Kunyatsotarisa kuMitungamiri yeKliniki
Apo hyperthyroidism isiri kutarisirwa pakuberekwa, inobatanidza nemhando dzakasiyana-siyana, kusanganisira kusununguka kwepamuviri, kuberekwa-kunokonzerwa nehutano hwepfungwa, kuberekwa kusati kwapera, kuberekwa kwepamusoro kuberekwa, intrauterine kukura kwechiremera, kuberekwa, chirwere chetachiona, uye kuberekwa kwepabonde kwemoyo kusakwana. Nokudaro, kuongororwa kwakakodzera uye kurapwa kweBraves 'chirwere uye hyperthyroidism munguva yekuzvitakura kunokosha.
Maererano ne " 2011 " Mirayiridzo yeAmerican Thyroid Association yekuziva uye Kutungamirirwa kwezvirwere zveTroroid PaKuberekwa uye Postpartum, " vakadzi vane chirwere cheGraves 'vanofanira kufungira mushure mokunge vaine euthyroid - vanotsanangurwa sevanorwara nehutachiona hwemazuva ose . Iyi Nhungamiro inonyatsokurudzira kubata pamuviri kusvikira izvi zvaitika, uye kurumbidza kuti vanachiremba vanopa mazano kuvakadzi pamusoro pezvinoreva kurapwa pamagadziro emimba.
Kunyanya, iyo Mirayiridzo inokurudzira kuti varwere veCheves 'vanowana chirwere chinopfurikidza nekuvhiyiwa kana iodine inonzi radioactive (RAI), kana mishonga inotapira maitiro antithyroid .
Iyi Nhungamiro inokurudzira kuvhidzira mukadzi ane high TSH receptor antibody (TRAb) mazinga uye ndiani ari kuronga kubata pamuviri mukati memakore maviri. Chikonzero ndechekuti maTrAb anowanzosimudza mushure meRI uye anoramba akasimudzirwa.
Kana RAI ichiitwa, kuve nekudzivirira pamuviri kunofanirwa kuitwa maawa 48 isati yasvika pakuronga kweRAI.
Mushure mekuvhiyiwa kana RAI, Mirayiridzo inokurudzira kumirira mwedzi mitanhatu kuti ive nepamuviri, kubvumira kuti mukadzi awane chirwere chakachengetedzeka chetachiona hormone chinotsiviwa , nechinangwa cheTSH chikamu pakati pe3 uye 2.5.
Nezvinodhaka zvinotapira mishonga, vakadzi vanofanira kuziviswa nezvengozi dzinosangana nepropylthiouracil (PTU) uye methimazole, uye kana zvinodhaka izvi zvishandiswa, PTU inofanira kushandiswa mumutambo wekutanga wekuita pamuviri.
Methimazole (zita rechiratidzo: Tapazole) rinokonzera njodzi kumucheche kana yakashandiswa mumutatu wekutanga. Iyi Nhungamiro inokurudzirawo kufunga nezvekuregererwa kwePUU mushure mekutanga kwetatu uye kuchinja kune methimazole, kuderedza dambudziko rechirwere chechiropa chinosangana neTPU .
Kuchengetedza Makungu 'Hyperthyroidism Panguva Yokudzivirira
Kunyanya kurapwa kweHyperthyroidism panguva yekuzvitakura mishonga yevitithyroid , asi, kubva ku3 kusvika ku5% yevarwere vane mishonga inokonzerwa nemishonga yakadai semagetsi anokonzerwa nemishonga.
Nemhaka yokuti mishonga yeitrothyroid inodarika mu-placenta, kutarisirwa kunofanira kutorwa nekushandiswa kwemishonga inotapira mishonga panguva yekuzvitakura. Kunyanya, chinonyanya kukoshesa kukwanisa kwemethimazole kunokonzera kuberekwa kwehupombwe - izvi zvinetso hazvibatanidzi nekushandiswa kwe PTU. PTU, zvisinei, inotakura chiropa chekutyisa chechiropa , uye Mirayiridzo inokurudzira kuti PTU ishandiswe mumutatu wekutanga, uye kuti varwere vanofanira kutendeukira kune methimazole mushure mokutanga kwemitatu.
Beta blockers hazviwanzokurudzirwe panguva yekuzvitakura, sezvo dzinobatanidzwa ne-intrauterine kukura kwechigadziriswa, kuderera kwemoyo wemukomana, uye hypoglycemia muzvitsva.
