Research Institute for Endocrine Sciences, Endocrine Research Center, Shahid Beheshti University, PO Box 19395-4763, Tehran 198517413, Islamic Republic of Iran.
Eur J Endocrinol. 2011 Jun;164(6):871-6. doi: 10.1530/EJE-10-1030. Epub 2011 Mar 9.
Poorly treated or untreated maternal overt hyperthyroidism may affect pregnancy outcome. Fetal and neonatal hypo- or hyper-thyroidism and neonatal central hypothyroidism may complicate health issues during intrauterine and neonatal periods.
To review articles related to appropriate management of hyperthyroidism during pregnancy and lactation.
A literature review was performed using MEDLINE with the terms 'hyperthyroidism and pregnancy', 'antithyroid drugs and pregnancy', 'radioiodine and pregnancy', 'hyperthyroidism and lactation', and 'antithyroid drugs and lactation', both separately and in conjunction with the terms 'fetus' and 'maternal.'
Antithyroid drugs are the main therapy for maternal hyperthyroidism. Both methimazole (MMI) and propylthiouracil (PTU) may be used during pregnancy; however, PTU is preferred in the first trimester and should be replaced by MMI after this trimester. Choanal and esophageal atresia of fetus in MMI-treated and maternal hepatotoxicity in PTU-treated pregnancies are of utmost concern. Maintaining free thyroxine concentration in the upper one-third of each trimester-specific reference interval denotes success of therapy. MMI is the mainstay of the treatment of post partum hyperthyroidism, in particular during lactation.
Management of hyperthyroidism during pregnancy and lactation requires special considerations and should be carefully implemented to avoid any adverse effects on the mother, fetus, and neonate.
未经治疗或治疗不当的母体显性甲状腺功能亢进症可能会影响妊娠结局。胎儿和新生儿的甲状腺功能减退症或甲状腺功能亢进症以及新生儿中枢性甲状腺功能减退症可能会在宫内和新生儿期引发健康问题。
回顾与妊娠和哺乳期甲状腺功能亢进症的适当管理相关的文章。
使用 MEDLINE 数据库，使用“甲状腺功能亢进症和妊娠”、“抗甲状腺药物和妊娠”、“放射性碘和妊娠”、“甲状腺功能亢进症和哺乳期”和“抗甲状腺药物和哺乳期”等术语进行文献复习，单独或与“胎儿”和“产妇”等术语一起进行检索。
抗甲状腺药物是治疗母体甲状腺功能亢进症的主要方法。甲巯咪唑（MMI）和丙硫氧嘧啶（PTU）均可在妊娠期间使用；然而，PTU 更适用于妊娠早期，且应在该时期后用 MMI 替代。MMI 治疗的胎儿鼻后孔和食管闭锁以及 PTU 治疗的母体肝毒性是最令人担忧的问题。将游离甲状腺素浓度维持在每个特定妊娠阶段参考区间的上三分之一表示治疗成功。MMI 是治疗产后甲状腺功能亢进症的主要方法，尤其是在哺乳期。
妊娠和哺乳期甲状腺功能亢进症的管理需要特别考虑，并应谨慎实施，以避免对母亲、胎儿和新生儿产生任何不良影响。
