Azizi Fereidoun, Amouzegar Atieh, Mehran Ladan, Alamdari Shahram, Subekti Imam, Vaidya Bijay, Poppe Kris, Sarvghadi Farzaneh, San Luis Teofilo, Akamizu Takashi
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocr J. 2014;61(8):751-8. doi: 10.1507/endocrj.ej14-0145. Epub 2014 May 22.
Maternal hyperthyroidism in pregnancy is associated with adverse impacts on both mother and fetus. Recently, the American Thyroid Association and the Endocrine Society have published guidelines for the management of thyroid diseases in pregnancy. We aimed to disclose the impact of these guidelines in current practices of Asian members of the Asia-Oceania Thyroid Association (AOTA) regarding the management of hyperthyroidism in pregnancy. Completed questionnaire survey, based on clinical case scenarios, was collected from 321 Asian physician members of AOTA from 21 Asian countries in 2013. For a woman with Graves' disease planning pregnancy, 92% of clinicians favored antithyroid treatment, 52% with propylthiouracil (PTU) while 40% preferred methimazole (MMI). For a pregnant woman with newly diagnosed overt hyperthyroidism, nearly all responders initiated PTU treatment. To monitor dosage of antithyroid drugs, approximately 73% of responders used TSH and free T4 (FT4) levels without free T3 (FT3) (53%) or with FT3 (20%). Majority of responders targeted achieving low serum TSH with FT4 (or total T4) in the upper end of the normal range. For management of gestational thyrotoxicosis, 40% chose to follow up and 52% treated patients with PTU. Although timing of TSH receptor antibodies measurement in pregnant hyperthyroid patients was variable, 53% of responders would check it at least once during pregnancy. Nearly 80% of responders do not treat subclinical hyperthyroidism in pregnancy. Therefore, despite wide variations in the management of hyperthyroidism during pregnancy in Asia, majority of Asian physicians practice within the recommendations of major professional societies.
妊娠期母体甲状腺功能亢进对母亲和胎儿均有不良影响。最近，美国甲状腺协会和内分泌学会发布了妊娠期甲状腺疾病管理指南。我们旨在揭示这些指南对亚洲-大洋洲甲状腺协会（AOTA）亚洲成员在妊娠期甲状腺功能亢进管理的当前实践中的影响。2013年，我们从21个亚洲国家的321名AOTA亚洲医师成员那里收集了基于临床病例情景的完整问卷调查。对于一名计划怀孕的格雷夫斯病女性，92%的临床医生倾向于抗甲状腺治疗，52%选择丙硫氧嘧啶（PTU），而40%更倾向于甲巯咪唑（MMI）。对于一名新诊断为显性甲状腺功能亢进的孕妇，几乎所有应答者都开始使用PTU治疗。为监测抗甲状腺药物剂量，约73%的应答者使用促甲状腺激素（TSH）和游离甲状腺素（FT4）水平，其中53%未检测游离三碘甲状腺原氨酸（FT3），20%检测了FT3。大多数应答者的目标是使血清TSH降低，同时FT4（或总T4）处于正常范围上限。对于妊娠期甲状腺毒症的管理，40%选择随访，52%用PTU治疗患者。尽管妊娠甲亢患者促甲状腺激素受体抗体检测时间各不相同，但53%的应答者会在孕期至少检测一次。近80%的应答者不治疗妊娠期亚临床甲状腺功能亢进。因此，尽管亚洲在妊娠期甲状腺功能亢进管理方面存在很大差异，但大多数亚洲医生的实践符合主要专业学会的建议。
