Hyperthyroidism is common and hyperthyroidism is also common. To talk about hyperthyroidism during pregnancy, we must first introduce a few concepts related to hyperthyroidism.
It means that there are too many thyroid hormones in the blood circulation and cause hyperthyroidism.The prevalence of thyroid poison during pregnancy is 1%, of which 0.4%of the clinical hyperthyroidism is 0.4%, and the sub -clinical hyperthyroidism accounts for 0.6%.Analyzing the cause, 85%of Graves disease, including pre -pregnancy and new Graves disease; hyperthyroidism syndrome (SGH, also known as one excessive hyperthyroidism), accounts for 10%;The fetus and so on account for only 5%.
In early pregnancy, serum TSH <0.1miu/L, indicating the possibility of having thyroid disease, and further determining FT4, TT3, Trab, and TPOAB.However, the taboo 131 iodine intake rate and radioactive nucleo scan examination, and the contraindication is for 131 iodine treatment.
Pregnancy hyperthyroidism syndrome
It occurred in the first half of pregnancy and was excessive, which was related to the increase in HCG and excessive stimulation of thyroid hormones.The clinical characteristics are 8-10 weeks of disease. High metabolic symptoms such as palpitations, anxiety, and sweat are high. Serum FT4 and TT4 have increased, serum TSH is reduced or unable to measure, and the thyroid antibody is negative.This disease is related to the vomiting of pregnancy, and 30%-60%of pregnancy drama vomiting occurs SGH.SGH needs to be identified with hyperthyroidism with Graves. The latter is often accompanied by eye signs and TPOAB, such as TPOAB, such as nails such as positive.When the serum TSH <0.1miu/L, FT4> The reference value of the special reference value of pregnancy, and the exclusion of hyperthyroidism syndrome (SGH), the diagnosis of hyperthyroidism can be established.
Treatment of hyperthyroidism syndrome
SGH is dominated by symptomatic treatment. Pregnant drama needs to control vomiting, correct dehydration, and maintain hydrolysis balance.It is not argued that anti-thyroid drugs (ATD) treatment is generally treated, because serum thyroid hormones can be returned to normal at 14-18 weeks of pregnancy.When SGH and Graves are difficult to identify, ATD can be used in a short period of time, such as propyl sulfide (PTU).Graves’s hyperthyroidism is not easy to alleviate, and ATD requires further treatment.
It is an organ specific self -immune disease with abnormal increased secretion of thyroid hormone.
(1) Symptoms and signs of common clinical hyperthyroidism;
(2) Physical examination and imaging examination shows that the thyroid gland is diffuse enlargement (a small number of cases may not have obvious thyroid enlargement);
(3) The level of serum TSH decreases, and the level of serum thyroid hormone levels increases;
(4) Eye outstanding and other invasive eye symbols;
(5) Ahead of the tibial mucus edema;
(6) Trab or thyroid stimulation anti -body positive;
(7) Thyrum adherence 131 I increase.
In the above standards, (1) (2) (3) is a necessary condition for diagnosis, while (4) (5) (6) (7) item is the diagnostic auxiliary condition, which can be further clearly diagnosed.The above does not include sub -clinical hyperthyroidism.
Graves disease women’s choice of pre -pregnancy treatment method
If patients with Graves chose thyroid surgical resection or 131 iodine therapy, there are the following recommendations: (1) patient TRAB high titration, and those who are planning to be pregnant within 2 years should choose thyroid surgical resection.because
After the application of 131 iodine treatment, TRAB maintains a high drop of high drops for several months, which may have adverse effects on the fetus;
(2) For 48h before iodine treatment, you need to do pregnancy test to verify whether you are pregnant to avoid the radiation effect of 131 iodine on the fetus;
(3) Thyroid surgery or 6 months after 131 iodine treatment can be pregnant.At this stage, the alternative treatment of L-T4 was received to maintain the serum TSH at 0.3-2.5miu/L level.
