甲状腺毒症的管理：孕前、孕期和产后期间。

MANAGEMENT OF THYROTOXICOSIS: PRECONCEPTION, PREGNANCY, AND THE POSTPARTUM PERIOD.

出版信息

Endocr Pract. 2019 Jan;25(1):62-68. doi: 10.4158/EP-2018-0356. Epub 2018 Oct 5.

DOI:10.4158/EP-2018-0356

Abstract

OBJECTIVE

To review the diagnosis and management of thyrotoxicosis in women who are preconception, pregnant, and in the postpartum period.

METHODS

Literature review of English-language papers published between 1980 and 2018.

RESULTS

Overt thyrotoxicosis occurs in 0.2% of pregnancies and subclinical thyrotoxicosis in 2.5%. Hyperthyroidism in women of childbearing age most frequently is caused by Graves disease (GD). Gestational thyrotoxicosis, transient human chorionic gonadotropin (hCG)-mediated hyperthyroidism, may develop in the first trimester. In the first year following delivery, postpartum thyroiditis, which frequently includes a thyrotoxic phase, occurs in 5% of women. Hyperthyroidism from nodular autonomy is uncommon in women of childbearing age. It is essential to understand the underlying etiology for thyrotoxicosis in order to recommend appropriate treatment. Gestational thyrotoxicosis requires supportive care, without antithyroid drug therapy. GD may be treated with antithyroid drugs, radioactive iodine, or thyroidectomy. Pregnancy, plans for pregnancy, and lactation have important implications for the choice of GD treatment. When thyrotoxicosis presents following delivery, postpartum thyroiditis must be differentiated from GD.

CONCLUSION

The diagnosis and management of thyrotoxicosis in the peripregnancy period present specific challenges. In making management decisions, it is essential to weigh the risks and benefits of treatments not just for the mother but also for the fetus and for breastfed infants. A team approach to management is critical, with close collaboration among endocrinologists, maternal-fetal medicine specialists, and neonatologists.

ABBREVIATIONS

GD = Graves disease; hCG = human chorionic gonadotropin; MMI = methimazole; PPT = postpartum thyroiditis; PTU = propylthiouracil; T3 = triiodothyronine; T4 = thyroxine; TBG = thyroxine-binding globulin; TRAb = TSH receptor antibody; TSH = thyroid-stimulating hormone.

摘要

目的

回顾孕前、孕期和产后女性甲状腺功能亢进的诊断和治疗方法。

方法

对 1980 年至 2018 年间发表的英文文献进行综述。

结果

显性甲状腺功能亢进在妊娠中的发生率为 0.2%，亚临床甲状腺功能亢进为 2.5%。生育年龄女性的甲状腺功能亢进最常由 Graves 病（GD）引起。妊娠早期可能发生绒毛膜促性腺激素（hCG）介导的短暂性妊娠一过性甲状腺毒症。产后甲状腺炎在 5%的女性中发生，常包括甲状腺毒症期，出现在分娩后 1 年内。生育年龄女性结节性自主性甲状腺功能亢进症并不常见。了解甲状腺功能亢进的潜在病因对于推荐适当的治疗至关重要。妊娠一过性甲状腺毒症需要支持性治疗，无需抗甲状腺药物治疗。GD 可以用抗甲状腺药物、放射性碘或甲状腺切除术治疗。妊娠、妊娠计划和哺乳对 GD 治疗的选择有重要影响。分娩后出现甲状腺毒症时，必须将产后甲状腺炎与 GD 相鉴别。