What to do if hyperthyroidism is detected during pregnancy? ——Comprehensive analysis and response guide
In recent years, thyroid health issues have attracted much attention, especially the detection rate of hyperthyroidism during pregnancy. Hyperthyroidism (hyperthyroidism) can pose risks to the health of both mother and baby if not promptly intervened. This article will combine the hot discussions and medical advice from the entire Internet in the past 10 days to provide structured solutions for pregnant mothers.
1. Core data of hyperthyroidism during pregnancy
| data item | Value/ratio |
|---|---|
| Incidence of hyperthyroidism during pregnancy | 0.2%-0.7% |
| Common causes (proportion of Graves’ disease) | More than 85% |
| Untreated risk of premature birth | Increase 2-3 times |
| Drug control target time | 4-8 weeks |
2. Diagnosis and staged response plan
1.Diagnosis stage: When TSH is less than 0.1mIU/L and FT4 is elevated, you need to be vigilant and combine it with TRAb antibody testing to confirm the cause.
| Check items | normal reference value | Hyperthyroidism criteria |
|---|---|---|
| TSH | 0.27-4.2mIU/L | <0.1mIU/L |
| FT4 | 12-22pmol/L | >22pmol/L |
2.treatment stage: Propylthiouracil (PTU) is the first choice, and methimazole (MMI) can be used after the second trimester. Medication needs to strictly follow the dosage ladder:
| Degree of illness | Initial dose (PTU) | Adjust frequency |
|---|---|---|
| Mild | 50-100mg/day | Review every 2 weeks |
| Moderate | 200-300mg/day | Weekly review |
3. Key points of nutritional management
1.Avoid iodine diet: Avoid high-iodine foods such as kelp and seaweed. It is recommended to choose:
| food category | Recommended ingredients | Limit ingredients |
|---|---|---|
| seafood | freshwater fish | Marine fish and shellfish |
| Condiments | non-iodized salt | iodized salt |
2.Key nutrient supplements: It is necessary to focus on ensuring the intake of calcium (1000mg/day), vitamin D (400IU/day) and high-quality protein.
4. Top 3 high-frequency questions and answers
1.Q: Will hyperthyroidism affect fetal intelligence?
A: Well-controlled hyperthyroidism usually has no effect, but persistent FT4 <12 pmol/L may increase the risk of cognitive impairment.
2.Q: Can I breastfeed while taking medication?
A: It is relatively safe when the PTU dose is <300mg/day or MMI <20mg/day. It is recommended to breastfeed 3-4 hours after taking the medicine.
3.Q: How to choose the mode of delivery?
A: Those with stable thyroid function can give birth vaginally. If there are serious complications, the indications for cesarean section need to be evaluated.
5. Monitoring and follow-up plan
| Gestational age | Check items | target value |
|---|---|---|
| 12 weeks ago | TSH+FT4+TRAb | TSH>0.3 |
| 20-24 weeks | Fetal heart color ultrasound | Rule out tachycardia |
Warm reminder: About 60% of patients with Graves' disease have symptoms relieved in the third trimester of pregnancy, but they need to be wary of recurrence within 6 months after delivery. It is recommended to establish a triple monitoring system of "thyroid function-drug dosage-fetal development", which should be jointly managed by endocrinologists and obstetricians.
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