甲状腺疾病常见，主要包括甲状腺功能异常和甲状腺自身免疫（thyroid autoimmunity, TAI）。在我国18~49岁育龄女性中，临床甲状腺功能亢进症（简称临床甲亢）、亚临床甲亢、临床甲状腺功能减退症（简称临床甲减）及亚临床甲减的患病率分别为1.08%、0.58%、1.28%、14.28%[1]，而甲状腺自身抗体的阳性率高达20.35%[2]。男性甲状腺疾病的患病率相对较低，临床甲亢、亚临床甲亢、临床甲减、亚临床甲减以及TAI的患病率分别为0.55%、0.29%、0.53%、9.87%和8.16%[2]。
甲状腺激素与生殖功能密切相关。随着生育力低下问题的日益突出，甲状腺疾病与不孕以及辅助生殖技术（assisted reproductive technology, ART）的关系受到广泛关注，但现有研究结论不完全一致。本文就甲状腺疾病与不孕的研究进展及热点问题进行简述，以期提高临床医师的认识，并为开展高质量的临床研究提供方向。
北京大学第一医院
北京大学第一医院内分泌科主任
医学博士 主任医师 博士研究生导师
中华医学会内分泌学分会青年委员会委员
甲状腺学组及免疫内分泌学组成员
北京医学会内分泌学分会委员
研究方向为自身免疫甲状腺疾病
多次获得国家及北京市自然基金资助
已发表中英文论文近50篇
参与的研究项目获得中华医学科技奖三等奖
教育部高等学校科学研究优秀成果奖（科学技术）自然科学奖一等奖
入选北京大学医学部“青年学者”奖励计划
北京市“科技新星”及教育部“新世纪优秀人才支持计划”
曾获得“华夏内分泌大会青年研究者奖”
北京大学黄廷芳/信和青年杰出学者奖
目前是JCEM、CEI、CMJ的审稿人
甲状腺激素对生殖功能的影响
不孕不育患者甲状腺功能的筛查
甲状腺自身免疫对生殖功能的影响及筛查策略
不孕患者甲状腺疾病的治疗
参考文献：
[1] LI Y, SHAN Z, TENG W. The Iodine Status and Prevalence of Thyroid Disorders Among Women of Childbearing Age in China: National Cross-sectional Study [J]. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 2021, 27(10): 1028-33.
[2] LI Y, TENG D, BA J, et al. Efficacy and Safety of Long-Term Universal Salt Iodization on Thyroid Disorders: Epidemiological Evidence from 31 Provinces of Mainland of China [J]. Thyroid : official journal of the American Thyroid Association, 2020, 30(4): 568-79.
[3] CONCEPCIóN-ZAVALETA M J, CORONADO-ARROYO J C, QUIROZ-ALDAVE J E, et al. Thyroid dysfunction and female infertility. A comprehensive review [J]. Diabetes & metabolic syndrome, 2023, 17(11): 102876.
[4] BHATT S H E, SEUNGDAMRONG A. Thyroid dysfunction and infertility [M]. Thyroid disease and reproduction: a clinical guide to diagnosis and management. Switzerland; Springer, Cham. 2019: p157–68.
[5] PICCIRILLI D, BALDINI E, MASSIMIANI M, et al. Thyroid hormone regulates protease expression and activation of Notch signaling in implantation and embryo development [J]. The Journal of endocrinology, 2018, 236(1): 1-12.
[6] KRASSAS G E, POPPE K, GLINOER D. Thyroid function and human reproductive health [J]. Endocrine reviews, 2010, 31(5): 702-55.
[7] MICHALAKIS K G, MESEN T B, BRAYBOY L M, et al. Subclinical elevations of thyroid-stimulating hormone and assisted reproductive technology outcomes [J]. Fertility and sterility, 2011, 95(8): 2634-7.
[8] MAZZILLI R, MEDENICA S, DI TOMMASO A M, et al. The role of thyroid function in female and male infertility: a narrative review [J]. Journal of endocrinological investigation, 2023, 46(1): 15-26.
[9] LA VIGNERA S, VITA R. Thyroid dysfunction and semen quality [J]. International journal of immunopathology and pharmacology, 2018, 32: 2058738418775241.
[10] WAJNER S M, WAGNER M S, MAIA A L. Clinical implications of altered thyroid status in male testicular function [J]. Arquivos brasileiros de endocrinologia e metabologia, 2009, 53(8): 976-82.
[11] 冯帆，张霖，谢广妹，倪亚莉. 重视不孕患者的甲状腺功能筛查 [J]. 生殖医学杂志, 2019, 28(2): 202-5.
[12] POPPE K, GLINOER D, VAN STEIRTEGHEM A, et al. Thyroid dysfunction and autoimmunity in infertile women [J]. Thyroid : official journal of the American Thyroid Association, 2002, 12(11): 997-1001.
[13] ABALOVICH M, MITELBERG L, ALLAMI C, et al. Subclinical hypothyroidism and thyroid autoimmunity in women with infertility [J]. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 2007, 23(5): 279-83.
