Hello everyone, I am Dr. Sandra Fryhofer, welcome to my medical lecture.Today’s theme is a new guide for thyroid dysfunction during pregnancy. It is taken from the US thyroid association and published in the journal of the "thyroid".Please listen to me to analyze its importance.
Pregnancy can be used as a pressure test for thyroid gland.During pregnancy, the volume of the thyroid gland increases by about 10%.The secretion of thyroid hormones increases, and the T3 and T4 values increased by 50%compared to not pregnant.Obviously, the level of thyroid hormone (TSH) during pregnancy is lower than the normal value of non -pregnancy TSH.
Suggestions on the examination of thyroid disease during pregnancy
The new suggestions for TSH value control during pregnancy are as follows:
Early pregnancy: below 2.5, range between 0.1-2.5
Medium-term pregnancy: between 0.2-3.0
Satellite pregnancy: between 0.3-3.0
During pregnancy, if the TSH value> 2.5, check the T4 level to determine whether there is a clinical thyroid dysfunction or sub -clinical thyroid dysfunction.
If the level of T4 is lower than the normal value, the diagnosis is a clinical hypothyroidism, causing damage to the fetus’s nervous system.At the same time, the risk of premature babies, low weight, and abortion.Clinical hypothyroidism must be treated.
If the TSH value is high and the T4 value is normal, the diagnosis is sub -clinical hypothyroidism.If so, the next step should be detected to detect thyroid peroxidase antibodies (TPOAB).The test results are positive pregnant women need to be treated.The impact of sub -clinical hypothyroidism on the development of fetal nervous system is not very clear.However, a large study shows that the child with children without treatment is low.
If the TSH value is ≥10, it must be treated regardless of whether the T4 value is normal.Before 20 weeks of pregnancy, check the TSH level every 4 weeks, and then check again at 26-32 weeks of pregnancy.
Views of female patients with thyroid dysfunction
What should I do if a woman with hypothyroidism wants to get pregnant?It should be emphasized that additional thyroid hormones should be supplemented at 4-6 weeks in the early pregnancy.According to the recommendation of the new guide, before the patient is pregnant, the clinicians should recommend the patient to adjust the dose of the drug to make the TSH value <2.5.In addition, once patients have menopause or active pregnancy test at home, it should increase the dose of 25-30%.
The dose of the drug should be adjusted according to the TSH level, so the TSH must be checked every 4 weeks before pregnancy.
Recommended dose for drugs during pregnancy
The treatment of hypothyroidism during pregnancy clearly stipulates oral left thyroxine.Other thyroid drugs, such as T3 or thyroid, are not recommended.
The demand for iodine in the body during pregnancy increased by 50%.So how much iodine does pregnant women need?The thyroid association supports the recommended dose of the World Health Organization. It is recommended that each pregnancy woman or breastfeeding woman consumes 250Ug iodine per day.
The new guide recommends that women who are pregnant, lactating or preparing to be pregnant daily take 150Ug iodine to ensure sufficient daily intake.It is better if you take potassium iodide.The content of iodine in kelp and seaweed is not enough.
Warning: If the daily intake of iodine is higher than 500-1100Ug, it will cause fetal thyroid dysfunction.
This guideline integrates 76 different management and treatment recommendations for thyroid dysfunction, postpartum thyroiditis, and thyroid nodules during pregnancy.There is also a suggestion that is very helpful for postpartum depression assessment: consider thyroid and detect TSH, T4, and thyroid antibodies.
Be wary: After radioactive iodine treatment, contraceptives should be contraceptive for 6 months or more than 6 months.Of course, the dose of thyroxine before pregnancy must be stable.
1. Over 30 years old.
2. Live in iodine deficiency areas.
3. Personal or family history of thyroid diseases, including thyroid mosque, type 1 diabetes, history of abortion, infertility or premature birth.
4. Weight index (BMI)> 40 or higher.
5. The history of some drugs such as iodine or lithium batteries.
6. Recently use the history of iodide chefs.