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Propylthiouracil

内分泌

关键词内分泌 治疗药物 甲状腺药物

词汇介绍

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解析

Propylthiouracil   英/'prəupil,θaiə'juərəsil/

       n. [药] 丙基硫氧嘧啶;[药] 丙硫氧嘧啶

       No such cases have been reported with propylthiouracil use during pregnancy.若妊娠期使用的是丙硫氧嘧啶,则不会出现上述情况。

概述

丙硫氧嘧啶是一种口服抗甲状腺药物。丙硫氧嘧啶抑制甲状腺激素的合成,因此可有效治疗甲状腺功能亢进症。该药物不会使存在于甲状腺中或在血液中循环的现有甲状腺素和三碘甲状腺原氨酸失活,也不会干扰口服或注射给予甲状腺激素的有效性。丙硫氧嘧啶抑制外周组织中甲状腺素向三碘甲腺原氨酸的转化,因此是治疗甲状腺亢进的有效方法。适应症患有甲状腺功能亢进或多结节性甲状腺肿的格雷夫斯病甲亢期患者,他们对甲巯咪唑不耐受,并且手术或放射性碘治疗不适合作为治疗选择;对甲巯咪唑不耐受的患者进行甲状腺切除术或放射性碘治疗,以改

Hyperthyroidism and Pregnancy复制标题

甲状腺功能亢进症与妊娠

发表时间:2019-09-01

影响因子:3.3

作者: Kristen Kobaly

期刊:Endocrinol Metab Clin N Am

Women with gestational thyrotoxicosis generally require no treatment. Antithyroid drugs (ATDs) are not recommended because of the transient nature of the abnormalities, risk of maternal/fetal hypothyroidism, and concern for teratogenicity. Thyroid function tests should be followed periodically through resolution of the abnormalities with monitoring for a hypothyroid phase if there is suspicion for transient autoimmune thyroiditis as an alternate diagnosis. b-Blockers may be considered; details of the use of these drugs in pregnancy is discussed further later. Hyperemesis gravidarum requires supportive care, including antiemetics, intravenous fluids, and correction of electrolytes abnormalities, if severe. GRAVES’ DISEASE IN PREGNANCY Graves’ disease may present for the first time during pregnancy or postpartum. A recent population-based cohort study using the Danish nationwide registry found the incidence ratio of hyperthyroidism to be high in the first 3 months of pregnancy, very low in the last 3 months, and highest at 7 to 9 months postpartum. For women with known Graves’ disease, exacerbation or relapse may occur by 10 to 15 weeks gestation. In the late second or third trimester, a period of immune tolerance, patients often enter remission, a process that correlates with decreases in TRAb levels. Disease may relapse postpartum as TRAb levels increase, with the greatest risk occurring around 7 to 9 months following delivery. There is a 2- fold to 4-fold increased risk of new-onset Graves’ disease in the postpartum period.PRECONCEPTION THERAPY FOR WOMEN WITH PREEXISTING GRAVES’ DISEASE In women with Graves’ disease interested in childbearing, therapeutic considerations include the time course of planned conception, disease history and activity, and TRAb levels. A discussion of the risk of birth defects from ATDs should occur. If ATDs are continued, women may either be treated with propylthiouracil (PTU) before conceiving or changed to PTU as soon a pregnancy is confirmed. Definitive treatment is often preferable unless disease course is mild or pregnancy is imminent. Hyperthyroidism should be controlled for several months before attempting pregnancy, and, if radioactive iodine or surgery are used, hypothyroidism should be treated with levothyroxine to achieve a euthyroid state before trying to conceive. Pregnancy should be avoided for 6 months following radioactive iodine.

译文

患有妊娠期甲状腺毒症的女性通常不需要治疗。不推荐使用抗甲状腺药物(ATD),因为异常的短暂性,母体/胎儿甲状腺功能减退的风险以及对致畸性的担忧。如果怀疑短暂的自身免疫性甲状腺炎作为替代诊断,应定期通过甲状腺功能检查来确定异常情况并监测甲状腺功能减退期。可以考虑阻挡者;稍后将进一步讨论这些药物在怀孕期间的使用细节。妊娠剧吐需要支持治疗,包括止吐药,静脉输液和纠正电解质异常,如果严重的话。格拉维斯的怀孕疾病 格雷夫斯病可能在怀孕期间或产后第一次出现。最近使用丹麦全国登记处进行的基于人群的队列研究发现,妊娠头3个月甲状腺功能亢进的发病率很高,过去3个月非常低,产后7到9个月最高。对于已知格雷夫斯病的女性,妊娠10至15周可能发生恶化或复发。在妊娠中期或妊娠晚期,一段时间的免疫耐受,患者经常进入缓解期,这一过程与TRAb水平的降低相关。随着TRAb水平的增加,疾病可能会在产后复发,最大的风险发生在分娩后7到9个月左右。产后新发格雷夫斯病的风险增加2倍至4倍。 对患有预防性疾病的妇女进行预防治疗对于对生育感兴趣的格雷夫斯病患者,治疗方面的考虑因素包括计划受孕的时间过程,疾病史和活动以及TRAb水平。应该讨论ATD出生缺陷的风险。如果继续使用ATD,女性可在怀孕前接受丙硫氧嘧啶(PTU)治疗,或在妊娠确诊后立即改为PTU。除非疾病病程轻微或怀孕迫在眉睫,否则通常优选最终治疗。在尝试怀孕前应该控制甲状腺功能亢进几个月,如果使用放射性碘或手术,甲状腺功能减退症应该用左旋甲状腺素治疗,以便在试图怀孕前达到甲状腺功能正常状态。放射性碘后6个月应避免怀孕。