Kuyang'anitsitsa kwambiri njira za kuchipatala
Pamene hyperthyroidism sichiyendetsedwa ndi mimba, imakhudzana ndi mavuto osiyanasiyana, kuphatikizapo kuperewera kwa amayi, kutenga mimba, kutenga mimba, kutaya msinkhu, kuchepetsa kuchepa, kuperewera kwa intrauterine, kuchepa, chithokomiro, komanso kutaya mtima kwa amayi. Choncho, kuyezetsa bwino ndi kuchiritsidwa kwa matenda a Graves ndi hyperthyroidism pa nthawi yoyembekezera ndikofunikira.
Malingana ndi "Malangizo a 2011 a American Thyroid Association kuti apeze matenda ndi chithokomiro cha matenda a chithokomiro Pakati pa Mimba ndi Postpartum," amayi omwe ali ndi matenda a Graves ayenera kuganiza kokha atakhala ndi euthyroid. Malangizowa amalimbikitsa kwambiri kulera chithandizo mpaka izi zitheke, ndipo amalangiza kuti madokotala apereke uphungu kwa amayi pokhudzana ndi momwe angapangire mankhwala pazinthu zogonana.
Malangizowa amavomereza kuti odwala a Graves amalandira mankhwala osakaniza ndi opaleshoni kapena ayodini ya radioactive (RAI), kapena mankhwala osokoneza bongo .
Malangizowa amalimbikitsa opaleshoni kwa mkazi yemwe ali ndi ma tanki amphamvu a TSH receptor antibody (TRAb) ndipo akukonzekera kutenga mimba mkati mwa zaka ziwiri. Cholinga chake n'chakuti ma CRAB amakonda kuwuka pambuyo pa RAI ndikukhala okweza.
Ngati RAI ikuchitidwa, kuyesedwa kwa mimba kuyenera kuchitidwa maola 48 isanayambe kulamulira kwa RAI.
Pambuyo pa opaleshoni kapena RAI, Malangizi amalangiza akuyembekezera miyezi isanu ndi umodzi kuti avomereze, kulola kuti mkazi akhale ndi mlingo wokhazikika wa mahomoni otere , m'malo mwa TSH pakati pa .3 ndi 2.5.
Kwa mankhwala osokoneza bongo, amayi ayenera kuuzidwa za ngozi zomwe zimapezeka ndi propylthiouracil (PTU) ndi methimazole, ndipo ngati mankhwalawa amagwiritsidwa ntchito, PTU iyenera kugwiritsidwa ntchito m'miyezi itatu yoyamba ya mimba.
Methimazole (dzina lachidziwitso: Tapazole) limayambitsa zoopsa kwa mwanayo ngati atagwiritsidwa ntchito m'miyezi itatu yoyamba. Malangizowa amalimbikitsanso kuganizira za kuchotsedwa kwa PTU pambuyo pa trimester yoyamba ndi kusintha kwa methimazole, kuchepetsa chiopsezo cha matenda a chiwindi ndi PTU .
Kuteteza 'Hyperthyroidism' M'manda Pakati pa Mimba
Chithandizo chachikulu cha hyperthyroidism panthawi yomwe ali ndi pakati ndi mankhwala osokoneza bongo , komabe, kuyambira 3% mpaka 5% mwa odwala ali ndi zotsatira zoledzeretsa monga mankhwala omwe amachititsa mankhwalawa.
Chifukwa mankhwala osokoneza bongo amayenda pamtunda, chisamaliro chiyenera kuthandizidwa ndi kugwiritsa ntchito mankhwala osokoneza bongo pamene akuyembekezera. Makamaka, chodetsa nkhaŵa ndicho mphamvu ya methimazole kuyambitsa matenda opatsirana pogonana - mavutowa sagwirizana ndi kugwiritsa ntchito PTU. Komabe, PTU imayambitsa chiwindi cha chiwindi , ndipo Malangizo amalimbikitsa PTU kugwiritsidwa ntchito m'miyezi itatu yoyamba, ndipo odwala ayenera kusinthana ndi methimazole pambuyo pa trimester yoyamba.
Olemba Beta sali ovomerezeka pa nthawi yomwe ali ndi mimba, chifukwa amakhala okhudzidwa ndi kukula kwa intrauterine, kuchepa kwa mtima wamimba, komanso hypoglycemia m'mimba.
