Pregnancy with hyperthyroidism

Overview of hyperthyroidism (hyperthyroidism) is a common endocrine disease, the Department of thyroid hormone secretion caused by excessive. Hyperthyroidism women speaking menstrual disorders, reduce or amenorrhea, low fertility. But after treatment or untreated hyperthyroidism women, pregnancy are also many, and its incidence is approximately 1 : 1000 ~ 2500 pregnancy. Hyperthyroidism in pregnancy most of Graves disease, which is a major auto-immune and mental stimulation. Characteristics of a diffuse goiter and exophthalmos. Clinical manifestations of normal pregnancy as maternal thyroid morphology and function changes In many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output, increased thyroid, skin warmth, sweating, fear fever, loss of appetite, hyperthyroidism, and hyperthyroidism during pregnancy were common. Mild hyperthyroidism right no obvious pregnancy, but moderate and severe symptoms of hyperthyroidism and not control the abortion rate, the incidence of preeclampsia, premature, full-term infants and the incidence of perinatal mortality rate increased. Hyperthyroidism in pregnancy right reasons is not yet clear, perhaps because of hyperthyroidism so that 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. Pregnancy hyperthyroidism little impact on the contrary, pregnancy often cause hyperthyroidism disease have varying degrees of ease. But pregnancy with severe hyperthyroidism, pregnancy may increase the burden on the heart and increase the hyperthyroid patients original change of heart disease. Individual patients due to childbirth, postpartum bleeding, infection can be induced hyperthyroidism crisis. As normal pregnancy diagnosis of maternal thyroid morphology and function changes, in many respects similar to the clinical manifestation of hyperthyroidism. For example, tachycardia, cardiac output, increased thyroid, skin warmth, sweating, fear fever, loss of appetite, hyperthyroidism, Hyperthyroidism in pregnancy and were uncommon, so that the diagnosis of hyperthyroidism during pregnancy has been difficult. In prenatal tests found hyperthyroidism symptoms and signs, should make further thyroid function test for diagnosis. The diagnosis of hyperthyroidism during pregnancy criteria : high metabolic syndrome. total serum thyroxine (96.25%) ≥ 180.6nmol / L (14μg/dl) three total triiodothyronine (TT3) ≥ 3.54nmol / L (230ng/dl) free thyroxine index (FT4I) ≥ 12.8. Hyperthyroid condition to the highest level of 96.25% "1.4 times the normal upper limit of mild hyperthyroidism; "1.4 times the upper limit of normal moderate hyperthyroidism; a crisis, hyperthyroid heart disease and heart failure, Severe myopathy, such as hyperthyroidism. Treatment (1) pre-pregnancy : Hyperthyroidism due to a series of adverse fetal effects, such as the diagnosis of hyperthyroidism. should wait until a stable condition ~ 3 years after the pregnancy properly, medication (anti-thyroid drugs or radioactive iodine), should not be pregnant, should take contraceptive measures. (2) dealing with a pregnancy) hyperthyroidism in high-risk pregnant women should check with outpatient follow-up, pay attention to fetal growth rate, actively control preeclampsia. 2) can be tolerated during pregnancy mild hyperthyroidism, the light conditions and generally do not have anti-thyroid medication, because of antithyroid drug can affect the fetus through the placenta thyroid function. However, severe illness and should continue to use anti-thyroid medication. During pregnancy, late antithyroid drug dose should not be too large. to maintain the general level of maternal TT4 not exceed the normal limit of 1.4 times, also can have a mild hyperthyroidism. "1.4 times the normal upper limit when using anti-thyroid drugs. Antithyroid drugs, the PTU not only can block thyroid hormone synthesis, T4 and blocked the surrounding tissue into play interim efficacy of T3, serum T3 levels decline rapidly. Usual dose PTU 150 ~ 300 mg / d, or tapazole 15 ~ 30 mg / d, Hyperthyroidism can gradually control reductions. In before the expected date of 2 ~ 3 weeks medication, or use of controlled hyperthyroidism the smallest effective dose. PTU daily dosage 200 mg below tapazole below 20 mg, Fetal goiter occurrence is very unlikely. For the application of antithyroid drug therapy with whether to increase the thyroid hormone dispute Thyroid hormone is not easy due to pass through the placenta, but increased use of antithyroid drug dose, Joint application can eliminate antithyroid drug-induced hypothyroidism and the prevention of fetal because antithyroid drugs impact occurred hypothyroidism or goiter. 