If patients with Graves chose ATD treatment, there are the following recommendations:
(1) MMI (MMI) and PTU have risks to both mothers and fetuses;
(2) MMI may cause the risk of fetal deformity, so it is recommended to stop MMI before pregnancy and change the PTU.Early pregnancy is preferred to choose PTU, MMI is a second -line option;
(3) After the early pregnancy, change it to MMI to avoid the liver toxicity of the PTU.
During the pregnancy, the state of thyroid function is directly related to the ending of the pregnancy. Poority of thyroid poison is related to abortion, pregnancy hypertension, premature birth, low weight, intrauterine growth, dead tires, thyroid hazards, and pregnant women with congestive heart failure.
How to choose drugs to control hyperthyroidism during pregnancy?
There are two commonly used ATDs: MMI and PTUs. During the early pregnancy, MMI will increase the risk of skin development and "hydimazole -related embryo disease", including the locking of the posterior nose and esophageal, facial deformity, etc.Therefore, the PTU is preferred before and early pregnancy to avoid using MMI.However, recently the US FDA report PTU may cause liver damage, and even cause acute liver failure. It is recommended to use PTU only during early pregnancy to reduce the chance of causing liver damage.Therefore, in addition to early pregnancy, priority is given to MMI.The equivalent dose ratio of PTU and MMI is 10: 1 to 15: 1 (ie PTU100mg = MMI7.5-10mg).The initial dose of ATD depends on the severity of the symptoms and the level of serum thyroid hormones.In general, the starting dose of ATD is as follows: MMI 5-15mg/D, or PTU 50-300mg/d, take it in daily.Pay attention to monitoring thyroid dysfunction and adverse drug reactions (especially blood and liver function) when converting PTU and MMI.
β adrenaline receptor resistant agent, Pulfalol 20-30mg/d, every 6-8 h, is helpful for controlling the symptoms of hyperthyroidism.The long -term treatment of β receptor blocking agent is related to the limited growth of the palace, the fetal heart movement alleviates the hypoglycemia of the newborn, and the profit and disadvantage should be weighed when used, and the β adrenal receptor resistant agent can be used for thyroid resectionPreoperative preparation.
Objectives for hyperthyroidism during pregnancy
ATD can use the placenta barrier. In order to avoid adverse effects on the fetus, the minimum dose of ATD should be used to achieve its control target, that is, the serum FT4 value of the pregnant woman is close or mild than the reference value.
The TSH and FT4 are monitored every 2-4 weeks during the starting stage, and monitors are monitored every 4-6 weeks after the target value is achieved.ATD should be avoided because there is a possibility of fetal goiter and hypothyroidism.Pregnant women’s serum FT4 is the main monitoring indicator of hyperthyroidism, because serum TSH can hardly be measured during pregnancy.The serum TT3 is not recommended as a monitoring indicator, because the literature reports that when the mother TT3 reaches normal, the TSH of the fetus has risen; howeverFrom the perspective of natural diseases, Graves’s hyperthyroidism may increase during early pregnancy and gradually improved.Therefore, the ATD dosage can be reduced in the middle and late pregnancy. In the late pregnancy, 20%-30%of patients can be disabled, but pregnant women with high levels of TRAB must be continuously applied in these cases until delivery.
Can surgical therapy be taken during pregnancy to treat hyperthyroidism?
The adaptation of hyperthyroidism during pregnancy is:
(1) Allergic to ATD;
(2) A large dose of ATD is required to control hyperthyroidism;
(3) Patients are not treated according to ATD.
If the surgery is determined, the best time in the middle of pregnancy is the best time.The titer of the pregnant woman TRAB is determined during surgery to evaluate the potential risk of hyperthyroidism in the fetus. It is recommended to apply β-injury blocking agent and short-term iodized solution (50-100mg/d) before surgery to prepare.
The significance of the test of pregnant woman TRAB titer
Trab Titian is the main symbol of the Graves disease activity.
(1) fetal hyperthyroidism;
(2) Newborn hyperthyroidism;
(3) Fetal hypothyroidism;
(4) Newborn hypothyroidism;
(5) Central armor reduction.
