妊娠期及哺乳期抗甲状腺药物的使用研究进展

Use of Antithyroid Drugs in Pregnancy and Lactation——Recent Developments

正常的甲状腺功能是保证胎儿生长发育的重要前提,但妊娠期甲状腺功能亢进是极为常见的内分泌系统疾病,甲状腺功能亢进的母亲在哺乳期的治疗也关系到母亲及胎儿甲状腺功能的恢复。本文介绍了抗甲状腺药物包括甲巯咪唑(MMI)、丙硫氧嘧啶(PTU)的作用机制以及不良反应,简述了妊娠期和哺乳期甲状腺功能亢进母亲在不同时间服用不同剂量抗甲状腺药物对于母儿甲状腺功能的影响,最终推荐孕早期首选PTU,孕中/晚期首选MMI,并且鼓励甲状腺功能亢进母亲哺乳期服用抗甲状腺药物,推荐服用低到中度剂量的MMI作为一线治疗方案,PTU作为二线用药。此外,指出妊娠期和哺乳期合理服用抗甲状腺药物不会严重影响婴儿的甲状腺功能、身体以及智力的发育。

Normal maternal thyroid function plays an important role in fetal growth and development.However,hyperthyroidism during pregnancy,an endocrine disorder,is frequently seen.Moreover,its treatment during lactation is associated with the recovery of maternal and neonatal thyroid function.We introduced the mechanisms of action and adverse reactions of antithyroid drugs（ATDs）,such as methimazole（MMI） and propylthiouracil（PTU）,briefly described the effects of treatment with different doses of ATDs at different time points during pregnancy and lactation on maternal,fetal and neonatal thyroid functions,and based on this,we recommended PTU for treatment during first trimester,MMI for treatment during second and third trimester.Furthermore,we encouraged mothers to receive the treatment with ATDs during lactation,and low-to medium-dose MMI was suggested for first-line treatment,and PTU for second-line treatment.In addition,we suggested that appropriate treatment with ATDs during pregnancy and lactation could not significantly affect fetal and neonatal physical and intelligence development（including thyroid function）.