妊娠期甲状腺疾病诊断及治疗的研究进展

Research Progress of the Diagnosis and Treatment of Gestational Thyroid Disease

妊娠期妇女体内激素水平会发生变化,使妊娠妇女甲状腺激素水平的测定和判断存在一定的困难,应选择适用于妊娠妇女的甲状腺激素水平特异值,进而正确评估甲状腺功能状态及对母体和胎儿的影响。孕前及妊娠期测定促甲状腺素和游离甲状腺激素有很大的必要性,因为甲状腺疾病以及单纯性甲状腺抗体阳性会导致多种妊娠不良结局,尤其是甲状腺功能减退对胎儿智力发育和认知功能具有非常大的影响。孕期甲状腺激素的监测对评估甲状腺功能状态及疾病预后具有非常大的作用,可以提示临床医师是否给予药物干预及如何调整药量。对于孕期甲状腺激素补充治疗后应达到的目标值以及甲状腺抗体阴性的亚临床甲状腺功能降低的妊娠患者是否给予干预,目前仍有异议。

During pregnancy, the levels of hormones change, which makes it difficult to determinate the thyroid hormone levela lot. We should determine the specific thyroid hormone level in pregnant women, thus we can correctly evaluate the status of thyroid function and the effect on the mother and the fetus. It is necessary to determinate thyrotropin and free thyroxine in prepregnancy and pregnancy, because the thyroid disease and thyroid antibodies alone can cause a variety of adverse pregnancy outcomes, especially hypothyroidism on fetal development and cognitive function is not very big effect. Monitoring of maternal thyroid hormone has great influence on the prognosis of disease status and thyroid function, which can prompt the clinician to give drug intervention and adjust the dosage. There remain objections as to which target should maternal thyroid hormone replacement therapy reach and whether intervene thyroid antibody negative patients with subclinical hypothyroidism.