[14] FELDTHUSEN A D, PEDERSEN P L, LARSEN J, et al. Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study [J]. Journal of pregnancy, 2015, 2015: 132718.
[15] POPPE K, BISSCHOP P, FUGAZZOLA L, et al. 2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction [J]. European thyroid journal, 2021, 9(6): 281-95.
[16] 中国优生优育协会生育力保护与修复专业委员会. 辅助生殖前和期间甲状腺疾病筛查诊治专家共识 [J]. 中华生殖与避孕杂志, 2024, 44(8): 777-83.
[17] Subclinical hypothyroidism in the infertile female population: a guideline [J]. Fertility and sterility, 2024, 121(5): 765-82.
[18] LOTTI F, MASEROLI E, FRALASSI N, et al. Is thyroid hormones evaluation of clinical value in the work-up of males of infertile couples? [J]. Human reproduction (Oxford, England), 2016, 31(3): 518-29.
[19] EISENBERG M L, LI S, BROOKS J D, et al. Increased risk of cancer in infertile men: analysis of U.S. claims data [J]. The Journal of urology, 2015, 193(5): 1596-601.
[20] POPPE K, GLINOER D, TOURNAYE H, et al. Is systematic screening for thyroid disorders indicated in subfertile men? [J]. European journal of endocrinology, 2006, 154(3): 363-6.
[21] CHEN C W, HUANG Y L, TZENG C R, et al. Idiopathic Low Ovarian Reserve Is Associated with More Frequent Positive Thyroid Peroxidase Antibodies [J]. Thyroid : official journal of the American Thyroid Association, 2017, 27(9): 1194-200.
[22] KOREVAAR T I M, MíNGUEZ-ALARCóN L, MESSERLIAN C, et al. Association of Thyroid Function and Autoimmunity with Ovarian Reserve in Women Seeking Infertility Care [J]. Thyroid : official journal of the American Thyroid Association, 2018, 28(10): 1349-58.
[23] POLYZOS N P, SAKKAS E, VAIARELLI A, et al. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values [J]. Human reproduction (Oxford, England), 2015, 30(7): 1690-6.
[24] RAO M, ZENG Z, ZHANG Q, et al. Thyroid Autoimmunity Is Not Associated with Embryo Quality or Pregnancy Outcomes in Euthyroid Women Undergoing Assisted Reproductive Technology in China [J]. Thyroid : official journal of the American Thyroid Association, 2023, 33(3): 380-8.
[25] LI J, YU J, HUANG Y, et al. The impact of thyroid autoimmunity on pregnancy outcomes in women with unexplained infertility undergoing intrauterine insemination: a retrospective single-center cohort study and meta-analysis [J]. Frontiers in endocrinology, 2024, 15: 1359210.
[26] 康宜凡，王治鸿，杨园. 甲状腺自身性免疫对不孕女性辅助生殖技术结局影响的荟萃分析 [J]. 生殖医学杂志, 2021, 30(10): 1349-58.
[27] UNUANE D, VELKENIERS B, ANCKAERT E, et al. Thyroglobulin autoantibodies: is there any added value in the detection of thyroid autoimmunity in women consulting for fertility treatment? [J]. Thyroid : official journal of the American Thyroid Association, 2013, 23(8): 1022-8.
[28] PAN M, QI Q, LI C, et al. Effect and mechanism of Hashimoto thyroiditis on female infertility: A clinical trial, bioinformatics analysis, and experiments-based study [J]. Bioscience trends, 2024, 18(4): 356-69.
[29] DONOVAN L, COCKWELL H, TALLON N, et al. Committee Opinion No. 407: Thyroid Disease and Infertility [J]. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2020, 42(10): 1279-82.
[30] BRUBAKER W D, LI S, BAKER L C, et al. Increased risk of autoimmune disorders in infertile men: analysis of US claims data [J]. Andrology, 2018, 6(1): 94-8.
[31] VELKENIERS B, VAN MEERHAEGHE A, POPPE K, et al. Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs [J]. Human reproduction update, 2013, 19(3): 251-8.
[32] LENG T, LI X, ZHANG H. Levothyroxine treatment for subclinical hypothyroidism improves the rate of live births in pregnant women with recurrent pregnancy loss: a randomized clinical trial [J]. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 2022, 38(6): 488-94.
[33] WANG H, GAO H, CHI H, et al. Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer: A Randomized Clinical Trial [J]. Jama, 2017, 318(22): 2190-8.
[34] DHILLON-SMITH R K, MIDDLETON L J, SUNNER K K, et al. Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception [J]. The New England journal of medicine, 2019, 380(14): 1316-25.
[35] VAN DIJK M M, VISSENBERG R, FLIERS E, et al. Levothyroxine in euthyroid thyroid peroxidase antibody positive women with recurrent pregnancy loss (T4LIFE trial): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial [J]. The lancet Diabetes & endocrinology, 2022, 10(5): 322-9.
[36] NEGRO R. Thyroid and Assisted Reproduction Technologies: A Brief Clinical Update with Recommendations for Practice [J]. Endocrine, metabolic & immune disorders drug targets, 2018, 18(3): 194-200.
