妊娠期亚临床甲减患者甲状腺激素治疗剂量调整临床观察

目的:观察妊娠期亚临床甲状腺功能减退患者甲状腺激素剂量调整的时机和剂量调整规律,为临床治疗提供参考。方法:分析2008年1月～2010年10月门诊及住院患者45例,分两组:一组为妊娠前已知有甲状腺病史的甲减患者,替代治疗后早孕时仍为亚临床甲减组(A组)和既往无甲状腺病史,早孕检查发现亚临床甲状腺功能减退组(B组)。分析治疗期间药物剂量调整及开始药物替代后前后甲状腺素的变化和生化、血脂、肝功、肾功、心电图、甲状腺B超等指标变化规律。结果:两组患者替代的初始治疗剂量不同,达标时的剂量、达标时间均有统计学差异。两组补充量的峰值在孕七个月后增加不明显,但两组最终补充剂量有统计学差异,无甲状腺疾病史组所需剂量较小。结论:妊娠早期应尽快明确甲状腺功能,对亚临床甲减患者应尽快补充甲状腺激素,孕2月时可达标,甲状腺激素的剂量在妊娠第七个月后增加不明显,与临床甲减妊娠期亚临床甲减的患者比较,甲状腺素剂量较小,提醒临床医生注意变化规律,及时调节。

Dosage adjustment of thyroid hormone for subclinical typothyroids during gestation period

Objective: To observe the time and dosage adjustment of thyroid hormone for subclinical typothyroids during gestation period.Methods:A total of 45 cases admitted from January 2008 to October 2010 were selected and divided into two groups: group A with hypothyroids history before pregnancy,and still with subclinical typothyroids after replacement therapy and group B without hypothyroids history and with clinical hypothyroids at early pregnancy.The changes of tetraiodothyronine and various biochemical indexes,blood fat,liver,kidney function,electrocardiogram,thyroid type-b ultrasonic were monitored and the relationship with time and dose adjustment was analyzed.Results:The difference in initial dosage,target dosage and target time were significant between two groups.The increase in supplement dosage peak was not significant at the 7th month after gestation in both groups.But the final supplement dosage was statistically different from each other,which was lower in Group B.Conclusions:It is recommended that thyroid function should be examined as soon as possible during early pregnancy.Prompt thyroid hormones therapy should be performed to subclinical hypothyroids patients as soon as possible and the level should be in the standard level at the 2nd month after pregnancy.There was no significant increase in dosage at the 7th month after gestation.Adjustment of treatment should be paid attention to.