Pregnancy with hyperthyroidism

Pregnancy with hyperthyroidism
[Summary]



Hyperthyroidism (hyperthyroidism) is a common endocrine diseases of the thyroid hormone secretion caused by excessive. Hyperthyroidism women frequently manifests itself menstrual disorders, reduce or amenorrhea, low fertility. But after treatment of hyperthyroidism or untreated women, many also pregnant, the incidence of 1:1000 to 2500 about the pregnancy. Most of hyperthyroidism during pregnancy is Graves disease, which is a largely self-induced immunity and spirit, features diffuse goiter and exophthalmos.



[Diagnosis]




As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common, so that pregnant women with hyperthyroidism diagnosis has been difficult. In the prenatal examination found that the signs and symptoms of hyperthyroidism, the thyroid gland should be done further to the function of diagnosis. The diagnosis of hyperthyroidism during pregnancy criteria: high metabolic syndrome, serum total thyroxine (TT4) ≥ 180.6 nmol / L (14 μ g / dl), total triiodothyronine (TT3) ≥ 3.54 nmol / L (230ng / dl), free thyroxine index (FT4I) ≥ 12.8. TT4 hyperthyroid condition to the highest level <1.4 times the normal upper limit for those mild hyperthyroidism;> 1.4 times the normal upper limit for the moderate hyperthyroidism; crisis, heart disease and congestive heart failure hyperthyroidism, myopathy, etc. Severe hyperthyroidism.


[Treatment]




(1) Pre-pregnancy: hyperthyroidism due to a series of adverse effects on fetuses such as diagnosis of hyperthyroidism should be stable condition 1 to 3 years after pregnancy properly, medication (anti-thyroid drugs or radioactive iodine), should not be pregnant, should take contraceptive measures.

(2) dealing with pregnancy

1) hyperthyroidism in high-risk pregnant women should check with outpatient follow-up, pay attention to fetal growth, a positive control preeclampsia.

2) mild hyperthyroidism during pregnancy can be tolerated, the light conditions, in general do not have anti-thyroid medication, because of anti-thyroid drugs to fetus through the placenta affect thyroid function. However, severe illness, should continue to use anti-thyroid medication. Pregnancy, the late anti-thyroid drug dose should not be too large, in order to maintain the general level of maternal TT4 not more than 1.4 times the normal upper limit for the degree, but also can be mild hyperthyroidism. > 1.4 times the upper limit of normal when using anti-thyroid drugs. Antithyroid drugs, Propylthiouracil-not only can block thyroid hormone synthesis, and in the surrounding tissue blocking transit T4 into T3 effectiveness of the play, serum T3 levels decline rapidly. Common dose Propylthiouracil-150 ~ 300 mg / d, or tapazole 15 ~ 30 mg / d, hyperthyroidism can gradually reduce control. In the pre-production period of 2 to 3 weeks ago did not medication, or use of the minimum effective control of hyperthyroidism. Propylthiouracil-maintained in the amount of 200 mg per day below tapazole 20 mg below, the possibility of fetal goiter occurred minimal. For in the application of anti-thyroid drugs in the treatment of thyroid hormone increases with the problem of controversy, not because of thyroid hormone through the placenta, but increased use of anti-thyroid drug dose, but can be combined to eliminate anti-thyroid drug-induced hypothyroidism and the prevention of fetal due to the impact of anti-thyroid drugs in hypothyroidism or goiter.

3) The anti-thyroid drugs can rapidly fetus through the placenta affect thyroid function, it was argued that the anti-thyroid drug therapy later, underwent total thyroidectomy, and achieved good results, but the general view was that pregnancy should be avoided thyroidectomy because of pregnancy Hyperthyroidism surgery more difficult period, after the mother-merger hypothyroidism, hypoparathyroidism and recurrent laryngeal nerve injury, and surgery induce miscarriages and premature.

4) β-blocker propranolol (Inderal) the application of 10 ~ 20 mg dose three times daily. Propranolol hyperthyroidism pregnant women is an effective therapeutic drugs, to ease due to excessive thyroid hormone caused by systemic symptoms. Propranolol role faster, better results, applicable to hyperthyroidism crisis and implementation of emergency preparations for the rapid thyroid surgery. However, β-blockers, or heart failure in the early metabolic acidosis in patients with acute heart failure will lead to, under general anesthesia can cause severe hypotension, long-term use of propranolol can increase uterine muscle tone, leading to development of the placenta bad, and intrauterine growth retardation, it was not in hyperthyroidism during pregnancy as the preferred drug.

