中华内分泌外科杂志
中華內分泌外科雜誌
중화내분비외과잡지
CHINESE JOURNAL OF ENDOCRINE SURGERY
2013年
4期
272-274
,共3页
甲状腺癌%妊娠%甲状腺素%促甲状腺激素
甲狀腺癌%妊娠%甲狀腺素%促甲狀腺激素
갑상선암%임신%갑상선소%촉갑상선격소
Thyroid carcinoma%Pregnancy%Levothyroxine%Thyrotropin
目的 分析甲状腺癌术后妊娠期甲状腺素水平的调控过程,旨在降低母体甲状腺功能减退继发的胎儿异常发生率.方法 回顾性分析20例甲状腺癌术后妊娠妇女甲状腺激素水平的调控过程,通过每月监测其甲状腺功能,了解左旋甲状腺激素(优甲乐)增加剂量和目标TSH水平.结果 20例妊娠妇女孕21次,1例妊娠2次,第1次孕早期流产,20例优甲乐的基础剂量均为100 μg,以12.5 μg为调整增量,目标TSH水平设为0.10～0.25 mU/ml.20例优甲乐剂量平均增加50μg,即增加了基础剂量的50％.在孕16周左右TSH水平达到平衡,直至分娩.所有胎儿均健康,发育良好；所有20位妇女产后均规律随访,时间平均5年(6个月～10年),无复发.结论 甲状腺癌术后妊娠,应定期监测甲状腺功能,优甲乐以12.5 μg为调整剂量,将母体TSH水平控制在0.10 ～0.25 mU/ml,既保证胎儿健康发育,又抑制母体肿瘤生长.
目的 分析甲狀腺癌術後妊娠期甲狀腺素水平的調控過程,旨在降低母體甲狀腺功能減退繼髮的胎兒異常髮生率.方法 迴顧性分析20例甲狀腺癌術後妊娠婦女甲狀腺激素水平的調控過程,通過每月鑑測其甲狀腺功能,瞭解左鏇甲狀腺激素(優甲樂)增加劑量和目標TSH水平.結果 20例妊娠婦女孕21次,1例妊娠2次,第1次孕早期流產,20例優甲樂的基礎劑量均為100 μg,以12.5 μg為調整增量,目標TSH水平設為0.10～0.25 mU/ml.20例優甲樂劑量平均增加50μg,即增加瞭基礎劑量的50％.在孕16週左右TSH水平達到平衡,直至分娩.所有胎兒均健康,髮育良好；所有20位婦女產後均規律隨訪,時間平均5年(6箇月～10年),無複髮.結論 甲狀腺癌術後妊娠,應定期鑑測甲狀腺功能,優甲樂以12.5 μg為調整劑量,將母體TSH水平控製在0.10 ～0.25 mU/ml,既保證胎兒健康髮育,又抑製母體腫瘤生長.
목적 분석갑상선암술후임신기갑상선소수평적조공과정,지재강저모체갑상선공능감퇴계발적태인이상발생솔.방법 회고성분석20례갑상선암술후임신부녀갑상선격소수평적조공과정,통과매월감측기갑상선공능,료해좌선갑상선격소(우갑악)증가제량화목표TSH수평.결과 20례임신부녀잉21차,1례임신2차,제1차잉조기유산,20례우갑악적기출제량균위100 μg,이12.5 μg위조정증량,목표TSH수평설위0.10～0.25 mU/ml.20례우갑악제량평균증가50μg,즉증가료기출제량적50％.재잉16주좌우TSH수평체도평형,직지분면.소유태인균건강,발육량호；소유20위부녀산후균규률수방,시간평균5년(6개월～10년),무복발.결론 갑상선암술후임신,응정기감측갑상선공능,우갑악이12.5 μg위조정제량,장모체TSH수평공제재0.10 ～0.25 mU/ml,기보증태인건강발육,우억제모체종류생장.
Objective Hypothyroidism during pregnancy has been associated with impaired cognitive development and increased fetal mortality.In this retrospective study we attempt to identify the timing and adjustment of levothyroxine during pregnancy.Methods 20 women planning pregnancy after thyroidectomy because of thyroid cancer were observed before and throughout their pregnancies.Their thyroid function was measured before conception,and approximately every 4 weeks during pregnancy.The dose of levothyroxine was increased to maintain the thyrotropin concentration at preconception values throughout pregnancy.Results 21 pregnancies occurred in the 20 women and resulted in 20 full-term births.One woman had abortion.Their basal dose was all 100 μg.The dose increased by 12.5 μg a time to target the thyrotropin concentrations (0.1-0.25 mU/ml).The mean levothyroxine requirement increased 50 percent during the first half of pregnancy and plateaued by the 16th week.This increased dose was required until delivery.All the newborns and their mothers were healthy according to the follow-up.Conclusions We propose that women after thyroid cancer surgery should increase levothyroxine dose as soon as pregnancy is confirmed.Thereafter,serum thyrotropin level should be monitored and the levothyroxine dose adjusted accordingly.The adjustment dose is set at 12.5 μg and the maternal thyrotropin concentration is between 0.10 and 0.25 mU/ml,which guarantees healthy growth of fetus while suppresses thyroid tumor growth simultaneously.
