在卵巢刺激下對甲狀腺功能的影響

生育與絕育 2011年7月8搶鮮版

在卵巢刺激下對甲狀腺功能的影響:系統回顧

 

來自希臘的研究

摘要
目的:研究有關在婦女卵巢刺激(OS)對甲狀腺功能和甲狀腺自體免疫(TAI)的變化。

設計:研究資格的系統評估報告在婦女卵巢刺激(OS)之前和期間 OSOS 1個月內甲狀腺功能或甲狀腺自體免疫(TAI)的數據

背景:學術醫院。

病人(S):婦女甲狀腺功能異常或甲狀腺自體免疫(TAI(N=419)和對照組(n=425)。

干預(S):卵巢刺激。

主要觀察指標(S):血清TSH,游離甲狀腺素,游離三碘和甲狀腺抗體。

結果:7項研究,2000年至2011年,被列入。血清TSH濃度明顯增加於三項研究的報導,另兩項研究並沒有改變。兩項研究顯示血清游離甲狀腺素濃度增加了,一項研究沒有改變之一,並在另一個下降。只有一研究中進行了測量血清游離三碘,濃度沒有改變。在一項研究中,濃度降低,另兩項研究,即使是在存在甲狀腺功能的變化,甲狀腺抗體並沒有改變。

結論(S):現有的證據是不確定婦女卵巢刺激(OS)對甲狀腺功能影響大。血清TSH濃度可能在卵巢刺激(OS1個月內期間或之後增加,超過建議為懷孕的頭三個月閾值的2.5mU/ L,但進一步的前瞻性研究來提供確鑿的證據支持或反對的普遍評估甲狀腺功能受卵巢刺激(OS)影響仍有必要的。

 

PS:有很多婦女有甲狀腺疾病,不孕婦女有甲狀腺疾病者常期擔心人工生殖會影響甲狀腺功能和甲狀腺自體免疫(TAI)的變化而大量使用藥物治療。大型研究顯示未定論,見仁見智。

 

 

Fertil Steril. 2011 Jul 8. [Epub ahead of print]

Thyroid function during ovarian stimulation: a systematic review.

Mintziori GGoulis DGToulis KAVenetis CAKolibianakis EMTarlatzis BC.

Source

Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Abstract

OBJECTIVE:

To review the evidence regarding thyroid function and thyroid autoimmunity (TAI) changes in women undergoing ovarian stimulation (OS).

DESIGN:

Studies eligible for the systematic review were those that reported data on thyroid function or TAI both before and during OS or within 1 month after OS.

SETTING:

Academic hospital.

PATIENT(S):

Women with abnormal thyroid function or TAI (n = 419) and controls (n = 425).

INTERVENTION(S):

Ovarian stimulation.

MAIN OUTCOME MEASURE(S):

Serum TSH, free thyroxine, free tri-iodothyronine and thyroid antibodies.

RESULT(S):

Seven studies, between 2000 and 2011, were included. Serum TSH concentrations were significantly increased in three studies and were not changed in two studies. Serum free thyroxine concentrations were increased in two studies, were not changed in one, and were decreased in another. Serum free tri-iodothyronine concentrations were not changed in the only study in which they were measured. Thyroid antibody concentrations were decreased in one study and were not changed in two studies, even in the presence of changes in thyroid function.

CONCLUSION(S):

The current evidence is inconclusive regarding OS effect on thyroid function or TAI. Serum TSH concentrations may be increased during or within 1 month after OS, exceeding the threshold of 2.5 mU/L suggested for the first trimester of pregnancy, but further prospective studies are needed to provide conclusive evidence for or against universal evaluation of thyroid function and TAI in women undergoing OS.

陳啟煌

學位: 國防醫學院醫學系畢業(1985/08 - 1992/07) 台北醫學大學臨床醫學研究所博士畢業 (2012) 現職: 臺北醫學大學附設醫院婦產部不孕症科主任(2016.08~迄今) 臺北醫學大學醫學系婦產學科部定專任副教授 (2015年2月起~迄今) 經歷: 三軍總醫院婦產部住院醫師(1994/08 - 1999/07) 三軍總醫院婦產部主治醫師(1999/08 - 2011/02) 台灣駐查德共和國醫療團團長 (1999/08-2000/07) 美國Northwestern University試管嬰兒及人工生殖臨床研究員(2001/05~2002/04) 美國Johns Hopkins University生殖內分泌不孕症臨床研究員 (2001/04-2002/05) 國防醫學院婦產學科部定專任助理教授 臺北醫學大學醫學系婦產學科部定專任助理教授 臺北醫學大學附設醫院婦產部不孕症科主任(2016.08~迄今) 臺北醫學大學醫學系婦產學科部定專任副教授 (2015年2月起~迄今) 國際生殖保存醫學會Newsletter, co-editor 任期一年 中國婦幼保健協會聘任陳啟煌為中國婦幼保健協會生育力保存專家委員會顧問,聘期五年 (2017/11迄今) 海峽兩岸醫藥衛生交流協會生殖醫學分會第壹屆委員會副主任委員,任期三年 (2018/06/08~迄今) 台灣生殖醫學會副秘書長 (2018/09~2020/08)