561 1005-2216 2012 08-0561 - 05 Keywords pregnancy hyperthroidism ATA R714. 256 C 2011 10 The American Thyroid 3 6-8 Association ATA 2 - - 1 hyperthyroidism thyrotoxicosis FT 4 10 FT 3 HCG 3 HCG 1 TSH α HCG 0. 1% ~ 0. 2% 2 TSH 8 0. 1% ~ 0. 4% 3 ATA gestational transient hyperthyroidism GTH Graves 1% ~ 3% 4 20% ~ 40% 11 GD 30% ~ 40% 10 0. 1% ~ 1. 0% 5 FGR ATA 0. 4 ~ 4. 0 mu /L 510150 0. 1 ~ 0. 2 mu /L 1. 0 mu chendunjin@ hotmail. com 9 TBG TBG 10% TSH TSH TSH TSH
562 TT 3 TT 4 1 /3 1. 5 11 FT 3 FT 4 FT 3 FT 4 FT 3 FT 4 5% ~ 10% HCG TSH TSH 0. 1 mu /L 1 /3 10% ~ 30% 12 GTH TSH TBG Graves 3 GTH Graves TSH ATA 1 TSH HCG TSH < 0. 1 mu /L FT 4 TT 3 T 4 TRAb T 3 16 TSH B-USPSTF 2 11 I-USP- ATA 1 STF 3 3 D-USPSTF TSH B-USPSTF 2 3 TSH 1 2. 5 mu /L 0. 1 ~ 3. 1 GTH GTH 2. 5 mu /L 2 0. 2 ~ 3. 0 mu /L 3 0. 3 ~ 3. 0 mu /L I-USPSTF 3 FT 4 HCG - FT 4 TT 4 TSH - LC-MS-MS A-USP- STF 4 LC-MS-MS FT 4 GTH GTH FT 4 ATA 1 GTH TSH I-USPSTF A-USPSTF 2 ATD 5 FT 4 FT 4 GTH D-USPSTF 3 FT 4 GTH HCG B-USPSTF HCG GD GTH 3. 2 Graves 1 14 TSH Graves Graves 1 100 /min TSH < 0. 1 mu /L FT 3 FT 4 TBG TT 4 TT 3 GD HCG FT 4 TSH T 4 T 3 TRAb 95% 99% T 4 T 3 TSAb Graves 11-12 ATA Ⅲ 5'- 1 GD GD TG 20 ~ 24 TRAb B-USPSTF 2 TRAb 3
563 I-USPSTF GD TRAb 1% ~ 2% 5% 0. 1% ~ 0. 5% 0. 1% ~ 1% GD TRAb TRAb 7 16-17 TRAb ATD GD GD TRAb TRAb 22 ~ 26 22 ~ 26 TRAb 4. 1. 3 ATD GTH 3 ~ 4 d 7 ~ 10 d ATD ATD 3. 3 GD BMR 13 BMR MMI PTU 10% BMR 20% ~ 30% > 30% ~ 60% 60% 4 ATD ATA 3 PTU MMI 3 131 I PTU 3 MMI I-USPSTF PTU MMI 6 PTU MMI PTU 1 ~ 2 h 4. 1 4. 1. 1 ATD ATD - - 15 1 GD 6-7 PTU 2 TRAb 3 MMI PTU 20 4 Graves 5 6 131 I 25% ~ 50% 18-20 PTU MMI ATD ATD 7 1% ~ 5% ATD FDA ATD D ATD ATD MMI 6 ~ 8 h PTU MMI 7 MMI FGR PTU MMI MMI 4. 1. 2 ATD ATD PTU PTU MMI 2 12 4% ~ 6% 1% ~ 5% 2 PTU TRAb 22 ~ 26 MMI TRAb 22 ~ 26 MMI MMI PTU 22 ~ 26 TRAb TRAb 22 ~ 26 ATD TRAb 22 ~ 26 TRAb 22 ~ 26 PTU MMI 10 1 ~ 15 1 100 mg PTU 10 mg MMI ATD PTU MMI ATD
564 TSH 14 90% ~ 95% 0. 6% ~ ATD 9. 8% 22 PTU 50 ~ 150 mg 50 ~ 300 mg 2 ~ 3 /d MMI 5 ~ 15 mg 1 /d ATA ATD 2 ~ 6 FT 4 TSH FT 4 A-USPSTF B-USPSTF 4 TSH FT 4 4 TSH 6 ~ 8 FT 4 TSH 4. 5% ~ 5. 5% 23 TSH TSH ATD TRAb 5 ATD TRAb 5. 1 ATA ATD A-USPSTF 11 14 ATA ATD I-USPSTF 1 FT 4 ATD FT 4 ATD FT 4 ATD 1 /3 ATD ATA MMI 20 ~ 30 mg /d 5. 2 PTU300 mg /d ATD FGR A-USPSTF ATD MMI PTU ATD 1 PTU MMI ATA ATD 10% ~ 20% 75% 24 LT 4 D-USPSTF 2 ~ 4 h ATD ATD ATD 21 ATD LT 4 LT 4 ATD ATA 2 131 I 6 3 5. 3 4. 2 5. 4 22 ATD
