Wallace C, Couch R, Ginsberg J
Department of Endocrinology, University of Alberta, Edmonton, Canada.
Thyroid. 1995 Apr;5(2):125-8. doi: 10.1089/thy.1995.5.125.
A maternal history of Graves' disease places the fetus at risk for thyrotoxicosis in utero via the placental transfer of thyroid-stimulating immunoglobulins. Methods for prediction of fetal hyperthyroidism are available, but are not widely used. Clinical assessment of fetal thyroid status by monitoring of fetal heart rate and growth may be inaccurate. This raises some uncertainty in the initial diagnosis of fetal thyrotoxicosis and complicates the assessment of fetal response to maternal propylthiouracil therapy. A case illustrating these pitfalls in the diagnosis and management of fetal hyperthyroidism is presented. The condition was correctly diagnosed, but treatment based on fetal heart rate resulted in biochemical hypothyroidism in the infant at birth. Current recommendations for diagnosis and treatment of fetal hyperthyroidism are reviewed along with recent developments in the field. A modified approach is proposed.
格雷夫斯病的母亲病史会使胎儿通过胎盘转运甲状腺刺激免疫球蛋白而在子宫内面临甲状腺毒症的风险。预测胎儿甲状腺功能亢进的方法是存在的，但未得到广泛应用。通过监测胎儿心率和生长情况对胎儿甲状腺状态进行临床评估可能不准确。这在胎儿甲状腺毒症的初始诊断中引发了一些不确定性，并使评估胎儿对母亲丙硫氧嘧啶治疗的反应变得复杂。本文介绍了一个说明胎儿甲状腺功能亢进诊断和管理中这些陷阱的病例。病情得到了正确诊断，但基于胎儿心率的治疗导致婴儿出生时出现生化性甲状腺功能减退。本文回顾了目前关于胎儿甲状腺功能亢进诊断和治疗的建议以及该领域的最新进展。并提出了一种改进方法。
