妊娠合并甲状腺功能亢进症的诊断与治疗

目的　探讨妊娠合并甲状腺功能亢进症 (甲亢 )的诊断和治疗 ,提高母婴健康水平。方法　妊娠合并甲亢 2 7例行丙基硫氧嘧啶 (PTU)治疗 ,为治疗组 ;另外 2 0例 ,未给予治疗 ,为未治疗组 ;正常孕妇 3 0例 ,为对照组。产前测定孕妇外周血T3 、T4、TSH、FT3 、FT4,并行组间对照 ,以探讨其与分娩方式及新生儿结局之间的关系。通过抽脐血及出生后 3d、5d、7d查T3 、T4、TSH以了解新生儿甲状腺功能 ,探讨母体的治疗与新生儿甲状腺功能之间的联系。结果　甲亢未治疗组T3 、T4、TSH、FT3 、FT4水平与治疗组和对照组有明显差异 (P <0 0 5 ) ;未治疗组新生儿体重明显低于治疗组和对照组 (P <0 0 0 1) ,且有 2例新生儿甲亢出现 ;治疗组甲状腺激素水平控制在正常上限或增高 15 %以内 ,3例新生儿出现甲状腺功能低下 (甲低 ) ;甲亢组分娩顺产率明显低于对照组 ( 8/14 :19/3 9,P <0 0 5 )。结论　妊娠合并甲亢早期诊断和治疗可改善胎儿预后 ,但仍影响分娩方式 ,应适当放宽剖宫产的指征。甲亢缓解后对胎儿或新生儿仍有影响 ,应加强对胎儿或新生儿甲状腺功能的监测

Diagnosis and Treatment of Pregnancy with Hyperthyroidism

Objective To explore the diagnosis and treatment of hyperthyroidism in the pregnant women to improve maternal and infant healthy. Methods 47 cases of pregnant women with hyperthyroidism were divided into the treatment group receiving anti-thyroid drug PTU and the non-treatment group, and 30 cases of normal pregnant women served as control. The levels of serum T 3, T 4, TSH, FT 3 and FT 4 were measured before delivery, and the neonatal thyroid functions were evaluated by detecting the levels of T 3,T 4 and TSH of umbilical blood, as well as peripheral blood at 3th, 5th and 7th days after birth. Results The levels of T 3,T 4, TSH,FT 3 and FT 4 in the non-treatment group were significantly higher than those in the treatment group and control group(P<0 01), the neonatal body weight in the non-treatment group was significantly lower than those in the treatment group and control group, and the dystocia rate in the prognant women with hyperthroidism was much higher than that in normal pregnant women. There were 2 cases of infants with hyperthyroidism in the non-treatment group, and 3 cases of infants with hypothyroidism in the treatment group. Conclusion Pregnancy with hyperthyroidism should be diagnosed and treated as early as possible, and the delivery fashion should be paid more attention. Pregnancy with hyperthyroidism of post-treatment still had some effects on the outcome of infants, so thyroid function in fetus and infants should be examined strictly.