Pregnant women encounter thyroid diseases (hyperthyroidism or hyperthyroidism). Once the condition is not controlled, it will not only threaten their own health and safety, but also affect the growth and development of future generations.Therefore, starting from the health of maternal and infants, it is necessary to screen for thyroid diseases planning or pregnant women.
Before pregnancy: early screening, early treatment
A hypothyroidism can lead to female infertility. Even after pregnancy, it is prone to pregnancy hypertrophy, premature placenta, internal distress, abortion, premature birth, low birth weight, and dead tires.What’s more serious, hypothyroidism during pregnancy (especially early pregnancy) will affect the fetal brain and skeletal development of the fetus, leading to low intelligence and short figures after birth, which we often call "small disease".
Due to the hidden hypothyroidism, and the lack of characteristics of early symptoms (such as fatigue, poorness, drowsiness, etc.), it is easy to be mistaken for normal pregnancy reactions and missed diagnosis.If patients do not know that they have thyroid disease before pregnancy, they have a great impact on mothers and fetuses.Starting from the health of maternal and infants, it is necessary to screen for thyroid diseases planning or pregnant women.
High -risk populations have not yet reached a consensus on whether to conduct thyroid function on all pregnant women. The consistent point of view is to have a pre -pregnancy screening for high -risk groups of hypothyroidism.High -risk groups of hypothyroidism include: 1) those who have the history and family history of thyroid diseases; 2) those who have thyroidist, thyroid surgical resection, and 131i treatment history; 3) those who have increased TSH and positive thyroid antibody positive;Other personal history and family history of autoimmune diseases.
The timing of screening can be selected before 8 weeks of pregnancy, it is best to plan to be pregnant.Screening indicators mainly include serum TSH, FT4 and TPOAB.TPOAB is an independent risk factor for abortion.Clinically, normally, normally, only TPOAB -positive women, the risk of clinical hypothyroidism after pregnancy is very high, which is why patients with positive sub -clinical hypothyroidism in TPOAB must also be actively intervened.
Before pregnancy, prepare A Women must check the nail skills before planning to be pregnant. If there is a hypothyroidism, it should be temporarily contraceptive.MU/L) and FT4 are kept after 1/3 of the normal range of non -pregnant women before they are allowed to get pregnant.If pregnant women find hypothyroidism during pregnancy, they can choose to continue pregnancy, but the L-T4 replacement therapy should be started immediately, so that the serum TSH will be reached as soon as possible (preferably within 8 weeks of pregnancy) to ensure the first period of rapid development of the fetus (the first rapid development of the fetus (The thyroid hormones in the 4 to 6 months of pregnancy have a sufficient amount of supply.
Maternal breastfeeding is very safe and can be breastfeed.
Patients with hypothyroidism supplement thyroid hormones, which are nutrients in our bodies. When the body secretion is insufficient, replacement and supplementary therapy. In terms of thyroid hormones, it is a nutrients. There is no disadvantage to the body.Calcium, glucose, and vitamins are as safe and reliable.
However, even if nutrients are supplemented, they should pay attention to dose problems. Too much supplementation and lack will adversely affect the body.Just like supplementing water, the lack of supplement is water deficiency, and too much supplementation is water poisoning; supplementing insufficient oxygen hypoxemia, replenishment of too much oxygen to poisoning, and the same thyroid hormone cannot supplement too much or insufficient supplement. It should imitate physiological physiology.Dose keeps the normal level of TSH.
In fact, neonatal and babies mainly rely on iodine in breast milk to blend into thyroid hormones.Mother’s breast milk contains thyroxine (T4) in the first week of the milk t4, 8 micrograms/division, and T4 in the milk will gradually decrease. At 1, 2, 4, and 6 months, the T4 concentration in the milk is 5.4, 4.0, and 4.0, respectively.1.6 and 1.3 micrograms/cents rose, and the thyroid hormone obtained by milk alone is not enough.
Because newborn and babies need to get iodine from breast milk, in order to ensure the iodine nutrition of mothers and babies, the World Health Organization/UN International Children’s Emergency Rescue Foundation/International control iodine deficiency pathway (WHO/UniceF/IC-CIDD)The amount of iodine of breastfeeding mothers increases 50 micrograms per day compared to non -lactating women.However, some experts have different opinions. They believe that the breasts have the effect of thick polyetry iodine, and there is no need to increase iodine intake. At present, there is no evidence -based medical evidence about the iodine intake of breastfeeding mothers.
What should hyperthyroid women pay attention to their diet?
Pregnant women with hyperthyroidism should consume more foods with high energy, high protein, high calcium, and vitamin -rich foods. At the same time, iodine intake is limited, and high iodine foods such as kelp, sea fish, seafish skin, and seaweed are avoided.While ensuring the nutrition of maternal and infants, prevent the disease from worsening.
Q2
How to identify the "Sexylated Aggiper" and "Graves Diseases" during pregnancy?
"Gestational Transient Thyrotoxicosis, GTT), also known as" HCG -related hyperthyroidism ", accounts for 2 to 3%of pregnant women.This disease mainly occurred in the early stages of pregnancy. It was due to the rising level of chorionic gonadotropin (HCG) levels of the serum human choric membrane.), Often accompanied by pregnancy drama vomiting. With the extension of pregnancy time, the level of HCG in the body gradually falls, and the thyroid function gradually returns to normal.
It should be noted that "GTT" is an excessive physiological change that occurred in the early thyroid function of early pregnancy. The symptoms of hyperthyroidism are mild. Generally, anti -thyroid drugs are not required.Rebate, once misdiagnosis is misdiagnosed, taking anti -thyroid drugs is likely to lead to hypothyroidism and cause harm to pregnant women and fetuses.To avoid misdiagnosis, we must do a good job of identification.
Generally speaking, most patients with Graves disease have a history of autoimmune thyroid disease, which mainly manifested as symptoms of hyperthyroidism such as panic, weight loss, and sweat. Generally, severe vomiting will not occur., TRAB, TPOAB and other thyroid gland itself.If it is not treated, hyperthyroidism will gradually increase with the extension of pregnancy time, and it will not relieve itself.
"GTT" is mainly found in early pregnancy, highlighting the symptoms of digestive tract such as severe nausea and vomiting, and the symptoms of hyperthyroidism are relatively mild. Patients usually do not have the history of autoimmune thyroid disease.It is often negative in their own antibodies. Most of the patient’s thyroid function is temporary. As the pregnancy time is prolonged, it will gradually return to normal.
Q3
Can I breastfeed during taking antidoma drugs (ATD)?
Traditional concepts believe that mother’s hyperthyroidism cannot breastfeed.However, many clinical studies in recent years have shown that patients with hyperthyroidism (PTU <300㎎/day or MMI <20㎎/day) (whether PTU or MMI) breastfeeding is safe and will not affect the thyroid function of the baby.No complications such as reduced granulocytes and liver damage were found.For the sake of safety, it is recommended that patients take the medicine immediately after breastfeeding, and then feed the second milk after four hours, so that breastfeeding is at least 3 to 4 hours. At this timeInfluence.
Q4
Will thyroid disease be inherited?
The autoimmune thyroid disease (such as toxic permeable thyroid and thyroiditis) has a hereditary tendency.Parents have thyroid diseases, and their children’s chances of suffering from thyroid disease will increase, but it does not mean that future generations will definitely suffer from thyroid disease.Therefore, patients with thyroid disease and their children should understand some basic common sense of thyroid disease and regularly check the thyroid gland to prevent it from suffering from before.
