甲状腺疾病与妊娠

本文综述了甲状腺疾病对妊娠的影响和产后甲状腺炎的基础与临床研究进展，阐述了诊治的新动向。     

妊娠期呼吸系统疾病

妊娠合并呼吸系统疾病具有特殊的临床意义。妊娠能使肺功能发生改变,也能改变常见肺部疾病的自然病史。治疗的选择、药物作用及患者的顺应性会因药物差异而变化,治疗对胎儿也会发生影响。呼吸系统疾病的症状和体征1.呼吸困难和呼吸急促妊娠期,60～75％孕妇有呼吸困难。虽然妊娠期呼吸困难可能是生理性的,但呼吸急促总是异常现象,应当寻找原因,包括:焦虑、呼吸道感染、败血症、肺水肿、肺栓塞、哮喘、气胸或其它原因所致的低氧血症。2.咳嗽大多数为干咳。典型干咳常见于一种病毒综合征,而持续性咳嗽合并有脓     

关注甲状腺疾病与围产期健康

<正>20世纪30年代有学者关注妊娠与甲状腺功能亢进症(甲亢)之间的关系,传统观念认为:母体的甲状腺激素不会通过胎盘影响胎儿。所以此问题一直未引起围产医学界的重视。直至80年代发现:甲状腺激素合成障碍和无甲状腺新生儿的脐带血中存在甲状腺激素,并发现母体甲状腺激素在胎儿脑发育的第1期(妊娠的前20周)的重要地位,于是推翻了这一传统观念。甲状腺功能(甲功)异常包括甲状腺功能减退症(甲减)、亚临床甲减、临床甲亢、亚临     

妊娠期高血压疾病与甲状腺功能异常的临床研究

目的探讨妊娠期高血压疾病与妊娠晚期甲状腺功能异常的关系。方法选择2012年1月至2012年12月足月分娩的妊娠期高血压疾病患者326例作为研究组,其中妊娠期高血压133例,轻度子痫前期92例,重度子痫前期101例;同期201例正常妊娠孕妇为正常组。采用电化学发光技术进行血清甲状腺功能检测,比较两组甲状腺功能及孕妇合并甲状腺疾病情况。结果研究组患者血清促甲状腺激素水平[TSH,2.78mU/L（0.71~7.37mU/L）]与正常组[2.35mU/L（0.79~4.52mU/L）]比较,差异有统计学意义（P〈0.001）,研究组游离甲状腺素水平[FT4,12.13pmol/L（8.96~17.12pmol/L）]与正常组[12.80pmol/L（8.69~17.76pmol/L）]比较,差异有统计学意义（P〈0.001）,研究组甲状腺过氧化物酶抗体水平[TPO-Ab,19.06U/ml（5.00~78.35U/ml）]与正常组[18.58U/ml（5.00~49.98U/ml）]比较,差异无统计学意义（P〉0.005）;妊娠期高血压疾病严重程度与TSH呈正相关（r=0.122,P〈0.05）,与FT4和TPO-Ab水平无关（r分别为0.005和0.030,P均〉0.05）。研究组总甲状腺功能异常发生率（15.34%,50/326）与正常组（8.46%,17/201）比较,差异有统计学意义（χ2=5.303,P〈0.05）,其中子痫前期组甲状腺功能减退的发生率（4.35%,4/92）与正常组（4.95%,5/101）比较,差异有统计学意义（P〈0.05）。结论妊娠期高血压疾病与甲状腺功能异常密切相关。     

妊娠期自身免疫性甲状腺疾病的筛查及治疗

自身免疫性甲状腺疾病是妊娠期妇女最常见的疾病之一。研究发现,甲状腺自身抗体与流产、早产、不孕、胎盘早剥、围产儿死亡、产后甲状腺炎等相关,是一个重要的检测指标。孕前及孕期对甲状腺功能及自身抗体的筛查能早期检测相关疾病,以便早期干预,减少不良妊娠结局的发生。文章就妊娠期自身免疫性甲状腺疾病的筛查及治疗的最新进展做一阐述,希望对临床研究有指导作用。     

妊娠期甲状腺疾病对胎儿宫内生长发育的影响

目的 探讨妊娠期甲状腺疾病对胎儿宫内生长发育的影响.方法 采用前瞻性研究方法,随机纳入2020年1月至2020年12月在深圳市南山区妇幼保健院产科分娩的孕妇550例,并在孕妇早、中、晚期检测甲状腺素水平以及甲状腺过氧化物酶抗体,记录孕妇发生甲状腺功能减低(简称:甲低)、甲状腺功能亢进(简称:甲亢)的发生率,并进行分组,...     

