妊娠期间亚临床甲状腺功能减退的诊断与治疗

doi:10.3969/j.issn.1004-583X.2016.03.009

临床荟萃 ›› 2016, Vol. 31 ›› Issue (3): 268-271.doi: 10.3969/j.issn.1004-583X.2016.03.009

妊娠期间亚临床甲状腺功能减退的诊断与治疗

张松筠

河北医科大学第二医院内分泌科,河北石家庄 050051

收稿日期:2015-11-16 出版日期:2016-03-05 发布日期:2016-04-18
通讯作者: 张松筠, Email: 2574459696@qq.com
作者简介:张松筠，女，医学博士，河北医科大学第二医院内分泌科主任医师、教授、硕士研究生导师。河北省医学会内分泌代谢分会青年委员，河北省医学会行为学分会常务委员，河北省医学会心身医学分会委员兼秘书，河北省中西医结合学会内分泌与代谢专业委员会委员，石家庄医学会糖尿病分会委员。发表论著70余篇(SCI论文2篇)。曾获河北省科技厅科技进步三等奖、河北省卫生厅科技进步一、二等奖。目前承担河北省自然科学基金1项、卫生厅课题1项。

Diagnosis and treatment of subclinical hypothyroidism in pregnancy

Zhang Songyun

Department of Endocrinology, the Second Hospital of Hebei Medical University, Shijiazhuang 050051, China

Received:2015-11-16 Online:2016-03-05 Published:2016-04-18
Contact: Zhang Songyun, Email: 2574459696@qq.com

摘要/Abstract

摘要： 妊娠期亚临床甲状腺功能减退(SCH)是指妊娠期间血清促甲状腺激素(TSH)高于妊娠特异性参考值上限,而血清游离甲状腺素(FT4)在妊娠特异性参考值范围内。妊娠SCH特别是合并甲状腺自身抗体阳性者可以增加妊娠不良结局和围产期并发症的风险,并可能影响后代的智力和运动发育。建议对妊娠早期妇女开展SCH的筛查,筛查最佳时间是妊娠8周之内,筛查内容包括FT4、TSH和甲状腺过氧化物酶抗体(TPOAb)。建议孕前或妊娠期出现的SCH患者使用左旋甲状腺素(L-T4)治疗,治疗目标是将TSH恢复到妊娠特异参考值范围内。妊娠期间需碘量增加约50%,需适量补碘,建议每天额外补碘150 μg,以碘化钾最佳。

关键词: 心房颤动, 血流动力学, 治疗方案, 甲状腺功能减退, 妊娠, 筛查, 治疗

Abstract: Subclinical hypothyroidism(SCH) is defined as elevated serum thyrotropin (TSH) level with a normal serum-free thyroxine (FT4) level.Gestational age-specific criteria should be used for the diagnosis of SCH. Pregnant women with SCH,especialy those with higher thyroid autoantibody levels, have increased risks of adverse maternal outcomes, perinatal complications and their offsprings have increased risks of mental and physical disorders. Routine maternal thyroid function tests including FT4,TSH and TPOAb are necessary to improve maternal and perinatal outcomes. The best time for the screening is within eight weeks of pregnancy. Women with SCH whether before or during pregnancy should be treated with oral levothyroxine. TSH levels should be maintained within pregnancy specific reference range. Adequate iodine supplementation during pregnancy is critical and if feasible it should be initiated before the woman attempts to conceive. The extra 150 μg daily supplement is recommended and potassium iodide is the best choice.

Key words: acuteatrialfibrillation, hemodynamic, treatmentplan, hypothyroidism, pregnancy, screening, treatment

中图分类号:

R581.2

张松筠. 妊娠期间亚临床甲状腺功能减退的诊断与治疗[J]. 临床荟萃, 2016, 31(3): 268-271.

Zhang Songyun. Diagnosis and treatment of subclinical hypothyroidism in pregnancy[J]. Clinical Focus, 2016, 31(3): 268-271.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2016.03.009

https://huicui.hebmu.edu.cn/CN/Y2016/V31/I3/268

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妊娠期间亚临床甲状腺功能减退的诊断与治疗

Diagnosis and treatment of subclinical hypothyroidism in pregnancy

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