In the previous article, everyone has learned that there are two cases of hypothyroidism. One is that there is a clear diagnosis before pregnancy, and there is no hypothyroidism before pregnancy. The other is that there is no hypothyroidism before pregnancy.
The diagnosis of hypothyroidism during pregnancy includes 3 manifestations:
1. Clinical hypothyroidism, the test results are TSH elevated, TT4/FT4 decreases
2. A sub -clinical hypothyroidism, the test results are TSH elevated, TT4/FT4 is normal
3. Low free (FT4), the test result is TSH normal, TT4/FT4 is reduced
It should be emphasized that both TT4 and FT4 should be detected. Generally, TT4 is recommended as a thyroid function assessment indicator during pregnancy, because the TT4 detection results are more stable, and the FT4 results are affected by the detection method, and the fluctuations are large.
For hypothyroidism during pregnancy, according to the specific diagnosis of the patient, the test results of the thyroid antibody should be combined with the test results of the thyroid antibody:
1. For patients with hypothyroidism diagnosis of clinical hypothyroidism, the preferred L-T4 for drug replacement therapy:
1) Patients with hypothyroidism before pregnancy need to adjust the L-T4 dose. When the serum TSH and FT4 meet the standards, that is, TSH 0.3 ～ 2.5 mu/L, FT4 can only be allowed to reach the upper 1/3 level of the normal range of ordinary people before they are allowed to be allowedDuring pregnancy, during pregnancy, the L-T4 dose increases by 30%-50%during non-pregnancy.
2) Diagnose patients with hypothyroidism during pregnancy should be treated immediately. The dosage dosage of the L-T4 starts 1-1.6ug/kg weight.
3) TSH treatment target value for reference: 0.1-2.5mu/L in the early pregnancy (1-12 weeks), 0.2-3.0mu/L in the middle of pregnancy (13-27 weeks), in the third trimester (28-40 weeks) 0.3 0.3-3.0mu/L.
4) When the TSH does not meet the standard, the TSH, FT4 and TT4 are measured every 2-4 weeks, and the L-T4 dose is adjusted according to the results to strive to meet the standard within 8 weeks of pregnancy.After TSH meets the standard, monitor TSH, FT4 and TT4 every 6-8 weeks.
2. For patients with subtraction of sub-clinical clinical, whether it is inconsistent with L-T4 intervention treatment, but if TSH> 10mu/L, treatment should be given.If TSH exceeds 2.5-3mu/L but does not exceed 10mu/L, if it is accompanied by a positive Anti-thyroid peroxide antibody (TPOAB), it is also recommended to give L-T4 treatment.
3. For patients with low FT4, from the establishment of the diagnosis, the interpretation of indicators and the recommendation of the treatment, the professional physician should be determined according to the specific situation of the patient.
In short, the treatment of hypothyroidism during pregnancy is a very professional and very complicated problem. The best treatment plan for some special circumstances is still being explored.Under the guidance of obstetrics and endocrine doctors, hypothyroid women adhere to regular review and adjust the medication reasonably in order to get an ideal result.
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Note: Picture from Baidu Picture