Ho Hlahloba ka ho Fetisisa Litsamaiso tsa Kliniki
Ha hyperthyroidism e sa laolehe nakong ea bokhachane, e amahanngoa le mathata a fapa-fapaneng, ho akarelletsa le ho senyeheloa ke mpa, ho ba le bothata ba ho imeloa kelellong, ho ba le tsoalo pele ho nako, tlhaho e tlaase ea bokhachane, thibelo ea matla ea qoqotho le khaello ea pelo ea bokhachane. Ka hona, ho hlahloba hantle le kalafo ea lefu la Graves le hyperthyroidism nakong ea bokhachane ke habohlokoa.
Ho ea ka "Tataiso ea Mokhatlo oa American Thyroid Association oa 2011 bakeng sa Tlhahlobo le Tlhokomelo ea Maloetse a Thyroid nakong ea Bokhachane le Postpartum," basali ba nang le lefu la Graves ba lokela ho emola feela ka mor'a hore ba be le euthyroid - ba hlalosoa e le ba nang le qoqotho e tloaelehileng . Melao-motheo e khothaletsa ka matla ho thibela pelehi ho fihlela e finyelitsoe, mme ho khothaletsa hore lingaka li fane ka keletso ho basali mabapi le se boleloang ke phekolo ea merero ea ho emoloa.
Ka ho khetheha, Melao-motheo e khothalletsa hore bakuli ba lefu la Graves ba fumane phekolo e sebetsang le ho buoa kapa iodine ea radioactive (RAI), kapa lithethefatsi tsa antithyroid .
Litaelo li khothalletsa ho buuoa bakeng sa mosali ea nang le litekanyetso tse phahameng tsa TSH receptor antibody (TRAb) le ea rerang ho ima nakong ea lilemo tse peli. Sepheo ke hore litekanyetso tsa TRAb li atisa ho phahama ka mor'a RAI le ho lula li phahame.
Haeba RAI e etsoa, teko ea bokhachane e lokela ho etsoa lihora tse 48 pele ho tsamaiso ea RAI.
Kamora ho buuoa kapa RAI, Melao-motheo e khothaletsa ho ema likhoeli tse tšeletseng ho emola, ho lumella mosali hore a be le tekanyo e tsitsitseng ea hormone ea qoqotho , e nang le litekanyetso tsa TSH pakeng tsa .3 le 2.5.
Bakeng sa lithethefatsi tse nang le lithethefatsi, basali ba lokela ho tsebisoa ka likotsi tse amanang le propylthiouracil (PTU) le methimazole, 'me haeba lithethefatsi tsena li sebelisoa, PTU e lokela ho sebelisoa ha ho qeta ho qeta likhoeli tse tharo tsa bokhachane.
Methimazole (lebitso la lebitso: Tapazole) le beha likotsi ho lesea la motsoako haeba le sebelisitsoe ka lekhetlo la pele. Litaelo tsena li boetse li khothaletsa ho nahana ka ho tlohela PTU kamora 'ngoe ea trimester le ho fetola methimazole, ho fokotsa kotsi ea lefu la sebete le amanang le PTU .
Ho Phekola Hyperthyroidism ea Mabitla Nakong ea Bokhachane
Phekolo ea mantlha ea hyperthyroidism nakong ea bokhachane ke lithethefatsi tsa antithyroid , leha ho le joalo, ho tloha ho 3% ho isa ho 5% ho bakuli ba nang le litla-morao tse amanang le lithethefatsi tse kang ho itšoara ha lithethefatsi le li-rashes.
Hobane lithethefatsi tsa antithyroid li tšela placenta, tlhokomelo e lokela ho nkoa ka tšebeliso ea lithethefatsi tsa antithyroid nakong ea bokhachane. Haholo-holo, ntho e ka sehloohong e amehileng ke bokhoni ba methimazole ho bakela maikutlo a fokolang a congenital - mathata ana ha a amane le tšebeliso ea PTU. Leha ho le joalo, PTU, e na le kotsing ea chefo ea sebete , 'me Melao-motheo e khothalletsa hore PTU e sebelisoe ka lekhetlo la pele, le hore bakuli ba lokela ho fetela ho methimazole ka mor'a hore ho be le trimester ea pele.
Batho ba thibelang beta ha ba buellehe nakong ea bokhachane, kaha ba amahanngoa le lithibelo tsa ho hōla ha intrauterine, tekanyo ea pelo e fokolang, le hypoglycemia ho masea.
Lithethefatsi tsa Antithyroid nakong ea Bokhachane
Litaelo li khothaletsa hore mosali a noe lithethefatsi tsa li-antithroid ha a le moimana a hlahloba khafetsa ea Free T4 le TSH, e le hore litekanyetso tsa Free T4 li lule li le teng, kapa ka holim'a moeli o ka holimo oa tloaelehileng, ha o ntse o nka tekanyo e tlaase ka ho fetisisa ea lithethefatsi tsa antithyroid.