565 ATD 2007 10 Cooper DS. Antithyroid drugs in the management of patients ATA with Graves' disease an evidence-based approach to therapeutic controversies J. J Clin Endocrinol Metab 2003 88 8 3474-1 3481. 250 μg A-USPSTF 2 11 Stagnaro-Green A Abalovich M Alexander E et al. Guidelines 250 μg of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum 150 μg J. Thyroid 2011 21 10 1081-1125. B-USPSTF 3 12 Bahn Chair RS Burch HB Cooper DS et al. Hyperthyroidism and other causes of thyrotoxicosis management guidelines of the A-USP- American Thyroid Association and American Association of STF 4 GD Clinical Endocrinologists J. Thyroid 2011 21 6 593-646. 13 Soldin OP Tractenberg RE Hollowell JG et al. Trimester-specific changes in maternal thyroid hormone thyrotropin and thy- C-USPSTF roglobulin concentrations during gestation trends and associations across trimesters in iodine sufficiency J. Thyroid 2004 5 14 1084-1090. 14 Brent GA. Maternal thyroid function interpretation of thyroid 500 ~ 1100 μg C-USPSTF. function tests in pregnancy J. Clin Obstet Gynecol 1997 40 3-15. 6 15. M. 2. 2007 506-513. 16 Rivkees SA Mattison DR. Propylthiouracil PTU hepaltoxicity in children and recommendations for discontinuation of use J. Int J Pediatr Endocrinol 2009 2009 13204. 1 Braverman LE Utiger RD. 2005 Introduction to thyrotoxicosis M / /Braverman LE Utiger RD eds Werner and Ingbar's The Thyroid. A Fundamental and Clinical Text. 9th ed. Lippincott Williams and Wilkins Philadelphia 2005 453-455. 2. M. 2005 137-138. 3 Maurizio Clementi Elena Di Gianantonio Matteo Cassina et al. Treatment of hyperthyroidism in pregnancy and birth defects J. J Clin Endocrinol Metab 2010 95 11 337-341. 4 Tan JY Loh KC Yeo GS et al Transient hyperthyroidism of hyperemesis gravidarum J. BJOG 2002 109 683-688. 5 Patil-Sisodia K Mestman JH. Graves hyperthyroidism and pregnancy a clinical update J. Endocr Pract 2010 16 118-129. 6 Cooper DS. Antithyroid drugs J. N Eng J Med 2005 352 9 905-917. 7 Drews K Seremak-Mrozikiewicz A. The optimal treatment of thyroid gland function disturbances during pregnancy J. Curr Pharm Biotechnol 2011 12 5 774-780. 8. J. 24 Karger S Ftihrer D. Thyroid storm thyrotoxic crisis an update 2010 26 6 409-411. J. Dtsch Med Wochenschr 2008 133 10 479-484. 9 Glinoer D. The importance of iodine nutrition during pregnancy J. Public Health Nutr 2007 10 1542-1546. 17 Grzywa M Orlowska-Florek R Grzywa-Celinska A. Two cases of serious hepatic injury caused by antithyroid drugs J. Endokrynol Pol 2009 60 396-400. 18 Ruiz JK Rossi GV Vallejos HA et al. Fulminant hepatic failure associated with propylthiouracil J. Ann Pharmacother 2003 37 2 224-228. 19 Russo MW Galanko JA Shrestha R et al. Liver transplantation for acute liver failure from drug induced liver injury in the United States J. Liver Transpl 2004 10 8 1018-1023. 20 Bahn RS Burch HS Cooper DS et al. The role of propylthiouracil in the management of Graves disease in adults report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration J. Thyroid 2009 19 673-674. 21. M. 2003 424. 22. J. 2010 5 2 147-152. 23 Kuy SR Roman SA Desai R et al. Outcomes following thyroid and parathyroid surgery in pregnant women J. Arch Surg 2009 144 399-406. 2012-04 - 13 2012-05 - 10