Monitoring and treatment of hypothyroidism during pregnancy

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Cause of diseaseGestational hypothyroidism common disease because of chronic autoimmune thyroiditis (Hashimoto's disease), thyroid surgery,

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Cause of disease

Gestational hypothyroidism common disease because of chronic autoimmune thyroiditis (Hashimoto's disease), thyroid surgery, radioactive iodine treatment and iodine deficiency.

Physiological changes during pregnancy

Maternal thyroid hormone secretion and metabolism, including normal pregnancy: 1 thyroid binding globulin (TBG) increased, increased total serum T3 and T4 levels; 2 human chorionic gonadotropin (hCG) concentration in pregnancy first ~ 3 months increased gradually, reached a peak at 3 months, the pregnancy serum TSH decreased 3; the second half of pregnancy, placental deiodinase type III increased significantly, can lead to fetal low T3, high rT3; 4 pregnancy rate increased to remove kidney iodine, iodine and thyroid hormone levels in fetal demand increase, can make the demand for the increase of maternal iodine.

Adverse effects on the fetus

Gestational hypothyroidism failed to correct, often leads to premature birth, low birth weight and neonatal respiratory distress, fetal or perinatal mortality increases, but also affect the neonatal nervous system development and intelligence.

Treatment of hypothyroidism during pregnancy

Before pregnancy diagnosed with hypothyroidism levothyroxine (L-T4) treatment of women once pregnant, should be timely detection of thyroid function, adjust the dosage of L-T4.

At present, the best time to recommend the use of L-T4 is an early morning fasting. If it is not tolerated, it can be postponed until after the nausea and vomiting. If you need to supplement iron, calcium and vitamin L-T4, and at least interval of 2 hours or more to take, to prevent them from forming compounds, is not conducive to the absorption of L-T4.

General after 2 ~ 4 weeks later, the level of thyroid hormone restored to pre pregnancy levels, adjust the dosage of L-T4 the postpartum need to continue monitoring of thyroid function and. In addition, due to women with autoimmune thyroid disease risk of postpartum thyroiditis, and thyroid function in patients with postpartum monitoring such at least 6 months.

 

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