摘要
正确处理妊娠期间甲状腺疾病是优生优育的重要内容之一。本文结合2011年颁布的“妊娠和产后甲状腺疾病诊治指南”，对妊娠期间甲状腺功能的生理变化，妊娠期甲状腺功能评定，控制存在的甲状腺功能异常避免给胎儿和妊娠过程造成的不良影响做一概述。对于妊娠期Graves病的诊断，要特别强调与妊娠甲状腺功能亢进综合征相鉴别，抗甲状腺药物的选择早期为丙硫氧嘧啶，中晚期改为甲巯咪唑。妊娠期一旦确诊甲状腺功能减退，应立即选择左甲状腺素（L—T4）治疗，并尽早使得血清促甲状腺激素（TSH）水平达标，即孕早期0．1～2．5mU／L，孕中期0．2～3．0mU／L，孕晚期0-3～3．0mU／L。由于妊娠期分化型甲状腺癌的预后和非妊娠期相似，因此手术可推迟至产后施行，并给予L-T4抑制治疗，将血清TSH控制在0．1～1．5mU／L。对于孕期的良性甲状腺结节，不建议补充L-T4治疗。
Abstract Correctly handling thyroid disease during pregnancy is one of important elements in prenatal and postnatal care. In this article, based on the China guideline of diagnosis and treatment of thyroid disease during pregnancy and postpartum promulgated in 201 l, we summarized the knowledge on the physiologic changes of the thyroid and pathological function evaluation during pregnancy We also described how to control gestational thyroid dysfunction in order to prevent adverse maternal and fetal outcomes. For Graves disease during pregnancy, we stressed differential diagnosis between it and gestational hyperthyroidism syndrome when pregnancy hyperthyroidism is diagnosed. Propylthiouracil is recommended as anti-thyroid drug for the first 3 months, and then superseded by thiamazole during the middle-late pregnancy. Once hypothyroidism during pregnancy is diagnosed, levothyroxine （L-T4） therapy should be applied, and the serum level of thyroid stimulating hormone （TSH） should be insured to the recommended levels as soon as possible, i.e, first trimester 0.1-2.5mU/L, second trimester 0.2-3.0mU/L, and third trimester 0.3-3.0mU/L. The prognosis of pregnancy differentiated thyroid cancer （DTC） is similar with that of non-pregnant, therefore the surgery may be deferred to postpartum. L-T4 suppression therapy should be given before operation, and the serum TSH target level is kept in 0.1-1.5mU/L, For pregnancy benign thyroid nodules, L-T4 suppression treatment is not suggested.
出处
《中华老年多器官疾病杂志》
2013年第2期111-115,共5页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
甲状腺疾病
妊娠
诊断
thyroid disease
pregnancy
diagnoses
