Hyperthyroidism is a clinical syndrome that is hyperthyroidism, which refers to the high concentration of thyroid hormone in the blood, causing the nervous system, digestive system, and even excessive excitement of the entire metabolic system.
Women are high -risk groups of hyperthyroidism, especially women in pregnancy.There are two main reasons for the combination of hyperthyroidism during pregnancy: one is the hyperthyroidism caused by the rising human chorionic gonadotropin HCG during pregnancy, which is closely related to pregnancy.The immune system disease has nothing to do with whether it is pregnant.
Below, I will tell you what to do if pregnant women encounter the above situation.
Cause: During normal pregnancy, the mother placenta secretes a large number of human chorionic gonadotropin (HCG), reaches its peak in 10-12 weeks, and then starts to return to normal.HCG and hypothalamic pituitary glandular hormone TSH has a similar effect, and can also stimulate the formation of thyroid hormones.Therefore, it is easy to cause hyperthyroidism when the HCG concentration reaches the highest.
Symptoms: nausea, vomiting, fear of heat, sweating, irritability, insomnia and other symptoms.
Examination: There is no history of hyperthyroidism before pregnancy; the thyroid itself antibody (Trab and TPOAB) is negative; there is no obvious goiter and no thyroid eye disease; FT4 and TT4 are elevated, TSH is less than 0.1miu/L.The thyroid color Doppler ultrasound is normal.
Treatment: Watch closely without special treatment.
HCG -related hyperthyroidism is also called over -hyperthyroidism, which is a normal physiological change. It occurs mostly in the early stages of pregnancy. The symptoms are not serious and have no great impact on pregnant women and fetuses.After 3 months, as the level of HCG becomes stable, the above -mentioned uncomfortable symptoms will gradually dissolve.Therefore, no need to apply anti -noria glands in the treatment, it is sufficient for regular review.
However, after childbirth, the endocrine environment in the mother’s body will change significantly, and hyperthyroidism will increase again.Therefore, a mother with HCG hyperthyroidism should go to the hospital within 42 days after delivery.
Among all diseases that lead to hyperthyroidism during pregnancy, Graves’s disease accounts for more than 85%.Graves disease is caused by problems with thyroid immune systems.Therefore, the severity of the condition has nothing to do with HCG, it will not be relieved by itself, and drug treatment is needed.
Cause: Our thyroid gland has a leader, hypothalamus pituitary.The vertical body will secrete thyroid hormone (TSH) to command thyroid gland into thyroid hormones.The immune system in the body of the Graves fails, and another substance that can mislead the thyroid gland and let it continue to synthesize thyroid hormones. We call it LATS.This material has a longer action. If it is not suppressed in time, it will cause hyperthyroidism.
Symptoms: Patients will have a serious hyperthyroidism reaction, such as palpitations and heart rates can reach 100 times/minute during rest, panic, hands shake, good appetite, but weightlessness can not be accommodated by the week of pregnancy.Symptoms such as hot sweat, excitement, two -handed tremor, and thyroidistness.
Examination: Eye discomfort such as anepanic eye; diffuse thyroid enoplane, and color Doppler ultrasound shows that the nearby blood flow is abundant and the sea is like a sea of fire; the thyroid antibody is positive.
In order to control the development of hyperthyroidism, ensure the normal development of the fetus, and the mother’s safety delivery, the FT4 should be controlled to approach or slightly higher than the normal value.
Some pregnant women detected Graff’s disease before pregnancy, and this generally recommended that they are pregnant after being completely cured.Most of them are discovered during pregnancy. If the symptoms of pregnant women are mild, the weight is also in the normal range. FT3 and FT4 only increased slightly, only need to be observed closely, and there is no need to treat it for the time being.
However, if the symptoms of hyperthyroidism mentioned above have occurred above and have not been controlled in time, the mortality rate of pregnant women’s abortion, hypertrophy, premature birth, and even fetus will increase significantly.
There are generally three treatment methods for Graves diseases: drugs, surgery and radioactive iodine.In the special circumstances of pregnancy, the latter two are generally not considered.Drugs are mainly two types: propyl sulfide (PTU) and metalazole (MMI).The two drugs have the same mechanism. By oxidation in thyroid cells in the thyroid cells, they can achieve the purpose of hindering the synthesis of thyroid.
Compared with these two drugs, MMI has worked faster and has stronger efficacy, but slowly metabolism, long time in the body, and a great impact on the fetus.The PTU and protein are more combined, and the amount of placenta is relatively small, which has a small impact on the fetus.However, PTU has a serious injury to the liver and has great side effects on pregnant women.
After weighing the disadvantages of all parties, patients choose the following principles: taking MMI before pregnancy, and when you start to prepare for pregnancy, you must replace it with PTU; PTU is used in early pregnancy (before 13 weeks).The dose of medication is the smallest effective dose, generally 150 ~ 200 mg/day.In the middle and late pregnancy, the mmi is changed, and the dose of medication is also the smallest dose, 15 ~ 20 mg/day.Choose MMI during breastfeeding, take it in step, and take medicine after the baby is eaten.
The above content is edited and organized by "Ask the Medical". If you want to learn more about the knowledge of the thyroid gland, please pay attention to us and check the column of "Thyroid Self -Nursing: Stay away from hyperthyroidism"!