妊娠合并甲状腺病的诊断与治疗

妊娠合并甲状腺病,最常见的是甲状腺功能亢进、功能低下、桥本氏病、单纯性甲状腺肿和结节性甲状腺肿等。一般轻症或经过系统治疗的甲状腺病不影响妊娠,临床表现也不明显,故一般孕期检查时产科医师多不注意检查甲状腺及其功能。但是,由于重症和不易控制的甲状腺功能亢进或低下,容易引起流产、早产、死胎、死产及胎儿宫内生长迟缓(IUGR)、畸形,也容易引起妊娠高血压综合征、产时宫缩乏力出血、产后感染,甚至发生甲状腺危象。所以,近些年来随着围产医     

妊娠晚期妇女甲状腺疾病特点及甲状腺自身抗体变化的研究

目的 探讨妊娠晚期妇女甲状腺疾病的患病率、患病特点和甲状腺自身抗体的变化.方法 选择664例妊娠晚期妇女为妊娠组,276例非妊娠育龄妇女作为对照组.应用固相化学发光酶免疫法测定两组妇女的血清促甲状腺激素（TSH）和抗甲状腺过氧化物酶抗体（TPOAb）水平;TSH水平检测异常者加测游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）,同时测定尿碘水平.按如下标准确定诊断：TSH＜0.3 mU/L,FT4和（或）FT3水平升高者诊断为临床甲状腺功能亢进症（甲亢）;TSH＜0.3 mU/L,而FT4和FT3水平正常者诊断为亚临床甲亢;TSH＞4.8 mU/L,FT4水平降低者诊断为临床甲状腺功能减退症（甲减）;TSH＞4.8 mU/L,而FT4和FT3水平正常者诊断为亚临床甲减.TPOAb＞5 kU/L为阳性.结果 （1）妊娠组妇女尿碘平均水平为201.5μg/L,对照组妇女尿碘平均水平为196.0μg/L,均为碘充足水平.两组比较,差异无统计学意义（P＞0.05）.（2）妊娠组妇女甲状腺疾病总患病率为7.8%（52/664）,对照组妇女甲状腺疾病总患病率为6.9%（19/276）.两组比较,差异无统计学意义（P＞0.05）.（3）两组妇女的甲状腺患病类型有明显不同,妊娠组妇女甲亢患病率为1.1%（7/664）,甲减患病率为6.8%（45/664）,妊娠组妇女甲亢患病率明显低于甲减,两者比较,差异有统计学意义（P＜0.01）;对照组甲亢患病率为4.7%（13/276）,甲减患病率为2.2%（6/276）,两者比较,差异无统计学意义（P＞0.05）.妊娠组与对照组妇女的甲亢或甲减患病率分别比较,差异均有统计学意义（P＜0.01）.（4）妊娠组非患病妇女的TSH水平显著高于对照组,分别为2.50 mU/L及1.54 mU/L,差异有统计学意义（P＜0.01）;妊娠组妇女TPOAb阳性率显著低于对照组,分别为3.3%（22/664）及9.4%（26/276）,差异有统计学意义（P＜0.01）.结论 妊娠晚期妇女甲状腺疾病的特点是甲减的患病率高,同时甲状腺自身免疫功能受到抑制.     

妊娠期亚临床甲状腺功能减退症与妊娠期高血压疾病关系的研究进展

亚临床甲状腺功能减退症（subclinical hypothyroidism,SCH）是妊娠期最常见的甲状腺疾病,SCH患者存在血管内皮功能损伤和自主神经功能障碍,可能会增加心血管疾病的发病风险。妊娠期高血压疾病（hypertensive disorders of pregnancy,HDP）使妊娠复杂化,并导致孕产妇和胎儿不良妊娠结局发生率和死亡率升高。已有研究发现SCH与HDP发病率增加有关,但目前没有统一结论,且SCH孕妇应用左旋甲状腺素（levothyroxine,L-T4）治疗对HDP是否有益也尚存争议。综述妊娠期SCH对HDP的影响及L-T4的治疗效果,以规范临床妊娠管理方案,减少孕妇和胎儿围产期不良妊娠结局的发生。     

妊娠期母体甲状腺功能变化及其对胎儿的影响

妊娠期由于其特殊的生理过程甲状腺各项指标的变化很大,妊娠期甲状腺激素的产生、循环、代谢、调节以及甲状腺免疫均会随妊娠的不同阶段而改变。甲状腺激素是胎儿脑神经发育的必需激素,甲状腺激素缺乏严重影响胎儿的脑发育,近年来妊娠期甲状腺功能异常的发病率明显升高,可导致母儿不良妊娠结局。综述近年来关于妊娠期母体及胎儿甲状腺功能变化、相关母体甲状腺疾病发病情况及对胎儿的影响,旨在促进正确诊断妊娠期甲状腺疾病,合理保护妊娠期甲状腺功能,预防妊娠期甲状腺功能异常带来的一系列产科并发症及不良妊娠结局,避免新生儿远期生存质量的影响。     

Current management of gestational trophoblastic disease

Gestational trophoblastic disease incorporates a spectrum of disorders ranging from benign to malignant subtypes. At one end, hCG level monitoring is all that is required, whereas, at the other, patients require combination chemotherapy regimens and surgery to cure the disease. The diagnosis can have profound effects on both the patient and her family and it is essential this is recognized and managed appropriately. Although rare, clinicians in non-specialist units are expected to inform patients of their diagnosis and explain the management steps prior to being referred to a specialized Trophoblastic centre and unfortunately, patients may be given inaccurate or incomplete information and use the Internet as their primary source of information. This article intends to explain the diagnosis itself (incidence, genetics, subtypes), and summarize the clinical presentation and management, whilst answering some of the most commonly encountered questions asked by affected patients.     

