Lind P
Abteilung für Nuklearmedizin und Spezielle Endokrinologie, Landeskrankenhauses Klagenfurt.
Acta Med Austriaca. 1997;24(4):157-8.
Therapy of thyroid dysfunction needs a close cooperation between endocrinologist and gynecologist. In addition to a number of metabolic changes during pregnancy, the diaplacentar transfer of different substances (thionamides, antibodies) has to be considered. Pregnant women with overt and subclinical hypothyroidism should be treated using L-Thyroxine with the bTSH between 1 and 2 mU/l. Many of the women need an increase of the L-Thyroxine dose during pregnancy. Overt hyperthyroidism (mostly due to Graves' disease) has to be treated immediately after diagnosis using thionamides. Because thionamides cross the placenta, the dose should be as low as possible with the fT4 in upper level and bTSH in the lower level of normal range. Most studies show, that both methimazole (MI) and propylthiouracil (PTU) can be used in pregnancy. Although PTU is preferred especially in the USA, an advantage of PTU over MI is not proven. Surgery is necessary in only few cases of hyperthyroidism during pregnancy with the optimal time for surgery during the second trimester. In case of subclinical hyperthyroidism and HCG induced hyperthyroidism several controls of thyroid function should be performed to decide whether treatment is necessary.
甲状腺功能障碍的治疗需要内分泌科医生和妇科医生密切合作。除了孕期的一些代谢变化外，还必须考虑不同物质（硫代酰胺、抗体）的胎盘转运情况。临床显性和亚临床甲状腺功能减退的孕妇应使用左甲状腺素进行治疗，使促甲状腺激素（bTSH）维持在1至2 mU/l之间。许多女性在孕期需要增加左甲状腺素的剂量。临床显性甲状腺功能亢进（主要由格雷夫斯病引起）在诊断后必须立即使用硫代酰胺进行治疗。由于硫代酰胺可穿过胎盘，剂量应尽可能低，使游离甲状腺素（fT4）处于正常范围上限，促甲状腺激素（bTSH）处于正常范围下限。大多数研究表明，甲巯咪唑（MI）和丙硫氧嘧啶（PTU）在孕期均可使用。尽管在美国尤其首选PTU，但PTU相对于MI的优势尚未得到证实。孕期甲状腺功能亢进仅在少数情况下需要手术，手术的最佳时间是孕中期。对于亚临床甲状腺功能亢进和人绒毛膜促性腺激素（HCG）诱导的甲状腺功能亢进，应多次进行甲状腺功能检查，以决定是否需要治疗。
