论文部分内容阅读
妊娠期甲状腺激素代谢的生理性改变使Graves病的诊治更加复杂。妊娠期Graves病必须使用抗甲状腺药物(ATD)治疗,尽可能使用最低剂量的ATD维持母体游离甲状腺素(FT4)于非孕期的正常高值附近是最理想的选择。胎儿甲状腺功能取决于通过胎盘屏障的促甲状腺激素(TSH)受体抗体(TRAb)与ATD之间的平衡。晚孕早期母体TRAb滴度升高是胎儿发生甲状腺功能亢进的一个危险因素,此时亦应行胎儿甲状腺超声检查。临床可以通过调整孕妇ATD用量治疗胎儿甲状腺功能亢进。若妊娠期Graves病未得到控制,或孕妇曾因Graves病行放射性碘治疗或甲状腺切除术,怀孕时TRAb仍阳性者,须于分娩时检测脐带血TSH及FT4(总甲状腺素)。
Physiological changes in thyroid hormone metabolism during pregnancy complicate diagnosis and treatment of Graves’ disease. Graves’ disease during pregnancy must be treated with antithyroid drugs (ATD), and using the lowest possible dose of ATD to maintain maternal free thyroxine (FT4) in the vicinity of normal highs during non-pregnancy is the best option. Fetal thyroid function depends on the balance between the thyroid-stimulating hormone (TSH) receptor antibody (TRAb) that passes through the placental barrier and ATD. Increased maternal TRAb titer in early pregnancy is a risk factor for hyperthyroidism in the fetus and fetus thyroid ultrasound examination should also be performed at this time. Clinical treatment of fetal thyroid hyperthyroidism by adjusting the amount of ATD. If Graves’ disease is not controlled during pregnancy, or if pregnant women have had radiosurgery or thyroidectomy due to Graves disease and TRAb is still positive during pregnancy, cord blood TSH and FT4 (total thyroxine) should be tested at delivery.