Mankhwala a Antithyroid Pa Nthawi Yoyembekezera
Malangizowo amavomereza kuti mayi akugwiritsa ntchito mankhwala osokoneza bongo pa nthawi yomwe ali ndi mimba amayang'anitsitsa nthawi zonse a Free T4 ndi TSH, kotero kuti ma Free Free T4 amakhalabe, kapena pamwamba pa malire apamwamba, poyesa mankhwala ochepa kwambiri a antithyroid.
Free T4 ndi TSH ziyenera kuyesedwa milungu iwiri kapena inayi kuyambira chiyambi cha chithandizo, ndipo pakatha masabata anayi kapena asanu ndi limodzi, kuti akwaniritse zolinga zamagazi. Kawirikawiri, chifukwa nthawi zambiri hyperthyroidism imakhala ikuyimira pa nthawi yomwe ali ndi pakati, mankhwala osokoneza bongo amatha kuthetsedwa mu magawo atatu atatu mwa odwala 20 mpaka 30%.
Malangizowo amavomereza kuti amayi omwe ali ndi matenda apamwamba a TSH receptor antibody (TRAb) amapitirizabe ndi mankhwala osokoneza bongo amatha kusamba mpaka atabereka.
Matenda a Chithokomiro kwa Amanda a Manda Pakati pa Mimba
Ngati mkazi ali ndi mankhwala osokoneza bongo, amafunika kwambiri kuti aziletsa hyperthyroidism, kapena osatsatira mankhwala ake, Malangizo amasonyeza kuti chithokomiro chiyenera kuganiziridwa.
Ngati opaleshoni ya chithokomiro - yomwe imadziwika kuti thyroidectomy - imafunika, nthawi yabwino ndi yomwe imatenga nthawi yachitatu ya mimba.
Pa nthawi ya opaleshoni, mazira a TRAB ayenera kuyesedwa kuti aone ngati pangakhale chiopsezo cha hyperthyroidism m'mimba mwa mwanayo. Malangizowa amalimbikitsa kukonzekera ndi beta blocker , ndi kochepa kaye ya potassium ayodini yankho pasanayambe chithokomiro opaleshoni .
Zoopsa za Fetal Pakati pa Amayi Oyembekezera Amene Ali ndi Hyperthyroidism Yamphamvu
Pali zoopsa zingapo kwa mwana wamwamuna yemwe ali ndi hyperthyroidism ya Manda , kuphatikizapo:
- fetal hyperthyroidism
- nthenda ya hyperthyroidism
- fetal hypothyroidism
- matenda osakaniza ana
- central hypothyroidism
Zinthu zomwe zingakhudze chiopsezo cha fetus ndi izi:
- Kusamalidwa bwino kwa hyperthyroidism panthawi yonse ya mimba, zomwe zingayambitse pakatikati pathupi fetus hypothyroidism.
- Mankhwala osokoneza bongo, omwe amachititsa kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda.
- Matenda apamwamba a TRAb pakati pa masabata 22 mpaka 26, omwe angayambitse mwana wamwamuna kapena wamwamuna .
Malingana ndi Malangizo, amayi oposa 95% omwe ali ndi matenda a Graves ali ndi umboni wa TRAB, ngakhale atatha kuchipatala, ndipo TRAb iyenera kuyang'anitsitsa amayi oyembekezera :
- ndi hyperthyroidism yogwira ntchito;
- yemwe poyamba analandira chithandizo cha RAI ;
- ndi mbiri yakuwombola khanda ndi hyperthyroidism; ndi
- yemwe anali ndi chithokomiro pa nthawi ya mimba, kuti asamalire hyperthyroidism.
Fetal ndi neonatal hyperthyroidism zimachitika pakati pa 1% ndi 5% mwa amayi onse apakati omwe ali ndi ntchito yogwira ntchito kapena mbiri yakale ya Hyves hyperthyroidism, ndipo akugwirizana ndi mavuto ambiri.
Mayi amene ali ndi pakati omwe ali ndi mbiri yambiri ya matenda a Graves, ayenera kuyesedwa ndi masabata 20 mpaka 24 atsikana. Malingana ndi Malangizo, mtengo umene umaposa katatu kawiri kawiri umakhala ngati chizindikiro chotsatira kamwana kameneka, komwe kumakhudzana ndi dokotala wodziwa mankhwala okhudzana ndi amayi oyembekezera.
Ngati zotsatira zikufunika, amafunika kuyendetsa ululu kuti ayang'anire kukula kwa mwana.
Chitsime:
Stagnaro-Green, Alex, ndi. al. "Malangizo a Association of American Thyroid Association kuti Apeze Matenda ndi Kusamalira Matenda a Chithokomiro Pakati pa Mimba ndi Postpartum." Chithokomiro . Vesi 21, Nambala 10, 2011