Antithyroid Zvinodhaka Muhutano
Iyi Nhungamiro inokurudzira kuti mukadzi anotora zvinodhaka zvinoshandiswa mumitambo panguva yekuzvitakura anogara achiongororwa neFree T4 uye TSH, kuitira kuti mahara eT4 asarambe aripo, kana kuti pamusoro pekukwirira kwemazuva ose, achitora mishonga yakaderera zvikuru yezvinodhaka zvevhitithyroid.
Kusununguka T4 uye TSH kunofanira kuyerwa kwemavhiki maviri kusvika mana pakatanga kurapwa, uye kwemavhiki mana kusvika matanhatu, kuti zvizadzise chinangwa cheropa. Kazhinji, nokuti hyperthyroidism kazhinji inowanzoita panguva yekuzvitakura, mishonga yemitambo inopedzisira inoguma ichigumburwa mumatatu matatu mumakumi maviri kusvika ku30% evarwere.
Iyi Nhungamiro inokurudzira kuti vakadzi vane high TSH receptor antibody (TRAb) mazinga anoenderera mberi nekurapwa kwemishonga ye antithyroid kusvika pakuzvarwa .
Utachiona hwemapfupa 'Matenda panguva yekuzvitakura
Kana mukadzi ari yegenegisi kune zvinodhaka zvinotapira, inoda mizinga yakawanda yekudzora hyperthyroidism, kana kusatevera mushonga wake wemishonga, Mirayiridzo inoratidza kuti thyroidectomy inofanira kufungwa.
Kana chirwere cheropiyo - inozivikanwa se thyroidectomy - inodiwa, nguva yakakwana iri mukati mekupedzisira kwemamiriyoni matatu ekuzvitakura.
Panguva yekuvhiyiwa, mazinga eTrAb anofanira kuyerwa kuti aongorore ngozi inogona kuitika ye hyperthyroidism mu fetus. Iyi Nhungamiro inokurudzira kugadzirira ne beta blocker , uye pfupi pfupi ye potassium iodine solution musati maitwa chirwere che thyroidectomy .
Fetal Risks Mumadzimai Ari Kuberekwa Ane Makuva Akasimba 'Hyperthyroidism
Pane huwandu hwezvipingamupinyi kune fetus yemukadzi ane maHurusi anonzi 'hyperthyroidism , kusanganisira:
- fetal hyperthyroidism
- neonatal hyperthyroidism
- fetal hypothyroidism
- neonatal hypothyroidism
- central hypothyroidism
Zvimwe zvinogona kukanganisa njodzi ye fetus zvinosanganisira:
- kushaya masimba kwe hyperthyroidism panguva yose yekuzvitakura, izvo zvinogona kukonzera nguva duku mukati me hypothyroidism mumucheche.
- kukwirira kwemishonga inoshandiswa nemitambo, iyo inogona kukonzera fetal uye neonatal hypothyroidism.
- yakakwirira ye serum TRAb pakati pemasvondo makumi maviri nemaviri nemakumi maviri nemasere, iyo inogona kukonzera fetal kana neonatal hyperthyroidism .
Maererano neMirayiridzo, vanopfuura 95% yevakadzi vane chirwere cheBraves vane uchapupu hweTrAb, kunyange mushure mokunge chirwere chinopera , uye TRAb inofanira kuongororwa muvakadzi vane pamuviri :
- uye inoshanda hyperthyroidism;
- uyo akambowana chirongwa cheRAI ;
- ine nhoroondo yekusunungura mwana ne hyperthyroidism; and
- uyo aiva ne-thyroidectomy panguva yekuzvimba, kubata hyperthyroidism.
Fetal uye neonatal hyperthyroidism inowanikwa pakati pe1% uye 5% yevakadzi vose vane pamuviri vane simba kana zvakaitika kare yeCheves ' hyperthyroidism, uye inosanganiswa nematambudziko akawanda.
Mumukadzi ane pamuviri ane chiitiko chakashata kana chakaitika cheGurves 'chirwere, TRAb inofanira kuyerwa nemasvondo makumi maviri nemasere ekuberekwa. Maererano neMitungamiri, kukosha kunopfuura katatu kunopera kwemazuva ose kunofanirwa kuve chiratidzo chekutevera kwe fetus, zvinosanganisira chiremba anoziva nezvemishonga yemakereke.
Kana kutevera kuchidikanwa, ultrasound inofanira kuitwa kuitira kutarisa fetal development.
Kunobva:
Stagnaro-Green, Alex, et. al. "Nhungamiro yeAmerican Thyroid Association yekuziva uye Kurapa Matenda eTroroid Panguva Yokuberekwa uye Postpartum." Thyroid . Bhuku 21, Nhamba 10, 2011