Current status of the diagnosis and treatment on hyperthyroidism in pregnancy

doi:10.3877/cma.j.issn.2095-3259.2024.01.004

Abstract

Abstract:

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.

Key words: Pregnancy, Hyperthyroidism, Diagnosis, Therapeutics

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

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References 23

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分类	原因
TSH受体过度刺激	1.Graves病(TSH受体自身抗体) 2．妊娠期一过性甲状腺功能亢进(hCG诱导) 3．家族性妊娠期甲状腺功能亢进(TSH受体突变) 4．滋养细胞疾病(hCG诱导) 5．产生TSH的垂体腺瘤
自主甲状腺激素分泌	1.多结节性毒性甲状腺肿 2．孤立性毒性甲状腺腺瘤 3．基因组激活TSH受体突变
甲状腺滤泡破坏与释放	1.亚急性(肉芽肿性、德奎尔万性)甲状腺炎(病毒感染) 2．无痛性(无症状)甲状腺炎(自身免疫性) 3．急性甲状腺炎(细菌感染)
甲状腺激素的甲状腺外来源	1.甲状腺激素过度治疗 2．甲状腺激素的人为摄入 3．功能性甲状腺癌转移 4．卵巢甲状腺肿

分类	原因
TSH受体过度刺激	1.Graves病(TSH受体自身抗体) 2．妊娠期一过性甲状腺功能亢进(hCG诱导) 3．家族性妊娠期甲状腺功能亢进(TSH受体突变) 4．滋养细胞疾病(hCG诱导) 5．产生TSH的垂体腺瘤
自主甲状腺激素分泌	1.多结节性毒性甲状腺肿 2．孤立性毒性甲状腺腺瘤 3．基因组激活TSH受体突变
甲状腺滤泡破坏与释放	1.亚急性(肉芽肿性、德奎尔万性)甲状腺炎(病毒感染) 2．无痛性(无症状)甲状腺炎(自身免疫性) 3．急性甲状腺炎(细菌感染)
甲状腺激素的甲状腺外来源	1.甲状腺激素过度治疗 2．甲状腺激素的人为摄入 3．功能性甲状腺癌转移 4．卵巢甲状腺肿

疾病名称	发病时间	孕前症状	妊娠期症状	恶心/呕吐	甲状腺肿/眼病	TT₃/TT₄比率	STA-PSV(cm/s)	STA-D(mm)	TSH(mU/L)	hCG(mIU/mL)
Graves病	妊娠各期	＋＋	＋/＋＋＋	－/＋	＋	>20	<40	>2.0	<0.01	<70 000
GTT	8～12周	＋	－/＋	＋＋＋＋	－	<20	>40	<2.0	>0.01	>70 000

疾病名称	发病时间	孕前症状	妊娠期症状	恶心/呕吐	甲状腺肿/眼病	TT₃/TT₄比率	STA-PSV(cm/s)	STA-D(mm)	TSH(mU/L)	hCG(mIU/mL)
Graves病	妊娠各期	＋＋	＋/＋＋＋	－/＋	＋	>20	<40	>2.0	<0.01	<70 000
GTT	8～12周	＋	－/＋	＋＋＋＋	－	<20	>40	<2.0	>0.01	>70 000

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