Current management of gestational trophoblastic disease

Gestational trophoblastic disease incorporates a spectrum of disorders ranging from benign to malignant subtypes. At one end of the condition, hCG level monitoring is all that is required, whereas other patients require combination chemotherapy regimens and surgery to cure the disease. The diagnosis can have profound effects on both the patient and her family and it is essential this is recognised and managed appropriately. Although rare, clinicians in non-specialist units are expected to inform patients of their diagnosis and explain the management steps prior to being referred to a specialised Trophoblastic centre and unfortunately, patients may be given inaccurate or incomplete information and use the Internet as their primary source of information. This article intends to explain the diagnosis itself (incidence, genetics, subtypes), clinical presentation and management, whilst answering some of the most commonly encountered questions asked by affected patients.     

妊娠合并自身免疫性疾病临床监察与处理

随着免疫学的进展,妊娠合并自身免疫性疾病(autoimmune disease,AID)越来越多地被发现。妊娠与AID之间的相互影响,往往与不良妊娠结局相联系。因此,如何在孕前识别高危人群或潜在发病者、如何在孕期发现患病者,以及如何对已确诊AID患者进行恰当的病情评估及管理,减少AID对母胎的影响,是产科及多学科共同关注和管理的重要问题。     

Outcomes of pregnancy complicated by thyroid disease

AIMS: To perform a case note review of pregnancies complicated by thyroid dysfunction to determine management and therapeutic intervention in relation to pregnancy outcome. METHODS: A retrospective case note analysis of 81 ongoing pregnancies in 70 pregnant women with a history of thyroid dysfunction over a period of 5 years at the Glasgow Royal Maternity Hospital (GRMH), Glasgow, Scotland, United Kingdom. The results of thyroid function tests and whether a change in treatment was instituted were recorded. Thyroid function was assessed by standard laboratory reference ranges for free thyroxine (FT4) and thyroid stimulating hormone (TSH) in all trimesters. Other parameters were also noted. RESULTS: Medication levels needed to be increased in the hypothyroid group (45%), and decreased (38%) in the hyperthyroid group. CONCLUSION: Pregnancy outcome was good in majority of cases given appropriate replacement therapy for stated reference values.     

妊娠期甲状腺功能保护

甲状腺疾病可以导致母儿不良妊娠结局,由于妊娠期甲状腺功能发生特异性变化,用非妊娠妇女的诊断标准评估妊娠期甲状腺功能可导致妊娠期甲状腺功能减退症漏诊、甲状腺功能亢进症误诊和药物治疗剂量不足。只有正确诊断妊娠期甲状腺疾病,合理保护妊娠期甲状腺功能,才能避免不良妊娠结局的发生和减少对新生儿远期生存质量的影响,对实现我国优生优育的国策具有非常重要的意义。     

妊娠滋养细胞疾病误诊问题

妊娠滋养细胞疾病常与妊娠有关联,故需与流产、异位妊娠、双胎妊娠等相鉴别;而妊娠滋养细胞肿瘤因有病灶转移甚至破裂,可有脑血管意外、急腹症等表现,另外,还常需与人流或药流后、产后胎盘残留、宫角妊娠等相鉴别。     

Advanced thyroid carcinoma in pregnancy: case report of two pregnancies

Abstract

Differentiated thyroid carcinoma is one of the most frequently diagnosed cancers during pregnancy, second only to breast cancer. Therefore, it would be of value to determine if there are pregnancy-related physiological effects that impact long-term prognosis for patients with this disease. Hormone effects attributable to β-human chorionic gonadotropin and estrogens seem particularly likely. We present a case of a 40-year-old woman with thyroid follicular carcinoma with accompanying bone metastases. The cancer was discovered immediately after childbirth and the woman became pregnant again when the disease was in an advanced stage. We describe the cancer evolution and present the maternal and fetal results. Pregnancy in women with advanced thyroid carcinoma could affect long-term prognosis. However, more studies are needed to evaluate this hypothesis. In this unique case, there were two pregnancies and the second occurred in an advanced state of the disease. We evaluated how these pregnancies could affect short-term prognosis of the disease.     

滋养细胞疾病15例误诊分析

目的:探讨滋养细胞疾病的正确诊断及鉴别诊断。方法:回顾分析2000年1月至2004年7月收治的将滋养细胞疾病误诊为其它疾病8例及将其它疾病误诊为滋养细胞疾病7例的临床资料。结果:滋养细胞疾病8例误诊为异位妊娠5例,不全流产2例,子宫肌瘤1例;误诊为滋养细胞疾病的7例中异位妊娠4例,早孕合并阔韧带肌瘤、动静脉瘘及不全流产各1例。结论:滋养细胞疾病的正确诊断应该结合病史,HCG监测,影像学检查,刮宫等综合考虑,对难以诊断的患者不能盲目化疗,可以通过腹腔镜或开腹手术以明确诊断。