease.J Clin Endocrinol Metab,1952,12(7):846-55.
[20]Navas PB,Motta AB,Hapon MB,et al.Hyperthyroidism advances luteolysis in the pregnant rat through changes in prostaglandin balance.Fertil Steril,2011,96(4):1008-14.
[21]Silva JF,Vidigal PN,Galv?o DD,et al.Fetal growth restriction in hypothyroidism is associated with changes in proliferativeactivity,apoptosis and vascularisation of the placenta.Reprod Fertil Dev,2012,24(7):923-31.
[22]Gordon GG,Southren AL.Thyroid-hormone effects on steroidhormone metabolism.Bull NY Acad Med,1977,53(3):241-59.
[23]Marino M,Chiovato L,Pinchera A.Graves’disease./DeGroot LJ,Jameson JL,eds.Endocrinology.5th ed.Philadelphia:Elsevier Saunders,2006:1995-2028.
[24]van den Boogaard E,Vissenberg R,Land JA,et al.Significance of(sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy:a systematic review.Hum Reprod Update,2011,17(5):605-19.
[25]Kim CH,Ahn JW,Kang SP,et al.Effect of levothyroxine treatm ent on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection.Fertil Steril,2011,95(5):1650-4.
[26]Velkeniers B,van Meerhaeghe A,Poppe K,et al.Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies:systematic review and meta-analysis of RCTs.Hum Reprod Update,2013,19(3):251-8.
[27]Baker VL,Rone HM,Pasta DJ,et al.Correlation of thyroid stimulating hormone(TSH)level with pregnancy outcome in women undergoing in vitro fertilization.Am J Obstet Gynecol,2006,194(6):1668-74.
[28]Reh A,Grifo J,Danoff A.What is a normal thyroid-stimulating hormone(TSH)level?Effects of stricter TSH thresholds on pregnancy outcomes after in vitro fertilization.Fertil Steril,2010,94(7):2920-2.
[29]张艳馨,姚丽芬,冒韵东,等.促甲状腺激素(TSH)水平对IVF/ICSI妊娠结局的影响.生殖与避孕,2012,32(1):17-23.
[30]Twig G,Shina A,Amital H,et al.Pathogenesis of infertility and recurrent pregnancy loss in thyroid autoimmunity.J Autoimmun,2012,38(2-3):J275-81.
[31]Revelli A,Casano S,Piane LD,et al.A retrospective study on IVF outcome in euthyroid patients with anti-thyroid antibodies:effects of levothyroxine,acetyl-salicylic acid and prednisolone adjuvant treatments.Reprod Biol Endocrinol,2009,7:137.
[32]Bellver J,Soares SR,Alvarez C,et al.The role of thromboph ilia and th yroid autoimm unity in unexp lain ed infertility,implantation failure and recurrent spontaneous abortion.Hum Reprod,2008,23(2):278-84.
[33]Toulis KA,Goulis DG,Venetis CA,et al.Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF:a meta-analysis.Eur J Endocrinol,2010,162(4):643-52.
[34]Zhong YP,Ying Y,Wu HT,et al.Relationship between antithyroid antibody and pregnancy outcome following in vitro fertilization and embryo transfer.Int J Med Sci,2012,9(2):121-5.
[35]Kilic S,Tasdemir N,Yilmaz N,et al.The effect of anti-thyroid antibodies on endometrial volume,embryo grade and IVF outcome.Gynecol Endocrinol,2008,24(11):649-55.
[36]Matalon ST,Blank M,Levy Y,et al.The pathogenic role of antithyroglobulin antibody on pregnancy:evidence from an active immunization model in mice.Hum Reprod,2003,18(5):1094-9.
[37]Yan J,Sripada S,Saravelos SH,et al.Thyroid peroxidase antibody in women with unexplained recurrent miscarriage:prevalence,prognostic value,and response to empirical thyroxine therapy.Fertil Steril,2012,98(2):378-82.
[38]Negro R,Mangieri T,Coppola L,et al.Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies:a prospective study.Hum Reprod,2005,20(6):1529-33.
[2]Stavreus Evers A.Paracrine interactions of thyroid hormones and thyroid stimulation hormone in the female reproductive tract have an impact on female fertility.Front Endocrinol,2012,3:50.
[3]Aghajanova L,Lindeberg M,Carlsson IB,et al.Receptors for thyroid-stimulating hormone and thyroid hormones in human ovarian tissue.Reprod Biomed Online,2009,18(3):337-47.
[4]Aghajanova L,Stavreus-Evers A,Lindeberg M,et al.Thyroidstimulating hormone receptor and thyroid hormone receptors are involved in human endometrial physiology.Fertil Steril,2011,95(1):230-7.
[5]Earl R,Crowther CA,Middleton P.Interventions for preventing and treating hyperthyroidism in pregnancy.Cochrane Database Syst Rev,2010,8(9):CD008633.
[6]Joshi JV,Bhandarkar SD,Chadha M,et al.Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre.J Postgrad Med,1993,39(3):137-41.
[7]Krassas GE,Pontikides N,Kaltsas T,et al.Menstrual disturbances in thyrotoxicosis.Clin Endocrinol(Oxf),1994,40(5):641-4.
[8]Kakuno Y,Amino N,Kanoh M,et al.Menstrual disturbances in various thyroid diseases.Endocr J,2010,57(12):1017-22.
[9]Poppe K,Glinoer D,van Steirteghem A,et al.Thyroid dysfunction and autoimmunity in infertile women.Thyroid,2002,12(11):997-1001.
[10]Akande EO,Hockaday TD.Plasma oestrogen and luteinizing hormone concentrations in thyrotoxic menstrual disturbance.Proc R Soc Med,1972,65(9):789-90.
