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甲状腺激素(TH)一方面直接作用于卵巢,另一方面通过影响性激素结合球蛋白(SHBG)的合成,调节泌乳素(PRL)、促性腺激素释放激素(GnRH)的分泌和凝血因子的功能而对月经周期进行调控。不孕女性的自身免疫性甲状腺疾病(AITD)患病率明显高于年龄匹配的经产妇,尤其是继发于子宫内膜异位或多囊卵巢综合征(PCOS)的不孕女性。伴或不伴AITD的妇女行辅助生殖技术(ART)的成功率并无显著差异。但患AITD的孕妇在妊娠前3个月发生流产的风险明显高于正常孕妇。此外,行ART之前的控制性超排卵(COH)过程对甲状腺功能有着不可忽略的影响,特别是对于合并AITD的妇女。故不孕妇女应于行ART之前筛查甲状腺功能,及时发现AITD,并在COH之后和妊娠期随访AITD妇女的甲状腺功能。妊娠早期阶段出现甲状腺功能异常的孕妇应接受L-T4治疗以避免妊娠并发症的发生。但关于是否应在孕前或孕期使用L-T4治疗甲状腺功能正常的AITD妇女仍缺乏足够的临床研究。
Thyroid hormone (TH), on the one hand, acts directly on the ovary and on the other hand regulates the secretion of prolactin (PRL), gonadotropin-releasing hormone (GnRH) and the function of clotting factors by affecting the synthesis of sex hormone-binding globulin (SHBG) Menstrual cycle regulation. The prevalence of autoimmune thyroid disease (AITD) in infertile women is significantly higher than in age-matched mothers, especially in infertile women with endometriosis or polycystic ovary syndrome (PCOS). There was no significant difference in the success rate of assisted reproductive technology (ART) between women with and without AITD. However, women with AITD have a significantly higher risk of miscarriage in the first trimester of pregnancy than in normal pregnant women. In addition, pre-ART controlled-superovulation (COH) has a non-negligible effect on thyroid function, especially in women with AITD. Therefore, infertile women should screen thyroid function before ART, find AITD in time, and follow-up the thyroid function of AITD women after COH and during pregnancy. Pregnant women with abnormal thyroid function during early pregnancy should be treated with L-T4 to avoid pregnancy complications. However, there is still a lack of adequate clinical studies on AITD women with normal thyroid function who should use L-T4 before or during pregnancy.