5) Obstetric Care: pregnancy with hyperthyroidism, appropriate treatment, full-term pregnancy can be reached by vaginal delivery and access live births. Hyperthyroidism cesarean section is not the indication, pregnant women with severe hyperthyroidism, prematurity and perinatal infant mortality high, and intrauterine growth retardation may be, it hyperthyroidism during pregnancy to strengthen observation and control, regular follow-up fetus placental function and prevent premature.

6) puerperium treatment: after a recurrence of hyperthyroidism tendency to increase postpartum anti-thyroid drug dose. Breastfeeding on postpartum Although the issue of anti-thyroid drugs will be affected by infant milk thyroid function, but we believe that a combination of the severity of the maternal illness, as well as taking anti-thyroid drug dose to consider whether breast-feeding.

7) the treatment of hyperthyroidism Crisis: uncontrolled hyperthyroidism during pregnancy and stop anti-thyroid medication, surgery and post-natal visit obstetric postpartum bleeding and infection-induced hyperthyroidism crisis will be, if not timely treatment can occur high fever, tachycardia , heart failure, absence, coma. Should be given a large number of anti-thyroid drugs, such as methyl or propyl AECA, each 100 to 200 mg orally once every six hours; tapazole or hyperthyroidism-10 ~ 20 mg orally once every six hours. Thought to be oral, can be injected into the nasal feeding tube. Oral compound iodine solution, drops about 30 daily. Propranolol 20 ~ 40 mg every 4 to 6 hours a oral, or 0.5 to 1 mg intravenous injection, when the attention of cardiac function. Reserpine 1 ~ 2 mg, intramuscular injection, once every six hours. Hydrocortisone 200 ~ 400 mg daily, intravenous drip and to be broad-spectrum antibiotics, oxygen, cooling and sedation antipyretic agent, correct water and electrolyte imbalance and heart failure.

8) Neonatal Management: pregnant women to give birth on neonatal hyperthyroidism, should pay attention to check for hypothyroidism, goiter or hyperthyroidism, and thyroid function tests.

Maternal TSH, T4 and T3 difficult to pass the placenta barrier, but the long-term thyroid-stimulating hormone (LATS) very easily through the placenta barrier, suffering from hyperthyroidism mother to the possibility of a newborn baby hyperthyroidism, which can be apparent newborns exophthalmos and signs of hyperthyroidism, the umbilical cord blood of T4 and TSH concentration valuation newborn thyroid function. Neonatal hyperthyroidism may appear immediately after birth, or one week away. Neonatal hyperthyroidism treatment, including daily tapazole 0.5 to 1 mg / kg, or Propylthiouracil-daily 5 to 10 mg / kg, at times taking, plus compound iodine solution, each a dripping, three times a day; of heart failure, digitalis, excited to apply sedatives.

Pregnant mothers who have taken anti-thyroid drug, likely to be temporary neonatal hypothyroidism should be addressed.


[Clinical]




As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common.

Mild hyperthyroidism had no effect on pregnancy, but the severe symptoms of hyperthyroidism, as well as control of the abortion rate, the incidence of preeclampsia, premature birth rate, and term Xiaoyanger incidence of perinatal mortality increased. Hyperthyroidism causes of the impact of pregnancy is not clear, may be due to hyperthyroidism to excessive consumption of nutritional elements, as well as the high incidence of pregnancy-induced hypertension, and the impact caused by placental function.

By the placenta during pregnancy barriers, only a small amount of T3, T4 through the placenta, it will not cause neonatal hyperthyroidism. Hyperthyroidism little effect on pregnancy on the contrary, pregnancy often cause hyperthyroidism condition have varying degrees of ease. But pregnancy with severe hyperthyroidism, pregnancy may increase the burden of the heart, and increased heart disease patients with hyperthyroidism original variable. Individual patients due to childbirth, postpartum bleeding, infection can be induced hyperthyroidism crisis.