Assessment and treatment of thyroid disorders in pregnancy and the postpartum period.
Assessment and treatment of thyroid disorders in pregnancy and the postpartum period.
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DOI：
10.1038/s41574-021-00604-z
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发表时间：
2022-03
影响因子：
40.5
通讯作者：
Pearce, Elizabeth N.
中科院分区：
文献类型：
--
作者：
Lee, Sun Y.;Pearce, Elizabeth N.
甲状腺疾病在孕妇中很普遍。此外，甲状腺激素在胎儿发育中起着关键作用，甲状腺功能障碍会对产科结局产生不利影响。因此，甲状腺功能亢进症，最常见的格雷夫斯病引起的，甲状腺功能减退症，在碘充足的地区，最常见的桥本甲状腺炎，在怀孕期间的适当管理是重要的孕妇和他们的后代的健康。妊娠期也可发生短暂性甲状腺毒症，应与Graves病鉴别。甲状腺自身免疫和亚临床甲状腺功能减退症在妊娠中的作用仍有争议。碘缺乏是世界范围内甲状腺功能减退症的主要原因。尽管全球努力消除碘缺乏病，但由于妊娠期碘需求量增加，孕妇仍面临碘缺乏的风险。甲状腺癌的发病率在世界范围内不断上升，包括在年轻人中。因此，在怀孕期间诊断甲状腺结节或甲状腺癌变得越来越频繁。妊娠期甲状腺结节和甲状腺癌的评估和管理构成了一个特殊的挑战。产后甲状腺炎可在分娩后1年内发生，必须与其他形式的甲状腺功能障碍相鉴别，因为治疗方法不同。本综述为妊娠期和产后甲状腺疾病的评估和管理提供了现有的证据和建议。
Thyroid disorders are prevalent in pregnant women. Furthermore, thyroid hormone has a critical role in fetal development and thyroid dysfunction can adversely affect obstetric outcomes. Thus, the appropriate management of hyperthyroidism, most commonly caused by Graves disease, and hypothyroidism, which in iodine sufficient regions is most commonly caused by Hashimoto thyroiditis, in pregnancy is important for the health of both pregnant women and their offspring. Gestational transient thyrotoxicosis can also occur during pregnancy and should be differentiated from Graves disease. Effects of thyroid autoimmunity and subclinical hypothyroidism in pregnancy remain controversial. Iodine deficiency is the leading cause of hypothyroidism worldwide. Despite global efforts to eradicate iodine deficiency disorders, pregnant women remain at risk of iodine deficiency due to increased iodine requirements during gestation. The incidence of thyroid cancer is increasing worldwide, including in young adults. As such, the diagnosis of thyroid nodules or thyroid cancer during pregnancy is becoming more frequent. The evaluation and management of thyroid nodules and thyroid cancer in pregnancy pose a particular challenge. Postpartum thyroiditis can occur up to 1 year after delivery and must be differentiated from other forms of thyroid dysfunction, as treatment differs. This Review provides current evidence and recommendations for the evaluation and management of thyroid disorders in pregnancy and in the postpartum period.
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