Hyperthyroidism is short for hyperthyroidism. Because the thyroid gland synthesizes and releases too much thyroid hormone, it causes high metabolism and sympathetic nerve excitement, leading to palpitation, sweating, eating, defecation and weight loss. Many patients with hyperthyroidism will also have symptoms such as exophthalmos, eyelid edema and decreased vision. Hyperthyroidism is one of the common endocrine diseases, which is more common in female patients, especially women of childbearing age aged 20~40.
Hyperthyroidism in pregnancy means that a woman with hyperthyroidism is pregnant or a pregnant woman suffers from hyperthyroidism during pregnancy. Some data show that the incidence of hyperthyroidism complicated with pregnancy is 0.5%~2%, the abortion rate of hyperthyroidism pregnancy is as high as 26%, and the premature delivery rate is 15%.
Causes of pregnancy complicated with hyperthyroidism
Common causes of hyperthyroidism include diffuse toxic goiter (Graves' disease), chronic lymphocytic thyroiditis and temporary hyperthyroidism caused by vomiting during pregnancy. At the same time, some rare causes include toxic single thyroid adenoma, toxic nodular goiter, subacute thyroiditis and iodine-induced hyperthyroidism. Pathological hyperthyroidism in pregnancy is rare and the incidence is extremely low. Even if there is hyperthyroidism before pregnancy, due to the decline of immune activity after pregnancy, it will often relieve or alleviate itself. Hyperthyroidism caused by different causes has different physiological changes.
Symptoms of pregnancy complicated with hyperthyroidism
1, pregnant women with hyperthyroidism will have a physiological increase of thyroid gland, which can be 2 ~ 4 times of normal. Magnification can be symmetrical, or one leaf can be slightly larger. Gland texture can be from soft to tough, with occasional tenderness, smooth surface, tremor, and continuous vascular murmur. The hair of hyperthyroidism patients is thin and brittle, and hair loss will occur at the same time. Pregnancy vomiting patients with transient hyperthyroidism generally have fewer symptoms, a few patients have palpitations or weight loss or fear of heat and sweating, and there is no exophthalmos and mucinous edema in front of the tibia.
2, eye disease is also a major manifestation of hyperthyroidism. Eye strain is prominent, eyelid retracts, especially when the patient looks down, the upper eyelid retracts, and when looking down, there is obvious scleral margin between eyelid margins. Severe hyperthyroidism eye disease is rare, and the eye symptoms include eye irritation, photophobia, tears and eye discomfort. If the condition is serious, there will be phenomena such as unclear vision and diplopia. After the examination, you will find the patient's gaze, periorbital edema, conjunctival congestion and edema, eyelid insufficiency, corneal ulcer, incomplete dislocation of eyeball and a few cases of optic disc edema.
3. Hyperthyroidism can also lead to personality changes and nervousness, such as irritability, irritability, talkativeness and paranoia, inattention or reticence and depression, palpitation (paroxysmal or persistent), fatigue, fear of heat, weight loss, intestinal peristalsis, diarrhea in a few cases, itchy skin or rash after sun exposure. Due to different degrees of muscle weakness, you need to use your hands to stand up when sitting or lying down, and you will be obviously flustered and short of breath when you go upstairs.
4. Hyperthyroid pregnant women will also have changes in digestive system and metabolism, mainly manifested as fear of heat, weight loss and good appetite. In the case of increasing food intake, the weight of pregnant women can not increase with the increase of gestational age, and some sick pregnant women will lose weight. Moreover, the frequency of stool increases, and the stool is thin and soft.
Effect of pregnancy complicated with hyperthyroidism on fetus
1, hyperthyroidism is a very serious disease. Its severity rate is second only to gestational diabetes. If hyperthyroidism is not treated during pregnancy, it will lead to neonatal malformation, abortion, premature delivery or neonatal death. Therefore, hyperthyroidism in pregnancy is a serious disease.
2. Hyperthyroidism during pregnancy will also affect pregnant women. Pregnant women will have premature delivery, stillbirth, preeclampsia and congestive heart failure, as well as abortion, placental abruption, infection, etc., which will also have a certain impact on the fetus. At this time, it will lead to neonatal hyperthyroidism, intrauterine growth retardation and premature infants.
3. Hyperthyroidism during pregnancy can also lead to various types of thyroid dysfunction in fetuses and newborns. Include fetal or neonatal hyperthyroidism or fetal or neonatal hypothyroidism.
4. Hyperthyroidism occurs during pregnancy, and the weight of pregnant women will increase slowly, without increasing or even decreasing. At the same time, the heart rate will accelerate, and goiter will cause various complicated diseases such as vascular murmur.
How to do pregnancy complicated with hyperthyroidism?
Regular prenatal examination should pay attention to the detection and analysis of clinical symptoms and thyroid function of hyperthyroidism, and adjust the dose of antithyroid drugs appropriately. At the same time, we should pay attention to maternal and infant complications, such as abortion, premature delivery, fetal growth retardation, pregnancy-induced hypertension syndrome and so on. If pregnant women have few or no symptoms, and the serum free thyroid hormone level is only slightly increased and TSH is decreased, then they can be closely observed and temporarily not treated with drugs.
Treatment principles of pregnancy complicated with hyperthyroidism
When hyperthyroidism is complicated with pregnancy, the problem of fetal reservation should be carefully decided according to the specific situation of the patient. Patients with hyperthyroidism who are relieved after pregnancy can be followed up regularly. A few patients need antithyroid drugs before delivery. It is advisable to maintain thyroid function at the high limit of normal level during medication. Avoid hypothyroidism.