Free T4 le TSH li lokela ho lekanyetsoa libeke tse peli ho isa ho tse 'nè qalong ea phekolo,' me libeke tse ling tse 'nè ho isa ho tse tšeletseng ka morao, ho finyella sepheo sa mali. Hangata, hobane hangata hyperthyroidism e tloaelehile nakong ea bokhachane, lithethefatsi tsa li-antithroid li ka qetella li khaotse ho li-trimester tse ka bang 20% ho isa ho 30% ea bakuli.
Litaelo li khothaletsa hore basali ba nang le litekanyetso tse phahameng tsa TSH receptor antibody (TRAb) ba tsoele pele ka phekolo ea lithethefatsi ea antithroyroid ho fihlela ho beleha.
Thyroidectomy bakeng sa Mafu a Mabitla Nakong ea Boimana
Haeba mosali a le khahlanong le lithethefatsi tsa antithyroid, o hloka tekanyo e phahameng ea ho laola hyperthyroidism, kapa ha a latele phekolo ea hae ea lithethefatsi, Litaelo li bontša hore thyroidectomy e lokela ho nkoa.
Haeba ho etsoa opereishene ea qoqotho - e tsejoang e le thyroidectomy - e hlokahalang, nako e nepahetseng ke nakong ea habeli ea boraro ea bokhachane.
Nakong ea ho buuoa, litekanyetso tsa TRAb li lokela ho lekanyetsoa ho hlahloba kotsi e ka 'nang ea e-ba teng ea hyperthyroidism ka pōpelong. Melao-motheo e reretsa ho lokisetsa ka beta blocker , le koetliso e khutšoanyane ea tharollo ea iodine ea potassium pele ho ts'ebetso ea thyroidectomy .
Likotsi Tsa Fetal ea Bakhachane ba nang le Hyperthyroidism ea Mabitla a Matla
Ho na le likotsi tse 'maloa ho lesea la mosali ea nang le "Hyperthyroidism" tsa Mabitla a mafolofolo , ho akarelletsa:
- fetal hyperthyroidism
- neonatal hyperthyroidism
- fetal hypothyroidism
- neonatalatal hypothyroidism
- bohareng ba hypothyroidism
Lintho tse ka amang kotsi ea fetallo li kenyeletsa:
- ho laola boima ba hyperthyroidism ho pholletsa le bokhachane, e leng ho ka bakang nako e telele ea hypothyroidism lesea.
- litekanyetso tse phahameng tsa lithethefatsi tsa antithyroid, tse ka bakang hypothyroidism ea fetal le ea neonatal.
- tse phahameng tsa TRAb pakeng tsa libeke tse 22 le tse 26 tse nyenyane, tse ka etsang hore motsoako oa fetal kapa o-neonatal hyperthyroidism .
Ho ea ka Melao-motheo, basali ba fetang 95% ba nang le lefu la Graves ba na le bopaki ba TRAB, esita le ka mor'a phekolo ea phekolo e feteletseng, le TRAb e lokela ho shebeloa ho basali ba nang le bakhachane :
- ka hyperthyroidism e sebetsang;
- bao pele ba ileng ba fuoa kalafo ea RAI ;
- e nang le histori ea ho loantša lesea ka hyperthyroidism; le
- ea nang le thyroidectomy nakong ea bokhachane, ho phekola hyperthyroidism.
Fetal le neonatal hyperthyroidism e hlaha pakeng tsa 1% le 5% ea basali bohle ba moimana ba nang le histori e sebetsang kapa e fetileng ea Graves ' hyperthyroidism,' me e amahanngoa le mathata a 'maloa.
Ha mosali ea nang le moimana a e-na le histori e sebetsang kapa e fetileng ea lefu la Graves, TRAb e lokela ho lekanyetsoa ka libeke tse 20 ho isa ho tse 24 tsa bosoana. Ho ea ka Melao-motheo, bohlokoa bo fetang makhetlo a mararo moeli o ka holimo oa tloaelehileng bo nkoa e le letšoao bakeng sa ho latela lesea, e leng ho amanang le ngaka e khethehileng ka meriana ea bokhachane.
Haeba ho hlokahala hore ho lateloa, ho lokela ho etsoa li-ultrasound ho shebella tsoelo-pele ea lesea.
Mohloli:
Stagnaro-Green, Alex, le. al. "Litaelo tsa Mokhatlo oa American Thyroid bakeng sa Tlhahlobo le Tsamaiso ea Maloetse a Thyroid nakong ea Bokhachane le Postpartum." Thyroid . Buka ea 21, Palo ea 10, 2011