[11]Akande EO,Hockaday TD.Plasma luteinizing hormone levels in women with thyrotoxicosis.J Endocrinol,1972,53(1):173-4.
[12]Pontikides N,Kaltsas Th,Krassas GE.The hypothalamicpituitary-gonadal axis in hyperthyroid female patients before and after treatment.J Endocrinol Invest,1990,13(2 Suppl):203.
[13]Z?hringer S,Tomova A,von Werder K,et al.The influence of hyperthyroidism on the hypothalamic-pituitary-gonadal axis.Exp Clin Endocrinol Diabetes,2000,108(4):282-9.
[14]Tanaka T,Tamai H,Kuma K,et al.Gonadotropin response to luteinizing hormone releasing hormone in hyperthyroid patients with menstrual disturbances.Metabolism,1981,30(4):323-6.
[15]Vissenberg R,van den Boogaard E,van Wely M,et al.Treatment of thyroid disorders before conception and in early pregnancy:a systematic review.Hum Reprod Update,2012,18(4):360-73.
[16]De Groot L,Abalovich M,Alexander EK,et al.Management of thyroid dysfunction during pregnancy and postpartum:an endocrine society clinical practice guideline.J Clin Endocrinol Metab,2012,97(8):2543-65.
[17]Bjoro T,Holmen J,Kruger O,et al.Prevalence of thyroid disease,thyroid dysfunction and thyroid peroxidase antibodies in a large unselected population.Eur J Endocrinol,2000,143(5):639-47.
[18]陈立立,刘超.甲状腺疾病对女性生殖功能的影响.国际内科学杂志,2009,36(5):298-304.
[19]Goldsmith RE,Sturgis SH,Jacob L,et al.The menstrual pattern in thyroid disease.J Clin Endocrinol Metab,1952,12(7):846-55.
[20]Navas PB,Motta AB,Hapon MB,et al.Hyperthyroidism advances luteolysis in the pregnant rat through changes in prostaglandin balance.Fertil Steril,2011,96(4):1008-14.
[21]Silva JF,Vidigal PN,Galv?o DD,et al.Fetal growth restriction in hypothyroidism is associated with changes in proliferativeactivity,apoptosis and vascularisation of the placenta.Reprod Fertil Dev,2012,24(7):923-31.
[22]Gordon GG,Southren AL.Thyroid-hormone effects on steroidhormone metabolism.Bull NY Acad Med,1977,53(3):241-59.
[23]Marino M,Chiovato L,Pinchera A.Graves’disease./DeGroot LJ,Jameson JL,eds.Endocrinology.5th ed.Philadelphia:Elsevier Saunders,2006:1995-2028.
[24]van den Boogaard E,Vissenberg R,Land JA,et al.Significance of(sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy:a systematic review.Hum Reprod Update,2011,17(5):605-19.
[25]Kim CH,Ahn JW,Kang SP,et al.Effect of levothyroxine treatm ent on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection.Fertil Steril,2011,95(5):1650-4.
[26]Velkeniers B,van Meerhaeghe A,Poppe K,et al.Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies:systematic review and meta-analysis of RCTs.Hum Reprod Update,2013,19(3):251-8.
[27]Baker VL,Rone HM,Pasta DJ,et al.Correlation of thyroid stimulating hormone(TSH)level with pregnancy outcome in women undergoing in vitro fertilization.Am J Obstet Gynecol,2006,194(6):1668-74.
[28]Reh A,Grifo J,Danoff A.What is a normal thyroid-stimulating hormone(TSH)level?Effects of stricter TSH thresholds on pregnancy outcomes after in vitro fertilization.Fertil Steril,2010,94(7):2920-2.
[29]张艳馨,姚丽芬,冒韵东,等.促甲状腺激素(TSH)水平对IVF/ICSI妊娠结局的影响.生殖与避孕,2012,32(1):17-23.
[30]Twig G,Shina A,Amital H,et al.Pathogenesis of infertility and recurrent pregnancy loss in thyroid autoimmunity.J Autoimmun,2012,38(2-3):J275-81.
[31]Revelli A,Casano S,Piane LD,et al.A retrospective study on IVF outcome in euthyroid patients with anti-thyroid antibodies:effects of levothyroxine,acetyl-salicylic acid and prednisolone adjuvant treatments.Reprod Biol Endocrinol,2009,7:137.
[32]Bellver J,Soares SR,Alvarez C,et al.The role of thromboph ilia and th yroid autoimm unity in unexp lain ed infertility,implantation failure and recurrent spontaneous abortion.Hum Reprod,2008,23(2):278-84.
[33]Toulis KA,Goulis DG,Venetis CA,et al.Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF:a meta-analysis.Eur J Endocrinol,2010,162(4):643-52.
[34]Zhong YP,Ying Y,Wu HT,et al.Relationship between antithyroid antibody and pregnancy outcome following in vitro fertilization and embryo transfer.Int J Med Sci,2012,9(2):121-5.
[35]Kilic S,Tasdemir N,Yilmaz N,et al.The effect of anti-thyroid antibodies on endometrial volume,embryo grade and IVF outcome.Gynecol Endocrinol,2008,24(11):649-55.
[36]Matalon ST,Blank M,Levy Y,et al.The pathogenic role of antithyroglobulin antibody on pregnancy:evidence from an active immunization model in mice.Hum Reprod,2003,18(5):1094-9.
[37]Yan J,Sripada S,Saravelos SH,et al.Thyroid peroxidase antibody in women with unexplained recurrent miscarriage:prevalence,prognostic value,and response to empirical thyroxine therapy.Fertil Steril,2012,98(2):378-82.
[38]Negro R,Mangieri T,Coppola L,et al.Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies:a prospective study.Hum Reprod,2005,20(6):1529-33.