Graves病合并妊娠

妊娠期甲状腺激素代谢的生理性改变使Graves病的诊治更加复杂。妊娠期Graves病必须使用抗甲状腺药物（ATD）治疗，尽可能使用最低剂量的ATD维持母体游离甲状腺素（n）于非孕期的正常高值附近是最理想的选择。胎儿甲状腺功能取决于通过胎盘屏障的促甲状腺激素（TSH）受体抗体（TRAb）与ATD之间的平衡。晚孕早期母体TRAb滴度升高是胎儿发生甲状腺功能亢进的一个危险因素，此时亦应行胎儿甲状腺超声检查。临床可以通过调整孕妇ATD用量治疗胎儿甲状腺功能亢进。若妊娠期Graves病未得到控制，或孕妇曾因Graves病行放射性碘治疗或甲状腺切除术，怀孕时TRAb仍阳性者，须于分娩时检测脐带血TSH及FT4（总甲状腺素）。

Graves' disease complicated with pregnancy

The diagnosis of Graves＇ disease in pregnancy can be complex because of normal gravid physiologic changes in thyroid hormone metabolism. Mothers with active Graves＇ disease should be treated with antithyroid drugs （ATD）. Optimally, the lowest possible dose should be used to maintain matemal free thyroxine levels at or just above the upper limit of the normal nonpregnant reference range. Fetal thyroid function depends on the balance between the transplacental passage of thyroid-stimulating hormone （ TSH ） receptor antibody （ TRAb ） and ATD. Elevated level of serum TRAb early in the third trimester is a risk factor for fetal hyperthyroidism and prompt evaluation of the fetal thyroid by ultrasound. Maternal antithyroid medication can be modulated to treat fetal hyperthyroidism. Serum TSH and either total or free thyroxine levels should be measured in fetal cord blood at delivery in women with active Graves＇ disease, and those with a history of 1311-mediated thyroid ablation or thyroideetomy who have TRAb positive.