Today’s training class will be given!
Super excitement!A large number of dry goods are coming!
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Recently, a quasi -mother consultation: I have hyperthyroidism and I need to take drug control symptoms, but I am worried that it will affect the baby. What should I do?In fact, this kind of consultation is not a small number, so let’s follow the pharmacist to see the "medicine" of hyperthyroidism during pregnancy ~
1. What is hyperthyroidism?
HyperthyRoidism, referred to as hyperthyroidism, is referred to as hyperthyroidism, and the nail -shaped gland itself produces too much clinical syndrome caused by increasing excitement and metabolic hyperthyroidism in neurological, circulation, digestive and other systems.Typical symptoms include weight loss, heat resistance, tremor, palpitations, anxiety, increased number of defecation, and shortness of breath. Physical examination can usually be found to be metamia and prominent eyeballs.
2. Can patients with hyperthyroidism be pregnant?
Patients with hyperthyroidism can be pregnant, but not at any time, the best pregnancy is to consider pregnancy after the thyroid function is restored to normal.It is recommended to go to the hospital to check the level of thyroid hormones before preparing for thyroid patients. If thyroid hormones are basically normal, pregnancy can be prepared.Note that 131 patients with hyperthyroidism need to consider pregnancy after at least 6 months after the end of iodine therapy. 
What are the effects of hyperthyroidism on the mother and fetus?
The natural abortion rate of non -controlled hyperthyroidism in early pregnancy increases, and the incidence of hypertension in pregnancy also increases; those who are not controlled by hyperthyroidism in the later pregnancy, the incidence of signs of eclampsia, eclampsia, congestion, and hyperthyroidism has increased significantly;The incidence of premature birth, placental peeling and infection is much higher than those who are well controlled by hyperthyroidism in early pregnancy.
The impact on the fetus is mainly delayed in the fetal palace, premature babies, small moon, congenital malformations, dead tires, and early closing of cranial seams.The literature reports that the incidence of hyperthyroidism is 9 times the incidence of normal pregnancy; the incidence of fetal malformations in patients with hyperthyroidism patients who have not received drug treatment reached 6 %, while hyperthyroidism drug therapy is 1.7 %, and normal people’s pregnancy fetus malformationsThe rate is only 0.2 %.
4. Which treatment method should be used for hyperthyroidism pregnant women?
There are 3 treatment methods for hyperthyroidism, namely anti -thyroid drug treatment, surgical treatment and radioactive I131 treatment.
The treatment of thyroid drugs is the first choice of anti -thyroid drug treatment when hyperthyroidism of pregnant women. Only in the following situations, surgical treatment is considered: ① anti -thyroid drug treatment effect is not good;Patients with methamphetamine are obvious and large -dose of anti -thyroid drugs are required to control hyperthyroidism.Because surgery in the early or third trimester of pregnancy is likely to cause abortion or premature birth, the timing of surgery should generally be selected in the second trimester (that is, 4 to 6 months of pregnancy).
Pregnant women’s hyperthyroidism is treated with 131i treatment because radioactive iodine can enter the fetal thyroid gland through the placenta, causing fetal thyroid destruction, causing fetal goiter and hypothyroidism.
5. How to choose anti -thyroid drugs during pregnancy?
There are two main types of anti -thyroid drugs, namely propymiolinemine (PTU) and metalazole (MMI).
● Comparison of drug advantages and disadvantages and recommendations ●
Pifyl sulfoline is not easy to pass through the placenta, which causes less risk of fetal deformity. The disadvantage is that it can cause severe liver damage.Niamole has a certain teratogenicity, but hepatic toxicity is relatively low.Therefore, the American thyroid Society (ATA) recommends that propymiolinemidine is optional in the early pregnancy (organ formation period), and metamazole is replaced in the middle and later stages of pregnancy.The proportion of the two is: 100 mg of propyropiopyraine is about 10 mg of metalazole.Women with propyolinemine in early pregnancy can be switched to metamazole after 16 weeks of pregnancy, and can be used in subsequent pregnancy during the subsequent pregnancy period.
● Medication method ●
Pifyl sulfide 50 ～ 100 mg, 3 times/d; or tadpole pheumazole 10-20 mg, 1 time/d.Patients with symptoms control and normally should be reduced in a timely manner.When the patient relies on the minimum dose of anti -thyroid drugs (propymioline oxyraine 50 mg/d or methimimazole 5 mg/d) to maintain normally normally, you can stop the drug [pushing the thyroid hormone receptor antibody (TRAB)) specialExcept for high patients], in order to avoid recurrence, it is currently advocating to maintain the treatment until 32 weeks of pregnancy.Those who recur after the drug or the disease will be aggravated after the drug is reduced, which can take anthology drugs or increase the dosage of the drug again.
Note: ① It is not advisable to use anti-thyroid drugs with left paraphraphrine (L-T4) during pregnancy, because it will increase the amount of anti-thyroid drugs;The growth of the fetus in the fetus, the prolonged production process, the slowdown of the newborn, and the hypotension should be used carefully.