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中华产科急救电子杂志 ›› 2024, Vol. 13 ›› Issue (01) : 18 -23. doi: 10.3877/cma.j.issn.2095-3259.2024.01.004

妊娠合并内分泌疾病

妊娠合并甲状腺功能亢进的诊治进展
徐真1, 白桂芹1,()   
  1. 1. 710061 西安交通大学第一附属医院妇产科 基因联合实验室
  • 收稿日期:2023-10-30 出版日期:2024-02-18
  • 通信作者: 白桂芹

Current status of the diagnosis and treatment on hyperthyroidism in pregnancy

Zhen Xu, Guiqin Bai()   

  • Received:2023-10-30 Published:2024-02-18
  • Corresponding author: Guiqin Bai
引用本文:

徐真, 白桂芹. 妊娠合并甲状腺功能亢进的诊治进展[J/OL]. 中华产科急救电子杂志, 2024, 13(01): 18-23.

Zhen Xu, Guiqin Bai. Current status of the diagnosis and treatment on hyperthyroidism in pregnancy[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2024, 13(01): 18-23.

妊娠合并甲状腺功能亢进是指在妊娠期间甲状腺分泌过多的甲状腺激素,导致机体代谢率加快,并出现一系列症状,对母婴健康产生一定影响。妊娠期甲状腺功能亢进诊断的主要指标是促甲状腺激素抑制、高水平游离甲状腺素和(或)高水平游离三碘甲腺原氨酸。主要治疗方式是抗甲状腺药物,目标是用最小有效剂量的抗甲状腺药物使血清游离甲状腺素/总甲状腺素接近或轻度高于参考范围上限。定期监测,正确诊断与评估,以及合理管理是确保母儿良好结局的关键。

Pregnancy complicated by hyperthyroidism refers to the condition where the thyroid gland produces an excessive amount of thyroid hormone during pregnancy. This leads to an increased metabolic rate in the body and the occurrence of various symptoms, which can have an impact on the health of both the mother and the baby. The main diagnostic indicators of hyperthyroidism in pregnancy are thyroid stimulating hormone (TSH) suppression and high levels of free tetraiodothyronine (FT4) and free triiodothyronine (FT3). The primary treatment for hyperthyroidism during pregnancy involves the use of antithyroid drugs. The aim is to administer the lowest effective dose of these drugs to achieve FT4/TT4 levels that are close to or slightly above the upper limit of the reference range. Regular monitoring, accurate assessment, and appropriate management are essential to ensure favorable outcomes for both the mother and the fetus.

表1 妊娠期甲状腺功能亢进的原因[1]
表2 Graves病与GTT的鉴别诊断[11]
[1]
Cooper DS, Laurberg P. Hyperthyroidism in pregnancy[J]. Lancet Diabetes Endocrinol20131(3):238-249.
[2]
Greenhill C. Obesity: gut microbiome and serum metabolome changes[J]. Nat Rev Endocrinol201713(9):501.
[3]
Laurberg P, Andersen SL, Hindersson P, et al. Dynamics and predictors of serum TSH and FT4 reference limits in early pregnancy: a study within the Danish national birth cohort[J]. J Clin Endocrinol Metab.2016101(6):2484-2492.
[4]
Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum[J]. Thyroid201121(10):1081-1125.
[5]
Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J]. Thyroid201727(3):315-389.
[6]
ACOG. Thyroid disease in pregnancy: ACOG practice bulletin, number 223[J]. Obstet Gynecol2020135(6):e261-274.
[7]
《妊娠和产后甲状腺疾病诊治指南》(第2版)编撰委员会,中华医学会内分泌学分会,中华医学会围产医学分会. 妊娠和产后甲状腺疾病诊治指南(第2版)[J].中华内分泌代谢杂志201935(8):636-665.
[8]
Dong AC, Stagnaro-Green A. Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and meta-analysis[J]. Thyroid201929(2):278-289.
[9]
Laurberg P, Andersen SL. Endocrinology in pregnancy: pregnancy and the incidence, diagnosing and therapy of Graves′ disease[J]. Eur J Endocrinol2016175(5):R219-230.
[10]
Kinomoto-Kondo S, Umehara N, Sato S, et al. The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case-control study[J]. Arch Gynecol Obstet2017295(1):87-93.
[11]
Guo N, Xue M, Liang Z. Advances in the differential diagnosis of transient hyperthyroidism in pregnancy and Graves′ disease[J]. Arch Gynecol Obstet2023308(2):403-411.
[12]
Turunen S, Vääräsmäki M, Lahesmaa-Korpinen AM, et al. Maternal hyperthyroidism and pregnancy outcomes: a population-based cohort study[J]. Clin Endocrinol202093(6):721-728.
[13]
Andersen SL, Andersen S, Vestergaard P, et al. Maternal thyroid function in early pregnancy and child neurodevelopmental disorders: a Danish nationwide case-cohort study[J]. Thyroid201828(4):537-546.
[14]
Liu Y, Li Q, Xu Y, et al. Comparison of the safety between propylthiouracil and methimazole with hyperthyroidism in pregnancy: a systematic review and meta-analysis[J]. PloS One202318(5):1-13.
[15]
Kuy S, Roman SA, Desai R, et al. Outcomes following thyroid and parathyroid surgery in pregnant women[J]. Arch Surg2009144(5):399-406.
[16]
Erbil Y, Ozluk Y, Giris M, et al. Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves′ disease[J]. J Clin Endocrinol Metab200792(6):2182-2189.
[17]
Yoshihara A, Noh JY, Watanabe N, et al. Substituting potassium iodide for methimazole as the treatment for Graves′ disease during the first trimester may reduce the incidence of congenital anomalies: a retrospective study at a single medical institution in Japan[J]. Thyroid201525(10):1155-1161.
[18]
Azizi F, Amouzegar A. Management of hyperthyroidism during pregnancy and lactation[J]. Eur J Endocrinol, 2011164(6):871-876.
[19]
Gudala K, Bansal D, Kandikatla LR, et al. PRM12-Thyroid dysfunction detection in pregnancy: universal screening or targeted high-risk case finding? A meta-analysis[J]. Value in Health201316(7):A701.
[20]
《孕产期甲状腺疾病防治管理指南》编撰委员会,中华医学会内分泌学分会,中华预防医学会妇女保健分会. 孕产期甲状腺疾病防治管理指南[J]. 中华内分泌代谢杂志202238(7):539-551.
[21]
Rotondi M, Cappelli C, Pirali B, et al. The effect of pregnancy on subsequent relapse from Graves′ disease after a successful course of antithyroid drug therapy[J]. J Clin Endocrinol Metab200893(10):3985-3988.
[22]
Azizi F, Khoshniat M, Bahrainian M, et al. Thyroid function and intellectual development of infants nursed by mothers taking methimazole[J]. J Clin Endocrinol Metab200085(9):3233-3238.
[23]
Momotani N, Yamashita R, Makino F, et al. Thyroid function in wholly breast-feeding infants whose mothers take high doses of propylthiouracil[J]. Clin Endocrinol200053(2):177-181.
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