During pregnancy, sub -clinical hypothyroidism is found. Should we abandon the fetus?

Women of childbearing age are high -incidence of thyroid diseases. Among them, the clinical hypothyroidism of pregnancy is the most common. In the era of this fertility policy, many newlyweds of Yaner’s young couples and old couples of Sankou family are busy giving birth to baby.A hypothyroidism has also become a common disease in gynecological endocrine clinics …

Therefore, when doctors are a doctor, pregnant women who often have a clinical hypothyroidism in pregnancy are often asked. Is it too late to treat it now?Do you want to give up the fetus?Is it too late to take medicine or supplement iodine?

What is hypothyroidism and what is the diagnostic standard?

The thyroid dysfunction that occurs during pregnancy is "hypothyroidism". It includes clinical hypothyroidism (serum serum serum hypothyroidism, that is, the level of TSH levels, FT4 levels decrease), and sub -clinical hypothyroidism (heavier serum TSH level, increased level of serum, increased levels of serum.FT4 levels are normal) and low T4 hemiamond (serum TSH levels are normal, and FT4 levels are reduced). The common causes are chronic autoimmune thyroiditis (that is, "Hashimoto disease").

The harm of clinical hypothyroidism during pregnancy is greater than that of sub -clinical hypothyroidism, but data shows that clinical hypothyroidism during pregnancy accounts for only 2.4%of the increase in TSH.TSH’s elevated pregnant women are sub -clinical hypothyroidism.

If the clinical hypothyroidism during pregnancy, if the treatment is not good, it will increase the risk of poor pregnancy ending, which increases the chances of abortion, premature birth, low birth weight, and premature placental peeling.It is very harmful to both maternal and infants.

By understanding the process of fetal and infant brain development, we can clearly discover that the level of maternal thyroid hormone level plays an important role in fetal brain development.The development and maturity of the fetal brain-pituitary-thyroid axis through the entire pregnancy period.Therefore, from the beginning of pregnancy, replenishment of thyroxine and iodine to pregnant women at any time has the treatment value.

The influence of fetal brain nerves on the placenta is also very sensitive.The mother’s thyroid antibody and anti -thyroid drug can be reached to the fetus through the placenta, causing the fetus to varying degrees of nails, which will affect the development of the fetal nervous system.Studies have shown that the thyroid hormone -sensitive genes in human fetuses are affected by mothers’ thyroid hormone.Although the mechanism of mothers’ hypothyroidism affecting fetal brain development has not yet been clear, research has confirmed that the clinical hypothyroidism during pregnancy may indeed affect future generations of intelligence.

At the same time, combined with the time and clinical research of fetal nerve development, the early pregnancy (7 weeks) L-T4 intervention may be effective in improving the intellectual of offspring, while intervention in the middle and late pregnancy may be invalid.However, although the clinical hypothyroidism of pregnancy can reduce the fetal IQ by 7 to 10 points, it does not cause "small symptoms".

For patients, the metabolism during pregnancy increases the amount of thyroxine in the body. Compared with non -pregnancy period, it can increase by up to 50%. Coupled with the impact of HCG hormones in the receptor during pregnancy, the serum TSH concentration will also be reduced.The changes can cause women with normal thyroid dysfunction through alternative treatment before pregnancy. After pregnancy, due to no increased dosage of the drug, the dosage of the need for glory during pregnancy is 30%to 50%compared to before pregnancy.

The purpose of the medication is to hope that TSH controls the lower 1/2 of the reference range of the peculiar reference during pregnancy.

At the same time, 1-20 weeks in the first pregnancy, monitor serum TSH and FT4/TT4 every 4 weeks. After the TSH is stable, it can be extended to every 6 weeks. A sub-clinical hypothyroidism patient diagnosed during pregnancy can be discontinued after giving birth to L-T4, and and and.The thyroid function and various antibody indicators were reviewed 6 weeks after giving birth.

Professional reminder

Some drugs and foods affect the absorption of Youjia Le, such as soybeans, heavy coffee, milk and other foods and bile amine, testing, aluminum, aluminum hydroxide, H2 receptor blocker and proton pumpInhibitors, calcium tablets and other drugs, so take such drugs, the two should be separated by 4-5 hours.

Hormone replace it to simulate physiological secretion as much as possible. The secretion is the highest every day at 6-9 am, and it gradually drops. The lowest in the morning at midnight. In the morning, the medicine is more in line with the rhythmic changes in thyroid hormones.The medication time is more than half an hour before breakfast or 3 hours after dinner, and take it before bedtime. It is better to take L-T4 after dinner.

Is the drug used during pregnancy safe during pregnancy?

A sub-hypotonics that need to be treated during pregnancy. The L-T4 is preferred during treatment. The drug is graded by the FDA’s pregnancy safety grades to A-level, and it is not easy to pass through the placenta. Patients do not need to stop the drug during pregnancy.

Monitoring of pregnant women’s thyroid dysfunction is conducive to early diagnosis and treatment of pregnancy hypothyroidism, reducing complications and impact on the fetus.After the birth of the newborn, pay attention to the large goal of thyroidism during physical examination, check the level of thyroid hormone, and follow up for a long -term follow -up.

Because of the harm of hypothyroidism to both maternal and infants, pregnancy hypothyroidism needs to follow the principles of early initiative, meet the standards as soon as possible, and maintain the whole process of pregnancy.

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