怀孕期间甲亢怎样治疗

怀孕期间甲亢如何治疗配图，仅供参考

Treatment of GD in the pregnant woman
Thionamide antithyroid drugs (ATDs) are the mainstay of treatment for overt gestational hyperthyroidism due to GD,since radioiodine therapy is obviously contraindicated and thyroidectomy,though feasible,should be reserved for highly selected cases [,[ .
Different ATD strategies have been indicated,according to whether GD is first diagnosed in pregnancy,or pregnancy occurs in a woman already receiving ATDs for GD. In both cases the therapeutic goal is to control maternal hyperthyroidism in order to prevent obstetrical and medical complications (see paragraph Maternal an fetal adverse events of GD).
When GD is first diagnosed in pregnancy,decision to prescribe ATDs should be based on a careful risk–benefit assessment on an individual basis,taking into account either the severity of maternal hyperthyroidism or the potential deleterious effects of ATDs on the fetus [,[ . In general,starting doses of ATDs during pregnancy are within the range of 200–400 mg daily for PTU or 10–20 mg daily for MMI [ . If ATD therapy is started during the first trimester,PTU is preferred over MMI because the risk for severe birth defects is lower [ . Following initiation of therapy,close monitoring of maternal thyroid function should be performed,and ATD dosage adjusted to maintain maternal thyroid hormone levels in the upper reference range [ (see paragraph Effects of maternal ATD therapy on the fetal thyroid).
Management of women already treated with ATDs before pregnancy depends on the severity and activity of GD when pregnancy establishes. In general,discontinuation of antithyroid medications may be considered for women without large goiters or positive TRAbs,who had been receiving ATDs for at least 6 months prior to becoming pregnant and are euthyroid on low MMI or PTU doses (≤5-10 mg/day and ≤100–200 mg/day,respectively) [,[ . Conversely,women in whom the risk of recurrence of thyrotoxicosis is estimated to be high if ATDs were to be discontinued,should be maintained on medical therapy (PTU in the first trimester,MMI thereafter) at the lowest dosage useful to maintain thyroid hormone levels in the upper reference range [,[ . In both circumstances,i.e. if treatment is either suspended or continued,close monitoring of maternal thyroid function (every 1–2 weeks over the course of 1st trimester,and every 2–4 weeks during the 2nd and 3rd trimester) is needed to guide further management (conservative or interventional),bearing in mind that both hyperthyroidism and overtreatment may have deleterious effects on the fetus. Since pregnancy is usually associated with attenuation in both immunological and biochemical features of GD,most women with active GD prior to conception may withdraw their therapy in the last trimester,.
Alternative therapies for GD in pregnancy include thyroidectomy,potassium iodide and β-blocking drugs.
Thyroidectomy is indicated when the woman is not compliant with ATDs,or when these medications are ineffective (uncontrolled hyperthyroidism with doses as high as 40–60 mg daily of MMI or 800–1200 mg daily of PTU),or not tolerated,or there is a large goiter causing compressive symptoms. When deemed necessary,thyroidectomy can be performed most safely in the 2nd trimester,and both beta-blocking agents and a short course of potassium iodide solution are recommended in preparation for surgery [ .
Potassium iodide has also been effectively used to treat mild gestational hyperthyroidism in Japan [,[ . However,data on safety and efficacy of such therapy in populations with iodine intake lower than in Japan are limited,and this modality of treatment is not presently recommended for GD during pregnancy [ .
Finally,propranolol may be transiently given,because of its efficacy in reducing symptoms of thyrotoxicosis. Although this drug has no teratogenic effects,its use should be limited because chronic use has been reported in association with intrauterine growth restriction [ .","department":"