中国实用妇科与产科杂志

中国实用妇科与产科杂志 ›› 2013, Vol. 9 ›› Issue (6): 415-419.

• 专题笔谈 • 上一篇    下一篇

妊娠合并甲状腺功能亢进症的诊治

王红梅，王谢桐   

  1. 作者单位：山东大学附属省立医院妇产科，山东 济南250021
  • 出版日期:2013-06-02 发布日期:2013-05-27

  • Online:2013-06-02 Published:2013-05-27

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摘要：

毒性弥漫性甲状腺肿（Graves病）是妊娠合并甲状腺功能亢进症（甲亢）最常见的原因。血清促甲状腺激素（TSH）<0.1 mU/L，游离甲状腺素（FT4）高于妊娠特异参考值上限，排除妊娠期甲亢综合征（SGH）后，甲亢诊断可以成立。妊娠期治疗甲亢的药物主要是丙基硫氧嘧啶（PTU）和甲巯咪唑（MMI）。主要不良反应为肝脏毒性、粒细胞缺乏和致畸性。因此，建议孕早期用PTU，3个月后用MMI。抗甲状腺药物（ATD）应当使用最小有效剂量，防止胎儿甲状腺功能减退。高水平的促甲状腺激素受体抗体(TRAb)可通过胎盘造成胎儿甲亢。产后应用ATD可降低甲亢复发率。ATD可少量分泌到乳汁中，但都不会影响后代发育。

关键词: 甲状腺功能亢进症, 毒性弥漫性甲状腺肿, 抗甲状腺药物, 妊娠

Abstract:

Abstract：The diagnosis of hyperthyroidism is confirmed by elevated serum free thyroxine (FT4) and decreased TSH(<0.1 mU/L). Graves disease，the most common cause of hyperthyroidism during pregnancy，is characterized by a typical goiter，and presence of TSH receptor antibodies (TRAb).TRAb could cross the placenta and stimulate the fetal thyroid.Antithyroid drug therapy (ATD)，including propylthiouracil (PTU)and methimazole(MMI)，has been used to maintain FT4 in the upper limit of the normal reference range.PTU should be limited in the first trimester for its potential liver toxicity，while MMI should be used after the first trimester for its teratogenicity. ATD should be adjustmented according to the serum FT4 level to avoid side effects to the fetus.Postpartum ATD treatment cause little harm to the baby.

Key words: hyperthyroidism；Graves disease；antithyroid drug therapy, pregnancy

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