Graves' disease, toxic adenoma, toxic multinodular goiter, gestational trophoblastic disease로 인한
symptomatic, moderate-to-severe, overt hyperthyroidism 여성에서는
갑상선기능항진증에 대한 치료를 필요로 합니다.
이와 같은 환자들은 거의 항상 TSH 값이 0.05 mU/L보다 낮고,
trimester-specific free T4 concentrations 그리고/또는 total T4 and T3 concentration이 비임신 여성의 ULN의 1.5배를 넘습니다.
갑상선기능항진증이 경하다면 혈액검사로 overt hyperthyroidism인 모두 환자들을 치료하는 것은 아닙니다.
왜냐하면 치료의 목표도 mild maternal hyperthyroidism 상태를 유지하는 것이기 때문입니다.
다음과 같은 상황에서는 임신 중 갑상선기능항진증 치료를 하지 않습니다.
● Transient, subclinical hyperthyroidism (normal serum total or free T4 and T3 concentrations for pregnancy in the presence of a subnormal TSH) in the first trimester of pregnancy, because it is considered a normal physiologic finding and therefore does not require therapy.
● hCG-mediated, overt hyperthyroidism (also called gestational transient thyrotoxicosis), because it is usually transient and mild.
● Hyperemesis gravidarum-associated hyperthyroidism, because it is usually mild and subsides as hCG production falls(typically by 16 to 18 weeks gestation). Women with severe hyperemesis, however, require treatment of dehydration with intravenous fluids.
● Subclinical and mild, asymptomatic, overt hyperthyroidism due to Graves' disease, toxic adenoma, or toxic multinodular goiter.
Subclinical hyperthyroidism (subnormal TSH and free T4 within the trimester-specific reference range or total T4 and T3 <1.5 times above the upper limit of normal for nonpregnant patients) never requires treatment during pregnancy. Biochemical, overt hyperthyroidism (subnormal TSH and free T4 above the trimester-specific reference range or total T4 and T3 >1.5 times above the upper limit of normal for nonpregnant patients) may not require treatment if mild and asymptomatic (or minimally symptomatic), since the goal of treatment is to maintain mild maternal hyperthyroidism.
REF. UpToDate 2018.01.01
① 세균맨 의학블로그, 내과블로그 https://blog.naver.com/sjloveu2
세균맨 의학블로그, 내과블로그 http://tistorysjloveu2.tistory.com
② 세균맨 내과 KMLE, 전공의, 전문의 시험 대비 http://sjloveu2.tistory.com/
③ 의대생/의학전문대학원생/전공의 DAUM 카페 http://cafe.daum.net/sjloveu2
의대생/의학전문대학원생/전공의 NAVER 카페 http://cafe.naver.com/sjloveu2
