探讨妊娠期亚临床甲状腺血清学异常患者甲状腺超声表现特点。

选择2014年1月至2015年12月在首都医科大学附属北京妇产医院就诊的53例孕妇进行甲状腺超声检查。入组孕妇在孕早期检测血清促甲状腺激素（TSH）、血清游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPoAb）水平并首次发现甲状腺功能或血清TPoAb抗体水平异常。采用χ²检验比较血清TPoAb≥1300 IU/L和血清TPoAb<1300 IU/L孕妇甲状腺回声异常发生率及腺体血流增多发生率差异。

53例孕妇中21例为亚临床甲状腺功能亢进，10例为亚临床甲状腺功能减低，22例为单纯TPoAb水平增高。21例亚临床甲状腺功能亢进孕妇中，16例不伴有TPoAb水平升高的孕妇甲状腺超声表现未见明确异常，余5例伴有TPoAb水平升高的孕妇中2例孕妇（40.0%）甲状腺实质回声有轻度弥漫性改变；10例亚临床甲状腺功能减低孕妇中，5例不伴有TPoAb水平升高的孕妇中2例孕妇（40.0%）出现甲状腺轻度弥漫性改变，而余5例伴有TPoAb水平升高的孕妇中4例（80.0%）出现甲状腺弥漫性改变；22例单纯TPoAb水平升高的孕妇中，11例孕妇（50.0%）出现甲状腺弥漫性改变。在所有血清TPoAb水平升高的32例孕妇中，9例孕妇血清TPoAb≥1300 IU/L，23例孕妇血清TPoAb<1300 IU/L。血清TPoAb≥1300 IU/L的孕妇甲状腺回声异常发生率高于血清TPoAb<1300 IU/L的孕妇（8/9 vs 9/23），且差异有统计学意义（χ²=6.432，P=0.018）；而两者腺体血流增多发生率差异无统计学意义（6/9 vs 9/23，χ²=1.970，P=0.080）。

妊娠期甲状腺血清学指标异常患者可有不同超声表现，超声表现与血清学表现并不完全一致。

To investigate the features of thyroid ultrasonographic manifestations in patients with subclinical thyroid serological anomalies during pregnancy.

In present study, a total of 53 women who attended the obstetrics clinic in Beijing Obstetrics and Gynecology Hospital from January 2014 to December 2015 underwent thyroid ultrasound scanning. All women included in this study were checked up for the serological levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), thyroid peroxidase antibody (TPoAb) in the first trimester and were diagnosed as thyroid dysfunction or abnormal level of serological antibody for the first time. The χ² test was used to compare the incidences of abnormal thyroid echogenicity and increased blood flow in thyroid between groups with serological TPoAb level≥1300 IU/L and<1300 IU/L.

Among 53 cases, 21 were subclinical hyperthyroidism, 10 were subclinical hypothyroidism, and 22 were isolated elevated serum TPoAb cases. Among 21 subclinical hyperthyroid patients, 16 cases without elevated TPoAb were unremarkable on thyroid scanning, while 2 out of the rest 5 cases (40.0%) with increased serum TPoAb demonstrated mild thyroid diffuse abnormal echogenicity. Among 10 subclinical hypothyroid cases, 2 out of 5 cases (40.0%) without elevated TPoAb manifested mild thyroid diffuse abnormal echogenicity, while 4 of 5 cases (80.0%) with elevated TPoAb showed diffuse abnormal echogenicity of thyroid. In 22 women with isolated elevated serum TPoAb, 11(50.0%) demonstrated diffuse thyroid abnormal echogenicity. In all 32 cases with elevated serum TPoAb, the serum TPoAb level was≥1300 IU/L in 9 cases and<1300 IU/L in 23 cases. The incidence of thyroid abnormal echogenicity was higher in women with serum TPoAb level≥1300 IU/L than in women with <1300 IU/L (8/9 vs 9/23), which was statistically significant (χ²=6.432, P=0.018); while no significant difference in the incidence of increased blood flow in both groups was identified (6/9 vs 9/23, χ²=1.970, P=0.080).

The thyroid ultrasonographic manifestations varied in patients with thyroid serologic anomalies during pregnancy, and were not closely consistent with the serological findings.