胎儿和新生儿甲状腺功能亢进症的诊治进展

Progress in Diagnosis and Treatment of Fetal and Neonatal Hyperthyroidism

胎儿和新生儿甲状腺功能亢进症(甲亢)是同一疾病的不同阶段。根据病因可分为自身免疫性甲亢和非自身免疫性甲亢,其表现缺乏特异性,常呈现多系统受累。合理的孕期管理包括促甲状腺激素受体抗体(TRAb)水平、胎儿彩色多普勒超声及胎心率的动态监测可帮助早期发现胎儿甲亢。而恰当的新生儿筛查如生后0~5 d TRAb水平、3~7 d促甲状腺激素和游离甲状腺素水平的检测则可对新生儿甲亢做出可靠预测。胎儿甲亢的治疗主要通过调整母亲的抗甲状腺药物。新生儿自身免疫性甲亢多数为暂时性的,以药物治疗为主;非自身免疫性甲亢停药后易复发,根本的治疗为甲状腺切除术和(或)放射性碘治疗。

Fetal and neonatal hyperthyroidism is a name given to the same disease manifesting at different periods of life.It can be divided into autoimmune hyperthyroidism and non-autoimmune hyperthyroidism according to the etiology.The clinical manifestations are lack of specificity,and multiple systems can be involved.Rational management of pregnancy including dynamic monitoring of maternal thyroid stimulating hormone receptor antibodies(TRAb),fetal color Doppler ultrasound and fetal heart rate,can detect fetal hyperthyroidism early.The levels of TRAb at 0-5 days,and thyroid stimulating hormone and free thyroxine at 3-7 days after birth can be used to predict the occurrence of hyperthyroidism.The treatment of fetal hyperthyroidism is mainly through the adjustment of the maternal anti-thyroid drug.Neonatal autoimmune hyperthyroidism is mostly treated by anti-thyroid drug.Non-autoimmune hyperthyroidism is easy to relapse after withdrawal of anti-thyroid drug,and the radical treatment is thyroidectomy and/or radioiodine treatment.