The occurrence of the above complications depends on the following factors:
(1) Poor hyperthyroidism during pregnancy may induce short -term fetal central nail reduction;
(2) Excess ATD is related to the hypothyroidism of the fetus and neonatal;
(3) At 22-26 weeks of pregnancy, a high drop of TRAB is a risk factor for fetal or neonatal hyperthyroidism;
(4) 95%of the TRAB titration of hyperthyroidism in active Graves increased, and continued to rise after thyroid resection surgery.
Pregnancy Graves disease needs to monitor the Introduction to TRAB:
(1) Mother has active hyperthyroidism;
(2) History of radioactive iodine treatment;
(3) There was a history of the birth of hyperthyroidism;
(4) A hyperthyroidism was performed during pregnancy.
Pregnant women who have a history of hyperthyroidism in the history of active Graves or previous Graves hyperthyroidism have 1%and 5%of the incidence of hyperthyroidism in the fetus and neonatal.
At 24-28 weeks of pregnancy, the determination of serum TRAB is helpful for assessing the end of pregnancy. The TRAB is higher than the reference value of more than 3 times the upper limit of the reference value.It is generally decreased at 20 weeks of pregnancy.
Diagnosis of hyperthyroidism of fetus and neonatal
The prevalence of hyperthyroidism in women and neonatal hyperthyroidism in Graves disease is about 1%. The maternal thyroid stimulating antibody reaches the fetus through the placenta to stimulate the fetal noreal gland and cause hyperthyroidism.This mainly occurs in Graves disease women with high drops of TRAB (Trab> 30%or TSAB> 300%). They usually occur during pregnancy. They first have hyperthyroidism and hyperthyroidism after birth.The average TSAB in the newborn has an average of 1 month, which can be extended to 4 months after giving birth.As the newborn TSAB disappears, hyperthyroidism relieves.
The tachycardia of the fetus is the earliest signs of the fetal hyperthyroidism. The heart rate> 170 times/min, lasting more than 10min.Fetal goiter is another important signs and usually occurs before the tachycardia.Ultrasonic examination is the main method of discovery of thyroidism. The volume of the thyroid volume of different fetal age has already been reported. Ultrasonic examinations can also be found that fetal bone age acceleration and delay in the palace growth can be found.
Symptoms and signs of hyperthyroidism in neonatal usually appear around 10D after birth. Due to the simultaneous existence of the mother’s anti -thyroid drug or inhibitory antibody, the symptoms may appear or delayed after a few days later.Newborns with high -risk factors of hyperthyroidism, such as evidence of functional thyroid poison, mothers who have received anti -thyroid drugs during pregnancy, maternal thyroid stimulating immunoglobulin titer, and has a secondary student caused by secondary TSH receptor mutationsThe family history of the hyperthyroidism family, etc., should be closely monitored to the newborn thyroid function after birth.Obvious thyroid disease, the level of serum FT3, FT4, TT3, and TT4 increases, and TSH can be diagnosed with hyperthyroidism.
The treatment of neonatal hyperthyroidism includes anti -thyroid drugs, iodine and other supportive treatment.The hyperthyroidism caused by thyroid stimulation immunoglobulin is temporary. When the mother antibody is cleared from the neonatal body, it can be restored to normal.
How to treat Graves hyperthyroidism during lactation?
It is safe to take ATD in moderation during breastfeeding.Because of the toxicity of PTU, MMI should be preferred, and the MMI dose reaches 20-30 mg/d, which is safe for maternal and infants.PTU can be used as a second -line drug, and 300mg/d is also safe.The method of taking the medicine is to take the medicine after breastfeeding and monitor the thyroid function of the baby.
PS: Okay, if you do n’t understand, this is normal. Medicine is actually very complicated and boring. It is also full of helplessness. There is often no standard answer, and there are no good diagnostic methods, treatment methods, and solving solutions.plan.
It does n’t matter if you do n’t understand it yourself, show this article to your obstetrician or endocrine doctor, and discuss how to deal with your hyperthyroidism with TA. If you do n’t understand, I advise you to change the doctor quickly and change the hospital.
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