Clinical effect and effective dose of L-T4 replacement therapy in pregnant patients with SCH
LIU Minglan1 XIAO Liming1 SHI Weihong2
1.Department of Obstetrics and Gynecology, Rugao People’s Hospital, Jiangsu Province, Rugao 226541, China;
2.Department of Obstetrics and Gynecology, Nantong Maternal and Child Health Hospital, Jiangsu Province, Nantong 226006, China
Abstract：Objective To explore the initial dose selection and effect of Levothyroxine (L-T4) replacement therapy in pregnant patients with subclinical hypothyroidism (SCH). Methods A total of 100 pregnant patients with SCH diagnosed in Rugao People’s Hospital of Jiangsu Province from January 2016 to February 2018 were selected as the research subjects. They were divided into high-dose group (initial dose 50 μg, once a day) and low-dose group (initial dose 25 μg, once a day) according to drug dose, with 50 cases in each group. The levels of free triiodothyrogenine (FT3), free thyroxine (FT4), thyrotropin (TSH), folic acid (FA), nitric oxide (NO), endothelin-1 (ET-1), arterial flow mediated endothelium-dependent dilation (FMD), pregnancy outcome and perinatal outcome of two groups were compared before and after treatment. Results There were no significant differences in thyroid function and FA level between two groups before treatment (P > 0.05). After treatment, TSH level was lower than that before treatment, and FA level was higher than that before treatment; TSH level of high-dose group was lower than that of low-dose group, and FA level of high-dose group was higher than that of low-dose group, with statistical significances (all P < 0.05); and there were no significant differences in FT3 and FT4 levels between two groups (P > 0.05). Before treatment, there were no significant differences in NO, ET-1 and FMD levels between two groups (P > 0.05). After treatment; ET-1 level of two groups was lower than that before treatment, NO and FMD levels were higher than those before treatment. ET-1 level in high-dose group was lower than that in low-dose group, and NO and FMD levels in high-dose group were higher than those in low-dose group, with statistical significances (all P < 0.05). The incidence of obstetric complications in high-dose group was lower than that in low-dose group, with statistical significances (P < 0.05). The total incidence of fetal and perinatal adverse outcomes in high-dose group was lower than that in low-dose group, with statistical significances (P < 0.05). Conclusion L-T4 replacement therapy of 50 μg is more effective in regulating thyroxine level and endothelial function in pregnant patients with SCH than that of 25 μg, and has a positive effect on reducing the incidence of obstetric complications and fetal and perinatal adverse outcomes.
2021, Vol. 18 
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