Ashkar Claudia, Sztal-Mazer Shoshana, Topliss Duncan J
Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.
Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia.
Clin Endocrinol (Oxf). 2023 May;98(5):643-648. doi: 10.1111/cen.14705. Epub 2022 Mar 8.
The management of Graves' disease (GD) in women of childbearing potential has multiple specific complexities. Many factors are involved, which differ at the various stages from preconception, conception, first trimester, later pregnancy, postpartum and lactation, with both maternal and foetal considerations. The incidence and significance of the risks incurred from antithyroid drugs (ATDs) in pregnancy have been re-evaluated recently and must be balanced against the risks of uncontrolled hyperthyroidism during childbearing years. Contraception is advised until hyperthyroidism is controlled. ATD cessation should be considered in those who are well controlled on low dose therapy before conception and in early pregnancy. Advice on iodine supplementation does not generally differ in those with GD. Radioiodine (RAI) is contraindicated from 6 months preconception until completion of breastfeeding. In all women who have a history of GD, monitoring of TSH receptor antibodies (TRAb) is strongly recommended during pregnancy, and if elevated, foetal monitoring and assessment of thyroid function in the neonate are required. Of note, RAI increases TRAb for up to a year, making this treatment option even less attractive in this patient group. A small amount of ATD is transferred into breast milk but low doses are safe during lactation. Routine periodic thyroid function testing is recommended in remission to detect postpartum GD recurrence. We present our approach to the Clinical Question 'How to manage GD in women of childbearing potential?'
对有生育潜力的女性进行格雷夫斯病（GD）的管理存在多种特殊复杂性。涉及许多因素，这些因素在孕前、孕期、孕早期、孕晚期、产后和哺乳期等不同阶段各不相同，同时要兼顾母体和胎儿的情况。近期重新评估了孕期使用抗甲状腺药物（ATD）所带来风险的发生率和重要性，必须将其与育龄期甲亢未控制的风险进行权衡。在甲亢得到控制之前建议采取避孕措施。对于在孕前和孕早期接受低剂量治疗病情得到良好控制的患者，应考虑停用ATD。对于GD患者，碘补充建议通常并无差异。从孕前6个月到哺乳期结束，禁忌使用放射性碘（RAI）。对于所有有GD病史的女性，强烈建议在孕期监测促甲状腺激素受体抗体（TRAb），如果TRAb升高，则需要对胎儿进行监测并评估新生儿的甲状腺功能。值得注意的是，RAI会使TRAb升高长达一年，这使得该治疗方案在这类患者群体中更缺乏吸引力。少量的ATD会进入母乳，但低剂量在哺乳期是安全的。建议在病情缓解期进行定期甲状腺功能检测，以发现产后GD复发。我们展示了针对临床问题“如何管理有生育潜力女性的GD？”的处理方法。
