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早期妊娠期间母体的甲状腺功能与幼儿的认知功能：Generation R研究
Maternal Thyroid Function during Early Pregnancy and Cognitive Functioning in Early Childhood: The Generation R Study
Henrichs J, Bongers-Schokking JJ, Schenk JJ  2010/9/13 18:02:14 
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J Clin Endocrinol Metab, 2010,
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Abstract
Context:
Thyroid hormones are essential for neurodevelopment from early pregnancy onward. Yet population-based data on the association between maternal thyroid function in early pregnancy and children's cognitive development are sparse.

Objective:
Our objective was to study associations of maternal hypothyroxinemia and of early pregnancy maternal TSH and free T4 (FT4) levels across the entire range with cognitive functioning in early childhood.

Design and Setting:
We conducted a population-based cohort in The Netherlands.

Participants:
Participants included 3659 children and their mothers.

Main Measures:
In pregnant women with normal TSH levels at 13wk gestation (sd=1.7), mild and severe maternal hypothyroxinemia were defined as FT4 concentrations below the 10th and 5th percentile, respectively. Children's expressive vocabulary at 18 months was reported by mothers using the MacArthur Communicative Development Inventory. At 30 months, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring verbal and nonverbal cognitive functioning.

Results:
Maternal TSH was not related to the cognitive outcomes. An increase in maternal FT4 predicted a lower risk of expressive language delay at 30 months only. However, both mild and severe maternal hypothyroxinemia was associated with a higher risk of expressive language delay across all ages [odds ratio (OR)=1.44; 95%confidence interval (CI)=1.09–1.91; P=0.010 and OR=1.80; 95% CI=1.24–2.61; P=0.002, respectively]. Severe maternal hypothyroxinemia also predicted a higher risk of nonverbal cognitive delay (OR=2.03; 95% CI=1.22–3.39; P=0.007).

Conclusions:
Maternal hypothyroxinemia is a risk factor for cognitive delay in early childhood.
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疾病资源中心  疾病资源中心
病例分析 <span class="ModTitle_Intro_Right" id="EPMI_Home_MedicalCases_Intro_div" onclick="javascript:window.location='http://www.elseviermed.cn/tabid/127/Default.aspx'" onmouseover="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.cursor='pointer';document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='underline';" onmouseout="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='none';">[栏目介绍]</span>  病例分析 [栏目介绍]
甲状腺功能亢进合并黄疸

 王燕燕 王曙

上海交通大学附属瑞金医院内分泌科

患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
 

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