Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
Lancet Diabetes Endocrinol. 2013 Nov;1(3):238-49. doi: 10.1016/S2213-8587(13)70086-X. Epub 2013 Oct 18.
Changes in thyroid hormone concentrations that are characteristic of hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. Approximately one to two cases of gestational hyperthyroidism occur per 1000 pregnancies. Identification of hyperthyroidism in a pregnant woman is important because adverse outcomes can occur in both the mother and the offspring. Graves' disease, which is autoimmune in nature, is the usual cause; but hyperthyroidism in pregnancy can be caused by any type of hyperthyroidism--eg, toxic multinodular goitre or solitary autonomously functioning nodule. Gestational transient thyrotoxicosis is typically reported in women with hyperemesis gravidarum, and is mediated by high circulating concentrations of human chorionic gonadotropin. Post-partum thyroiditis occurs in 5-10% of women, and many of those affected ultimately develop permanent hypothyroidism. Antithyroid drug treatment of hyperthyroidism in pregnant women is controversial because the usual drugs--methimazole or carbimazole--are occasionally teratogenic; and the alternative--propylthiouracil--can be hepatotoxic. Fetal hyperthyroidism can be life-threatening, and needs to be recognised as soon as possible so that treatment of the fetus with antithyroid drugs via the mother can be initiated. In this Review, we discuss physiological and pathophysiological changes in thyroid hormone economy in pregnancy, the diagnosis and management of hyperthyroidism during pregnancy, severe life-threatening thyrotoxicosis in pregnancy, neonatal thyrotoxicosis, and post-partum hyperthyroidism.
必须将甲状腺激素浓度的变化与妊娠期间发生的甲状腺激素代谢的生理变化区分开来，尤其是在妊娠早期。大约每 1000 例妊娠中就会发生 1 到 2 例妊娠性甲亢。识别孕妇的甲亢很重要，因为母亲和胎儿都会出现不良后果。Graves 病本质上是自身免疫性的，是常见的病因；但妊娠期间的甲亢也可由任何类型的甲亢引起，如毒性多结节性甲状腺肿或孤立的自主功能结节。妊娠剧吐的孕妇通常会出现妊娠一过性甲亢，这是由人绒毛膜促性腺激素的循环浓度升高介导的。产后甲状腺炎在 5-10%的女性中发生，其中许多受影响的女性最终会发展为永久性甲减。抗甲状腺药物治疗妊娠甲亢存在争议，因为常用药物甲巯咪唑或卡比马唑偶尔有致畸性；而替代药物丙基硫氧嘧啶则可能具有肝毒性。胎儿甲亢可能危及生命，需要尽快识别，以便通过母亲对胎儿进行抗甲状腺药物治疗。在这篇综述中，我们讨论了妊娠期间甲状腺激素代谢的生理和病理生理变化、妊娠期间甲亢的诊断和管理、妊娠期间危及生命的严重甲亢、新生儿甲亢和产后甲亢。
