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selected，including 352 with a twin pregnancy（twin group），and 988 with a singleton pregnancy（singleton group）.
Clinical and laboratory data were collected. The lower and upper limits for determining normal maternal thyroid function during
twin pregnancies were the 2.5 （P 2.5 ） and 97.5 （P 97.5 ） percentiles of TSH and FT 4 . Clinical hyperthyroidism was defined
as TSH<P 2.5（total TSH） and FT 4 >P 97.5（total FT4） . Clinical hypothyroidism was defined as TSH>P 97.5（total TSH） and FT 4 <P 2.5（total FT4） .

Subclinical hypothyroidism was diagnosed by TSH>P 97.5 and P 2.5 ≤ FT 4 ≤ P 97.5 . Low T 4 syndrome was diagnosed by P 2.5（total
TSH） ≤ TSH ≤ P 97.5 （total TSH） and FT 4 <P 2.5 （total FT4） . FT 4 and TSH levels in the early，middle and late pregnancy were compared
between singleton and twin groups. Prevalence of thyroid function abnormalities in the early，middle and late pregnancy was in
twin group was recorded and analyzed. Results Three hundred and fifty-two pregnant women with a twin pregnancy and 988 with
a singleton pregnancy were finally included. The average FT 4 level in the twin group was higher than that of the singleton group
regardless of the stage of pregnancy （P<0.05）. The average TSH level in the twin group was lower in the early pregnancy，
but was higher in late pregnancy compared with that of singleton group （P<0.05）. For maternal thyroid function during a twin
pregnancy，the determined normal FT 4 in the early，middle and late pregnancy expressed as median and interquartile range M（P 2.5 ，
P 97.5 ） was 〔11.84（7.95，26.73）〕，〔8.24（5.53，18.58）〕，〔8.37（5.80，15.79）〕pmol/L，respectively，and
the determined normal TSH in the three stages of pregnancy was〔0.67（0.03，3.99）〕，〔1.44（0.06，4.79）〕，〔2.43（0.41，
6.92）〕mU/L，respectively. In the twin group，the prevalence of hyperthyroidism，clinical hypothyroidism，subclinical
hypothyroidism，and low T 4 syndrome was 0，0.28% （1/352），4.83% （17/352） and 3.98% （14/352），respectively，
by the above-mentioned criteria for diagnosing thyroid disease in a twin pregnancy，and that of the four diseases was 8.24%
（29/352），0，15.91% （56/352） and 1.99% （7/352），respectively，by the criteria for diagnosing thyroid disease in a
singleton pregnancy. Conclusion In this study, the recommended reference ranges of FT 4 in the early, middle and late stages of
pregnancy were 7.95-26.73, 5.53-18.58 and 5.80-15.79 pmol/L, respectively, and the reference ranges of TSH were 0.03-3.99,
0.06-4.79 and 0.41-6.92 mU/L, respectively. Based on the FT 4 and TSH standards of the pregnant women with twin pregnancies
obtained in our laboratory as the reference standards, the incidence of thyroid dysfunction detected in the pregnant women with
twin pregnancies is low, which is consistent with relevant literature reports. The FT 4 and TSH standard range of single pregnancy
obtained in our laboratory may lead to overdiagnosis of hyperthyroidism and subclinical hypothyroidism in pregnant women of twin
pregnancy. So it is necessary to establish specific reference intervals for pregnant women with twin pregnancies based on the FT 4
and TSH standard ranges obtained in our laboratory.
【Key words】 Thyroid diseases；Pregnancy，twin；Thyrotropin ；Free thyroxine；Reference values

妊娠合并甲状腺功能异常可引起流产、早产、胎 查的双胎妊娠健康孕妇作为双胎组。
盘早剥等不良妊娠结局 ［1］ ，影响胎儿神经系统发育， 双胎妊娠健康孕妇需符合美国国家临床生化学会
导致子代智力、体格发育落后 ［2］ 。双胎妊娠孕妇甲状 （National Academy of Clinical Biochemistry，NACB） 推
腺功能受胎盘分泌激素的影响，促甲状腺激素（thyroid 荐的妊娠期“标准人群”的条件 ［3］ ，包括：（1）妊娠
stimulating hormone，TSH）水平低于单胎妊娠孕妇，而 期进行 1 次及以上的甲状腺功能筛查；（2）TPOAb 水
游离甲状腺素（free thyroxine，FT 4 ）水平却高于单胎妊 平在检测试剂生产厂家提供的参考范围内；（3）年龄
娠孕妇 ［3］ 。如采用单胎妊娠实验室检查标准判断双胎 20~40 岁；（4）妊娠 6~9 周首次经超声确认为双胎妊娠，
妊娠孕妇的甲状腺功能状况，可能导致妊娠合并甲状腺 直至分娩为双活胎。
疾病的误诊和漏诊。因此，有必要建立适用于双胎妊 排除标准：有甲状腺疾病史（甲状腺肿大、甲状腺
娠孕妇甲状腺功能判断标准。本研究对妊娠期双胎健 功能亢进或减退、甲状腺癌、甲状腺手术或放射性碘治
康孕妇的甲状腺功能及甲状腺过氧化物酶抗体（thyroid 疗史）及甲状腺疾病家族史；妊娠期服用治疗甲状腺疾
peroxidase antibody，TPOAb）进行了检测，分析妊娠期 病的药物；使用可能影响甲状腺功能的药物（如抗惊厥
甲状腺功能的变化特点，建立其特异性的甲状腺功能指 药、抗精神病药、糖皮质激素、多巴胺等）；有心脏病
标参考范围，并对甲状腺功能异常在双胎妊娠中的患病 史、慢性高血压、糖尿病、哮喘、炎症性肠病、肿瘤、
情况进行探讨，旨在为双胎妊娠孕妇妊娠期甲状腺疾病 肾脏疾病、肝脏疾病、自身免疫性疾病和结缔组织疾病
的临床诊治提供参考。 等慢性疾病史；有血液传播疾病史；有妊娠相关并发症
1 资料与方法 （包括妊娠期高血压、妊娠期糖尿病、早产或其他不良
1.1 一般资料 回顾性选取 2009 年 1 月至 2019 年 9 妊娠结局、滋养细胞疾病或晚期妊娠出血等）；染色体
月在首都医科大学附属北京友谊医院产科门诊行产前检 异常或遗传综合征；辅助生殖术后；反复流产史；胎儿