臨床婦人科産科76巻4号

2022年04月発行

増刊号 最新の不妊診療がわかる！―生殖補助医療を中心とした新たな治療体系 第4章　生殖補助医療時代の一般不妊診療―検査や治療の意義と限界 内分泌学的検査

甲状腺ホルモンと不妊―TSH・FT₄・FT₃・抗甲状腺抗体

著者： 吉原愛¹

所属機関： ¹伊藤病院内科

ページ範囲：P.184 - P.187

▶甲状腺機能亢進症では月経異常を伴うことが多い．バセドウ病の場合には甲状腺機能を正常に維持することが重要である．
▶甲状腺機能低下症は不妊と関連を認めるが，甲状腺ホルモンを適切に補充することで改善を認める．潜在性甲状腺機能低下症においても，不妊，流産，早産との関連が報告されている．
▶胎児の成長には甲状腺ホルモンが必須であり，妊娠中は甲状腺ホルモンの需要が増加する．母体の甲状腺機能低下症では，児の中枢神経の発達の観点から速やかに甲状腺機能を正常化させることが重要である．

参考文献

1）Wakim AN, et al : Thyroid hormones in human follicular fluid and thyroid hormone receptors in human granulosa cells. Fertil Steril 59 : 1187-1190, 1993

2）Akande, EO, et al : Plasma oestrogen and luteinizing hormone concentrations in thyrotoxic menstrual disturbance. Proc R Soc Med 65 : 789-790, 1972

3）Southren AL, et al : The conversion of androgens to estrogens in hyperthyroidism. J Clin Endocrinol Metab 38 : 207-214, 1974

4）Akande EO, et al : Plasma luteinizing hormone levels in women with thyrotoxicosis. J Endocrinol 53 : 173-174, 1972

5）Kriplani A, et al : Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy. Eur J Obstet Gynecol Reprod Biol 54 : 159-163, 1994

6）Joshi JV, et al : Menstrual irregularities and lactation failure may precede thyroid dysfunction or goitre. J Postgrad Med 39 : 137-141, 1993

7）Unuane D, et al : Impact of thyroid disease on fertility and assisted conception. Best Pract Res Clin Endocrinol Metab 34 : 101378, 2020

8）Abalovich M, et al : Subclinical hypothyroidism and thyroid autoimmunity in women with infertility. Gynecol Endocrinol 23 : 279-283, 2007

9）Feldthusen AD, et al : Impaired fertility associated with subclinical hypothyroidism and thyroid autoimmunity : The Danish General Suburban Population Study. J Pregnancy 2015 : 132718, 2015

10）Orouji Jokar T, et al : Higher TSH levels within the normal range are associated with unexplained infertility. J Clin Endocrinol Metab 103 : 632-639, 2018

11）Negro R, et al : Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 95 : E44-E48, 2010

12）Abdel Rahman AH, et al : Improved in vitro fertilization outcomes after treatment of subclinical hypothyroidism in infertile women. Endocr Pract 16 : 792-797, 2010

13）Kim CH, et al : Effect of levothyroxine treatment on in vitro fertilization and pregnancy outcome in infertile women with subclinical hypothyroidism undergoing in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril 95 : 1650-1654, 2011

14）Rao M, et al : Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity : a systematic review and meta-analysis. Hum Reprod Update 25 : 344-361, 2019

15）Poppe K, et al : Thyroid dysfunction and autoimmunity in infertile women. Thyroid 12 : 997-1001, 2002

16）Negro R, et al : Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease : effects on obstetrical complications. J Clin Endocrinol Metab 91 : 2587-2591, 2006

17）Vissenberg R, et al : Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update 21 : 378-387, 2015

18）Korevaar TI, et al : Thyroid autoimmunity impairs the thyroidal response to human chorionic gonadotropin : two population-based prospective cohort studies. J Clin Endocrinol Metab 102 : 69-77, 2017

19）Haddow JE, et al : Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 341 : 549-555, 1999

20）Matsuura N, et al : Transient hypothyroidism in infants born to mothers with chronic thyroiditis-a nationwide study of twenty-three cases. Endocrinologia Japonica 37 : 369-379, 1990

21）Momotani N, et al : Neurodevelopment in children born to hypothyroid mothers restored to normal thyroxine（T4）concentration by late pregnancy in Japan : no apparent influence of maternal T4 deficiency. J Clin Endocrinol Metab 97 : 1104-1108, 2012