What is the criteria for the diagnosis of clinical hypothyroidism during pregnancy?(1) serum TSH> upper limit of pregnancy reference valu
What is the criteria for the diagnosis of clinical hypothyroidism during pregnancy?
(1) serum TSH> upper limit of pregnancy reference value (97.5th), serum FT4< > (2.5th) < strong=" " pregnancy;. (2012 China "guide to diagnosis and treatment of pregnancy and postpartum thyroid disease"; Chinese society of Endocrinology; recommended 2-1 recommendation level: A;
(2) if the serum TSH> 10mIU/L, whether the FT4 is reduced, also for the clinical diagnosis of hypothyroidism. (recommended 2-2 recommended level: B);
(3) clinical hypothyroidism is sure to harm the outcome of pregnancy, the treatment must be given (recommended 2-3 level: A)
What medications the preferred clinical hypothyroidism in pregnancy?
L-T4 is pregnant women or pregnant women for thyroid hormone replacement therapy preferred preparation, do not give three triiodothyronine (T3) or Thyroid Tablets (1): the treatment of fetal development especially maternal brain development mainly depends on the adequacy of T4 level, but not T3; (2) L-T4 were safe for pregnancy and breastfeeding, no teratogenic or a lot of evidence into the milk.
What is the treatment of clinical hypothyroidism during pregnancy?
(1) TSH treatment goals are:
Early pregnancy (T1, 1~3 months): 0.1-2.5mIU/L
Second trimester (T2, 4~6 months): 0.2-3.0 mIU/L
Late pregnancy (T3, 7~9 months): 0.3-3.0 mIU/L
(2) once the clinical hypothyroidism, start treatment immediately, as soon as possible to achieve the above goals of treatment; (TSH is the most accurate indicator for pregnancy thyroid function period);
(3) with stage T1 clinical hypothyroidism pregnant women TSH target value, it is more desirable to pre TSH 0.1 ~ 1.5 mIU/L;
(4) FT4 can be maintained at the upper limit of the normal range of non pregnant adults; TT4 maintained at a normal level of 1.5 times.
The dosage and method of clinical hypothyroidism L-T4 pregnancy?
(1) the initial dose of L-T4: 50-100mg/d; according to the patient's tolerance to increase the dose, as soon as possible, the need for a slow increase in the number of patients with heart disease.
(2) for serious clinical hypothyroidism patients, giving two times replacement dose at the beginning of treatment days, the thyroid T4 pool back to normal as soon as possible.
(3) the sooner the treatment starts, the better it is to achieve the serum TSH< and the standard of 2.5 mlU / L.
(4) the dose of L-T4 is more than that of non pregnant women, which is increased by an average of more than 25% to 30%, and the average amount of increase in the operation or 131I is much, and the average amount of autoimmune thyroid disease is less.
(5) L-T4 should be avoided at the same time with iron supplements, iron containing vitamins, calcium and soy foods, the interval should be more than 4 hours.