What do you think of the test form?What should I pay attention to after giving birth to my baby?The answers are here!
Born a healthy and smart baby is the expectation of every expectant mother.In recent years, as the public’s attention to hypothyroidism has risen, thyroid function tests have been included in the routine of pregnancy tests.Inpayment clinics often have the pregnancy checklist to the endocrinology department.Today, the author will take everyone to sort out the arrows on the upper and lower arrows on this armor test sheet.
Learn to see the test list of armor
We use several typical patients to give examples:
1. Clinical hypothyroidism during pregnancy
Both expectant mothers belong to clinical thyroid dysfunction during pregnancy.The diagnostic standard for clinical hypothyroidism during pregnancy is: the upper limit of the reference value of serum> serum, and the lower limit of the serum FT4 <pregnancy reference value; if the serum TSH> 10 miu/L, whether the FT4 is reduced, according to the clinical hypothyroidism.
Pregnant women with hypothyroidism during pregnancy should be treated with levotyroxine tablets (LT4). It is not recommended to use T3 and dry methamphetamine.The complete alternative dose can reach 2.0 ~ 2.4µg/kg · d.It can start from 50 ~ 100 dg/d, increase the dose according to the patient’s tolerance, and meet the standard as soon as possible.Both expectant mothers can give the starting treatment of left norexorine sodium 50µg/d.
Clinical hypothyroidism TSH treatment targets during pregnancy is: 0.1 ~ 2.5miU/L phase T1, 0.2 ~ 3.0miu/L phase, 0.3 ~ 3.0 miu/L stage.Therefore, the TSH of the expectant mother Xiao A should reach 3.0miu/L, and the TSH of the expectant mother Xiao B must reach 2.5miU/L.Monitor the thyroid function every 4 weeks and adjust the dose.
2. Pregnancy sub -clinical hypothyroidism
These two expectant mothers are sub -clinical hypothyroidism during pregnancy.The clinical hypothyroidism during pregnancy refers to the reference value of the serum TSH level of pregnant women’s serum higher than the specific reference value of the special reference value of the FT4.
For TPOAB negative sub -clinical hypothyroid women, neither opposition nor Recommend LT4 treatment; for TPOAB positive sub -clinical hypothyroidism women, it is recommended to give LT4 treatment, treatment methods, treatment goals and monitoring frequency as the same hypothyroidism as clinical hypothyroidismEssence
Therefore, expectant mothers can be treated or can not be treated; and expectant mothers Xiao C will be treated with left norexorine sodium. Starting from 50µg/d, monitoring monthly, adjusting the dose, and reaching the standard as soon as possible.
3. Low T4 serial and thyroid itself anti -body positive
Specific mothers little E belongs to simply low T4 blood disease.It refers to: TSH levels are normal, FT4 levels are lower than the 5th or 10 percentage point of the reference value range, and the thyroid itself antibody is negative.Existing research does not have sufficient evidence to prove that simple hypotropyarian disease will increase the endless pregnancy ending and the damage to the development of neuroscope, so it is not routine to recommend LT4 treatment.
Specific mothers small F belonged to the thyroid gland’s own anti -body positive.If it is first pregnancy, you can not be treated, but TSH should be detected every 4 to 6 weeks in the first half of pregnancy. At least once at least once at 26 to 32 weeks of pregnancy. If you find that TSH exceeds the range of reference value of special pregnancy, LT4 should be given to LT4Treatment; if there is a history of abortion, it is directly considered to supplement LT4 treatment, and the dose starts from 25 ~ 50µg/d.
4. Armal hypothyroidism and pregnancy
The expectant mother belongs to hypothyroidism and pregnancy.Clinical hypothyroid women plan to recover thyroid hormone levels to normal during pregnancy.Serum TSH0.1 ~ 2.5mii/L. The ideal goal is to achieve TSH0.1 ~ 1.5miu/L.Although there is no difference between the two control levels of pregnancy, the risk of mild hypothyroidism in the latter has further reduced the risk of mild hypothyroidism in the early pregnancy.
In addition, the LT4 alternative dose after pregnancy after pregnancy requires an increase of about 25%to 30%.The easiest way is to increase an additional 2D dose per week, which can effectively prevent hypertrophyphrotinemia in the T1 stage as soon as possible.
