Mandel S J, Brent G A, Larsen P R
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Thyroid. 1994 Spring;4(1):129-33. doi: 10.1089/thy.1994.4.129.
Thioamide therapy has improved the outcome of pregnancies complicated by maternal hyperthyroidism, without long-term effects on cognitive and somatic development. However, there remain questions concerning whether these drugs, especially methimazole (MMI), may be associated with aplasia cutis congenita (ACC) and how best to avoid impairment of fetal thyroid function during their use. We report an example of ACC and review the relevant literature. We conclude that there is insufficient evidence either to establish or eliminate a direct causal relationship between ACC and MMI use. Since propylthiouracil is an equally effective antithyroid agent and has not been associated with ACC, it is the preferred thioamide for hyperthyroidism during pregnancy. Our review also indicates that impairment of neonatal thyroid function may be minimized by using a thioamide dose that is just sufficient to maintain the maternal serum free thyroxine concentration in the high normal or slightly thyrotoxic range.
硫代酰胺疗法改善了患有母体甲状腺功能亢进症的孕妇的妊娠结局，且对认知和身体发育没有长期影响。然而，关于这些药物，尤其是甲巯咪唑（MMI），是否可能与先天性皮肤发育不全（ACC）有关，以及在使用过程中如何最好地避免胎儿甲状腺功能受损，仍然存在疑问。我们报告了一例ACC病例并回顾了相关文献。我们得出的结论是，没有足够的证据来确定或排除ACC与使用MMI之间存在直接因果关系。由于丙硫氧嘧啶是一种同样有效的抗甲状腺药物，且与ACC无关，因此它是孕期甲状腺功能亢进症首选的硫代酰胺药物。我们的综述还表明，通过使用刚好足以将母体血清游离甲状腺素浓度维持在高正常或轻度甲状腺毒症范围内的硫代酰胺剂量，可以将新生儿甲状腺功能受损降至最低。