3) As anti-thyroid drugs can quickly affect the fetus through the placenta thyroid function, Some people advocate that the anti-thyroid drugs intravenously thyroid total resection, and achieved good results. But generally of the opinion that should be avoided during pregnancy thyroidectomy for hyperthyroidism during pregnancy surgery rather difficult. Yi mother after the merger hypothyroidism, hypoparathyroidism and recurrent laryngeal nerve injury. and surgery can lead to miscarriages and premature. 4) beta-blocker propranolol (Inderal) applications, 10-20mg dose three times daily. Propranolol hyperthyroidism pregnant women is an effective drug treatment, Due to alleviate excessive thyroid hormone-induced systemic symptoms. Propranolol role of faster, better and apply to the crisis hyperthyroidism and thyroid surgery urgent preparations for the rapid. However, beta-blocker heart failure in early or metabolic acidosis will encourage patients with acute heart failure, Under general anesthesia could cause serious hypotension, long-term use of propranolol can cause increased muscle tension, lead to stunted placenta and fetal growth retardation, hyperthyroidism during pregnancy it is not appropriate as the preferred drug. 5) obstetric treatment : pregnancy with hyperthyroidism, treatment properly, can be reached full-term pregnancy, vaginal delivery and access live births. Hyperthyroidism is not the indication of cesarean section, pregnancy with severe hyperthyroidism, prematurity and perinatal mortality rates higher, and intrauterine growth retardation may, it is necessary to strengthen pregnancy hyperthyroidism observation and control, regular follow-up fetal placental function and prevent premature. 6) postpartum treatment : a recurrence of postpartum hyperthyroidism tendency to increase postpartum antithyroid drug dose. Breastfeeding on postpartum issues, although antithyroid drugs baby through breast milk affect thyroid function, But we think that a combination of maternal illness and the extent of use of antithyroid drug dose to consider whether breastfeeding. 7) the treatment of hyperthyroidism Crisis : uncontrolled hyperthyroidism during pregnancy and stop anti-thyroid medication, OK obstetric surgery and post-natal and post-natal infection bloody crisis will cause hyperthyroidism, if not treated in time can occur : high fever, tachycardia, Heart failure, absence seizures, coma. Treatment should be given a large number of anti-thyroid drugs such as methyl or propyl PTU, each 100-200mg, Every six hours a week; tapazole or hyperthyroidism-10 ~ 20 mg every 6 hours for a oral. Oral not disoriented, will be injected via nasal feeding tube. Oral Compound iodine solution, the daily 30% drop. Propranolol 20-40mg every 4 ~ 6 hours a oral, or 0.5 ~ 1 mg intravenous injection, application to cardiac function. Reserpine 1 ~ 2 mg intramuscular injection once every six hours. Hydrocortisone 200 ~ 400mg daily, intravenous drip; And to be broad-spectrum antibiotics, oxygen, cold compress and sedation antipyretic agent, correct water and electrolyte imbalance and heart failure. 8) Neonatal Management : pregnant women to give birth in hyperthyroidism newborns need to check for the presence of hypothyroidism. goiter or hyperthyroidism, and thyroid function tests for. Maternal TSH, T4 and T3 is difficult to pass through the placenta barrier. But long-term thyroid-stimulating hormone (LATS) easily through the placenta barrier, Therefore suffering from hyperthyroidism mothers of infants likely to have neonatal hyperthyroidism. These newborns can apparently exophthalmos hyperthyroidism and the signs, Determination of cord blood T4 and TSH concentration valuation neonatal thyroid function. Neonatal hyperthyroidism in soon after birth, or a week away. Neonatal hyperthyroidism treatment, including tapazole daily 1mg/kg 0.5 ~. or PTU 5 ~ 10 mg daily, at times using them, plus the compound of iodine solution, each a dripping, three times a day; a failure to apply the digitalis, excited to apply the sedatives. Pregnant mothers consumed antithyroid drugs, newborn likely temporary hypothyroidism should be addressed.