Specific mothers Xiao G, a history of hypothyroidism for 4 years, consult the doctor before preparing for pregnancy, adjust the LT4 dose to control the TSH at 2.0miu/L, and review the TSH3.8miu/L in 6 weeks of pregnancy./D.
If the expectant mothers have severe hypothyroidism, they can be given twice the dose within a few days of the treatment, so that the T4 pool outside the thyroid gland will return to normal as soon as possible.
3 things to pay attention to
Knowing how to interfere with treatment, so what problems need to pay attention to after the baby is born?
First of all, the dose of the L-T4 dose of pregnant women with a history of hypothyroidism before pregnancy should be reduced to pre-pregnancy levels, and the serum TSH level is required at 6 weeks after delivery, and the LT4 dose is adjusted.There may be no LT4 after childbirth that may be found in pregnancy during pregnancy. These are possible people who discontinue drugs, especially when the dose is <50µg/d.However, the serum TSH level should be reviewed within 6 weeks after delivery.
Second: After the baby is born, heel heel blood screening is congenital thyroid dysfunction.Blood collection should be performed 2 ~ 7D after the baby is born, and the best within 2 ~ 4D after birth.The cut point value is 10 ~ 20 mIU/L.The positive review of the serum TSH and FT4 is immediately reviewed.The diagnostic standards are determined by laboratories based on the reference value of this laboratory.Serum TSH> 9 miu/L, FT4 <7.7pmol/L can be used as a reference.
Also pay attention to the TSH reference value of special pregnancy.Different areas, different laboratories, and reagents from different manufacturers will make this reference value different.Therefore, each guide recommends the establishment of the reference value range of different people during different pregnancy.If the TSH specific reference value range cannot be established, it is recommended to limit the reference value of the early TSH in the early pregnancy to 4.0miu / L.
Avoid iodine deficiency
After speaking, the thyroid function test form, and there is a more relationship with thyroid disease is iodine nutrition. This is also what expectant mothers need to pay attention to.
During pregnancy, the synthesis of thyroid hormones increases, the renal iodine excretion increases, and the demand for fetal iodine has increased. Therefore, the amount of iodine of pregnant women is significantly increased compared to non -pregnancy women.Women who have sufficient iodine -taking in pre -pregnancy and pregnancy can ensure that sufficient iodine reserves in thyroid gland can meet the increased demand for thyroid hormone during pregnancy.
According to WHO recommendation standards: women are intended to ensure iodine intake of at least 250µg/d per day for women during pregnancy, pregnancy and lactation.In order to ensure the above iodine intake, in addition to the normal diet, an additional iodine is required every day.Iodine is preferably iodide, or composite vitamins containing potassium iodide in the same dose.However, iodine supplementation cannot be excessive, and excessive iodine supplementation can easily cause fetal hypothyroidism.Avoid iodine with continuous intake of more than 500 g/d.
So how to grasp this section?You can judge through the median urinary iodine.The criteria for pregnancy and lactating iodine nutrition during pregnancy and lactation in 2007 are: severe iodine deficiency: urinary iodine <20µg/L; moderate iodine deficiency: urinary iodine 20 ~ 50µg/L; mild iodine deficiency: urinary iodine 51 ~ 149µg/L; iodine is sufficient: 150 ~ 249µg/L urine iodine; over sufficient amount of iodine: 250 ~ 499µg/L urine iodine; excessive iodine: urinary iodine> = 500µg/L.
I hope that every expectant mother can make reasonable iodine supplement and healthy conception, and have a smart and strong baby!
Source: Medical Community
1. Endocrinology Branch of the Chinese Medical Association, Medical Branch of the Chinese Medical Association.
2. Ding Rong, Fan Jianxia. The Interpretation of the Guidelines for the Diagnosis and Treatment of Pitchnsal Diseases of pregnancy and postpartum thyroid disease in the United States.
3. World Health Organization/International Council for the Control of the iODINE DISONCYRDERS/United Nations Children ‘WHO/ICCIDD/Unicef). . Assessment of the iODINE DEFICIENCY DISORDERDers and Monitoring Their Elimination. World Health Organization, Geneva. 2007.