Thyroid disease and birth (10)

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Eight, "thyroid disease during pregnancy and the postpartum management guide" (2014) (excerpts):1, should be established early, middle and l

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Eight, "thyroid disease during pregnancy and the postpartum management guide" (2014) (excerpts):

1, should be established early, middle and late pregnancy, a specific indicator of the value of labor:

Reference value of Chinese pregnant women

TSH (mIU/L) FT4 (pmol/L)

Early metaphase and late metaphase

DPC 0.13-3.93 0.26-3.50.42-3.85 12.00-23.34 11.20-21.469.80-18.20

Abbott0.03-3.60 0.27-3.80 0.28-5.0711.49-18.84 9.74-17.15 9.63~18.33

Roche0.05-5.17 0.39-5.22 0.60-6.8412.91-22.35 9.81-17.26 9.12-15.71

Baery 0.03-4.510.05-4.50 0.47-4.54 11.80-21.0010.60-17.60 9.20-16.70

No.: different kit.

Press: in order to facilitate analysis, TSH and FT4 the highest and average value of the table:

Maximum value

TSH FT4

Early metaphase and late metaphase

DPC3.93 3.5 3.85 23.34 21.4618.20

Abbott3.60 3.80 5.0718.84 17.15 18.33

Roche5.17 5.22 6.84 22.35 17.2615.71

Baerv 4.514.50 4.54 21.0017.60 16.70

average value

TSH FT4

Early metaphase and late metaphase

DPC2.04 1.88 2.13 17.70 16.3314.00

Abbott1.81 2.05 2.99 15.16 13.4413.96

Roche2.61 2.80 3.72 17.63 16.5012.14

Baera 2.222.27 2.50 16.40 14.1012.95

As can be seen from the above table, FT4 in early pregnancy on the high side, late low. TSH early pregnancy is low, the late high.

2, gestational hypothyroidism after the L-T4 treatment immediately, as soon as possible to achieve the following indicators: TSH (mIU/L) 0.1~0.25 0.2~3.0 0.3~3.0 early middle late

3, TSH> 10 mIU/L, according to the treatment of hypothyroidism. TPO-Ab positive subclinical hypothyroidism, recommend L-T4 treatment.

4, clinical hypothyroidism before pregnancy should be controlled at < TSH; 2.5mIU/L. (Note: no hypothyroidism euthyroid women, whether according to requirements?)

5, pregnancy and low blood thyroxine (FT 4 low to 10%, TSH normal, antibody negative), the impact of pregnancy is not clear, do not recommend L-T4 treatment of.

6, postpartum thyroiditis thyrotoxicosis, without antithyroid treatment, found to timely L-T4 treatment of hypothyroidism.

7, pregnancy hyperthyroidism syndrome (SGH) is due to excessive hCG secretion of the placenta, the main treatment of antithyroid drugs.

8, the early stage of hyperthyroidism in pregnancy take C sulfide, later changed his methimazole, without L-T4.

9, there is a past or current Graves hyperthyroidism, pregnancy 20~24 weeks to check TRAb help evaluate pregnancy outcomes. (Note: TRAb is a general term, stimulating antibody and antibody inhibition plus kit stability and human specific factors, to evaluate its influence on the outcome of pregnancy, to avoid the only clinical, Aaron antibody".

10, pregnant, lactating women daily iodine intake of at least 250 G. In addition to normal diet, daily supplement of 150 G. At the same time should avoid high iodine drugs, daily intake of iodine > 500~1100 G has led to the risk of fetal hypothyroidism.

11. The prognosis of thyroid nodules and thyroid cancer is the same as that of non pregnancy. Thyroid cancer can be treated with L-T4, TSH control in 0.1~1.5mIU/L.

12, differentiated thyroid cancer before pregnancy with 131 iodine treatment, pregnancy and offspring have no risk, should be in

131 iodine pregnancy after 6 months.

13, newborn screening in 48 hours after birth in ~4 days, the heel blood TSH positive value is 10~20mIU/L. TSH> 9mIU/L, FT4< 7.7pmol/L (0.6ng/dl) for congenital hypothyroidism, L-T4 treatment as soon as possible.

14, early pregnancy (8 weeks ago) thyroid function screening, TSH, FT4, TPOAb:

TSH FT4TPOAb processing

Do not need to deal with

+ +

"Pure antibody positive", do not need to deal with

Here, "with low T4 level, without treatment

Relax, "subclinical", do not need treatment

Relax, and subclinical hypothyroidism, T4 treatment

Up / down "clinical hypothyroidism, T4 treatment

Here, "subclinical hyperthyroidism" without treatment

Down arrow "clinical hyperthyroidism, antithyroid drug therapy

15, pregnancy for 24 to 28 weeks of TRAb, high titer can cause neonatal for 1 to 4 months of transient hyperthyroidism.

16, pregnancy to ensure daily iodine intake, at least 250 g, in addition to normal diet is needed to supplement 150 g iodine, dietary supplement to achieve this purpose, can supplement iodine nutrition.

17, screening of neonatal congenital hypothyroidism:

(screening method) TSH primary screening T4 screening (TSH follow-up) TSH, T4 combined screening

Primary hypothyroidism Y Y Y

Secondary hypothyroidism N Y Y

Y N Y subclinical hypothyroidism

Delayed type TSH increased N Y N

Y: can be found N: can not find

In 18, congenital hypothyroidism children born after treatment should be initiated within 2 weeks, T4 will be adjusted to normal value within 2 weeks, TSH will adjust to the normal value in January.

19, neonatal hyperthyroidism in critical condition, high mortality, to use antithyroid drugs, corticosteroids, iodine solution, beta receptor inhibitors and systemic support, symptomatic treatment, such as active treatment.

20, hyperthyroidism mother lactation can clothing sulfur or methimazole.

 

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