妊娠合并甲状腺功能亢进19例临床诊治分析

目的分析妊娠合并甲状腺功能亢进（甲亢）患者孕期病情变化，评价其对妊娠结局的影响。方法对19例妊娠合并甲亢患者临床资料进行回顾性分析。结果14例孕前即有甲亢的患者，2例孕期无异常，10例孕期出现不同程度甲亢症状（7例复发于孕中晚期，由于治疗及时，所有患者症状都得到有效控制，无1例发生甲亢危象；其中1例发生中度妊高征，3例发生胎儿宫内发育迟缓，1例胎膜早破，发生早产），其余患者无母婴异常；而孕前未经正规治疗的2例，1例孕38周发生甲亢危象、甲亢性心脏病、心力衰竭、重度妊高征，1例孕37周胎死宫内。妊娠前无甲亢孕期诊断为甲亢的5例，4例患者不服从治疗，未服药物治疗，分娩时2例并发重度妊高征，1例35周早产，1例36周胎死宫内；而另1例服用药物患者孕38周正常分娩。结论妊娠各期均可发生甲亢或复发或加重，尤其见于孕中晚期；甲亢可导致不良妊娠结局，故孕期应加强监护，及时治疗。

Clinic Diagnosis Analysis of 19 Cases Pregnancy Merging Hyperthyreosis 19 Cases of Hyperthyroidism in Pregnancy

[ Objective ] To analyze state of hyperthyroidism in pregnancy, evaluate its effect on outcome of pregnancy. [ Methods ] Clinical data of 19 cases with hyperthyroidism in pregnancy were analyzed retrospectively. [ Results] Among 14 cases with hyperthyroidism before pregnancy, 2 cases were normal during pregnancy, 10 cases had different symptoms of hyperthyroidism in different levels during pregnancy （7 cases recrudesce during middle and later stage of pregnancy. After curing timely, all patients＇symptoms had been effectively controlled, and no case has been thyroid crisis. Among these patients, 1 case had middle pregnancy induced hy- pertension syndrome, 3 cases had intrauterine growth retardation, and 1 case happened premature rupture of membrane and abortion）. The rest 2 patients had no abnormity. In 2 cases without regular treatment before pregnancy, 1 case has been thyroid crisis, hyperthyroidism heart disease, congestive heart failure, severe pregnancy induced hypertension syndrome in 38th week, and 1 embryo died in 37th week. Among 5 pregnancy women without diagnosing hyperthyroidism before pregnancy, 4 cases refused treatment and didnt have drugs. Among them, 2 cases suffered from severe pregnancy-induced hyperthyroidism syndrome, 1 case had premature infant in 35th week1 lembryo died in 36th week. While another case had drugs and had a normal delivery in 38th week. [ Condusion] Hyperthyroidism happened in different stages of pregnancy, and recrudescence or getting worse, especially in middle and later stages. Hyperthyroidism may induce adverse pregnancy outcomes. Therefore, hyperthyroidism should be monitor carefully and treat timely during pregnancy.