不孕症合并甲状腺肿瘤的临床处理

Clinical management of infertility with thyroid tumor.

临床在对不孕症患者的诊治过程中,常常发现合并甲状腺肿瘤或甲状腺功能异常。近年来甲状腺肿瘤的发病率呈上升趋势,以45岁以下女性为主。由于不孕症患者是特殊群体,妊娠与甲状腺肿瘤之间互相影响,且甲状腺肿瘤可能影响妊娠结局,故诊治过程中应首先确定肿瘤的良恶性,小的良性肿瘤可以先治疗不孕症并妊娠,有压迫症状的良性肿瘤可以先切除甲状腺肿瘤再妊娠;如果为恶性甲状腺肿瘤,建议先手术治疗,待甲状腺功能平稳后再考虑妊娠;高龄及卵巢功能低下者,可考虑先行助孕全胚冷冻保存生育力,之后再治疗甲状腺恶性肿瘤。

In the course of diagnosis and treatment of infertility patients,thyroid tumors or thyroid dysfunc⁃tion are often found.In recent years,the incidence of thyroid tumors has been increasing,mainly in women under 45 years old.Because infertility patients are a special group,pregnancy and thyroid tumors affect each other,and may affect the outcome of pregnancy,so the diagnosis and treatment process should be very im⁃portent.We must determine the thyroid tumors benign or malignant firstly.Small benign tumors without any symptoms can be treated infertility to concive firstly,benign tumors with compression symptoms should be removed before pregnancy.If it is malignant thyroid tumor,at first,it is recommended to operative treat⁃ment,and then consider pregnancy after thyroid function is stable.In advantage and low ovarian reserve patients whole-embryo cryopreservation to preserve fertility may be considered before treatment of thyroid malignancies.