Mestman J H
Department of Obstetrics and Gynecology, University of Southern California, School of Medicine, Los Angeles, USA.
Clin Obstet Gynecol. 1997 Mar;40(1):45-64. doi: 10.1097/00003081-199703000-00007.
The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common cause is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be reduced to a minimum with careful attention to the clinical symptoms and interpretation of thyroid tests. Ideally, hyperthyroid women should be rendered euthyroid before considering conception. The incidence of maternal and neonatal morbidity is significantly higher in those patients whose hyperthyroidism is not medically controlled. Even the incidence of thyroid storm is high in women who are under poor medical supervision in the presence of a medical or obstetric complication. Maternal morbidity includes a higher incidence of toxemia, premature delivery, placenta abruptio, congestive heart failure, and thyroid crisis. In some series, anemia and infections were also reported. Neonatal morbidity includes SGA neonates, intrauterine growth retardation, LBW infants, and prematurity. Fetal goiter and transient neonatal hypothyroidism is occasionally reported in infants of mothers who have been overtreated with ATD. Propylthiouracil and MMI are equally effective in controlling the disease. In most patients, symptoms improved and thyroid tests returned to normal in 3-8 weeks after initiation of therapy. Resistance to ATD is extremely rare, most cases are caused by patient poor compliance. Surgery for the treatment of hyperthyroidism is reserved for the unusual patient who is allergic to both ATD; to those who have large goiters; to those who require large doses of ATD; or to those patients who poorly comply. Fetal and neonatal hyperthyroidism can be predicted in the majority of cases by the previous maternal medical and obstetric history and by the proper interpretation of thyroid tests. Finally, hyperthyroidism may recur in the postpartum period.
妊娠期甲状腺功能亢进症的患病率约为0.2%。最常见的病因是格雷夫斯病。通过密切关注临床症状和解读甲状腺检查结果，可将母婴及新生儿的发病率和死亡率降至最低。理想情况下，甲状腺功能亢进的女性在考虑受孕前应使甲状腺功能恢复正常。甲状腺功能亢进未得到医学控制的患者，母婴发病率显著更高。即使在合并内科或产科并发症且医疗监管不佳的女性中，甲状腺危象的发生率也很高。母亲的发病率包括子痫前期、早产、胎盘早剥、充血性心力衰竭和甲状腺危象的发生率较高。在一些系列研究中，还报告了贫血和感染情况。新生儿发病率包括小于胎龄儿、宫内生长受限、低体重儿和早产。母亲接受抗甲状腺药物过度治疗的婴儿偶尔会出现胎儿甲状腺肿和短暂性新生儿甲状腺功能减退。丙硫氧嘧啶和甲巯咪唑在控制疾病方面同样有效。大多数患者在开始治疗后3 - 8周症状改善，甲状腺检查结果恢复正常。对抗甲状腺药物耐药极为罕见，大多数情况是由于患者依从性差所致。甲状腺功能亢进症的手术治疗仅适用于对两种抗甲状腺药物均过敏的特殊患者；甲状腺肿大的患者；需要大剂量抗甲状腺药物的患者；或依从性差的患者。大多数情况下，通过既往母亲的内科和产科病史以及对甲状腺检查结果的正确解读，可以预测胎儿和新生儿甲状腺功能亢进症。最后，甲状腺功能亢进症可能在产后复发。
