Ukuqwalasela ngakumbi kwiikhokelo zeKlinikhi
Xa i-hyperthyroidism ingalawulwa ekukhulelweni, inxulumene neengxaki ezihlukahlukeneyo, kubandakanya ukukhulelwa komzimba, ukukhulelwa komzimba, ukuzala ngokukhawuleza, ubunzima bokuzala okuphantsi, ukukhawuleka kwe-intrauterine, ukukhulelwa komzimba, isithwathwa se-thyroid, kunye nesisu sokukhulelwa kwentliziyo. Ngoko ke, ukuxilongwa ngokufanelekileyo kunye unyango lwezifo ze-Graves kunye ne-hyperthyroidism ngexesha lokukhulelwa kubalulekile.
Ngokutsho kwe-2011 "Izikhokelo ze-American Thyroid Association yoLwazi kunye noLawulo lweZifo zeTyroid ngexesha loKhulelwa kunye nePostpartum," abafazi abaneSifo seMangcwaba kufuneka baveze kuphela emva kokuba be-euthyroid - bachazwa njengamazinga aqhelekileyo e-thyroid . Izikhokelo zicetyisa ngokukhawuleza ukukhulelwa kwelokuba kufikelelwe, kwaye uncomele ukuba oogqirha banike iingcebiso kubafazi malunga neempembelelo zonyango kwizicwangciso zokubamba.
Ngokukodwa, izikhokelo zincoma ukuba izigulane zezifo zeGrives zifumana unyango olusisigxina ngokuhlinzwa okanye ioday i-radioode (RAI), okanye iziyobisi ze-antithyroid .
Izikhokelo zincoma ukuhlinzwa ngowesifazane onomgangatho ophezulu we-TSH wamalungu omzimba (TRAb) kwaye ngubani oceba ukukhulelwa ngaphakathi kweminyaka emibini. Ingqiqo kukuba ama-TRAB amanqanaba athambekele ekuphakameni emva kwe-RAI kwaye ahlale ephakamileyo.
Ukuba i-RAI yenziwa, uvavanyo lokukhulelwa kufuneka lwenzeke iiyure ezingama-48 phambi kolawulo lwe-RAI.
Emva kokuhlinzwa okanye i-RAI, izikhokelo zincoma ukuba zilinde iinyanga ezilisithandathu ukuba zikhulelwe, ukuvumela ukuba umfazi afike kwi-dose egxininisiweyo yokutshintshwa kwe-hormone ye- thyroid , kunye namazinga e-TSH athile phakathi kwe .3 no-2.5.
Izidakamizwa ze-antithyroid, abafazi mabaxelelwe ngeengozi ezinxulumene nepropylthiouracil (PTU) kunye ne-methimazole, kwaye ukuba ezi zonyango zisetyenzisiweyo, i-PTU kufuneka isetyenziswe kwi-trimester yokuqala yokukhulelwa.
I-Methimazole (igama lomthi-mveliso: iTapazole) libeka ingozi kwi-fetus xa isetyenziswe kwi-trimester yokuqala. Izikhokelo zikwacetyiswa nokuqwalasela ukucinywa kwe-PTU emva kwe-trimeter yokuqala kunye nokutshintsha kwi-methimazole, ukunciphisa umngcipheko wesifo sesibindi esihambelana ne-PTU .
Ukunyanga ama-Graves 'Hyperthyroidism Ngethuba lokukhulelwa
Unyango oluphambili lwe-hyperthyroidism ngexesha lokukhulelwa yizidakamizwa ze-antithyroid , nangona kunjalo, ukususela kwi-3% kuya kwi-5% yezigulane ezineziphumo ezinxulumene neziyobisi ezinjengeziphumo ezinobungozi.
Ngenxa yokuba izidakamizwa ze-antithyroid ziyawela i-placenta, kufuneka kuthathelwe ingqalelo ngokusetyenziswa kwezidakamizwa ze-antithyroid ngexesha lokukhulelwa. Ngokukodwa, inkxalabo ephezulu kukuba amandla e-methimazole kubangela ukungalunganga komntwana - ezi ngxaki azihambelani nokusetyenziswa kwe-PTU. I-PTU, nangona kunjalo, inomngcipheko wesibindi sesibindi , kwaye izikhokelo zincoma ukuba i-PTU isetyenziswe kwi-trimester yokuqala, kwaye izigulane kufuneka zitshintshele kwi-methimazole emva kwe-trimester yokuqala.
Ababhali be-Beta abaxhaswanga ngokukhawuleza ngexesha lokukhulelwa, njengoko banxulumene nomqobo wokukhula kwe-intrauterine, izinga lokunciphisa intliziyo yesisu, kunye ne-hypoglycemia kwiintsana ezisanda kuzalwa.
I-Antithyroid Izidakamizwa ngexesha lokukhulelwa
Izikhokelo zincoma ukuba ibhinqa ethatha izidakamizwa ze-antithyroid ngexesha lokukhulelwa lijongwa rhoqo kwi-Free T4 ne-TSH, ukwenzela ukuba amaxabiso e-Free T4 ahlale apha, okanye nje ngaphezu komda osemgangathweni oqhelekileyo, ngelixa uthatha iqondo eliphantsi kakhulu lezilwanyana zamachiza e-antithyroid.
I-T4 yama-T4 kunye ne-TSH kufuneka ilinganiswe nganye kwiiveki ezimbini ukuya kwezine ekuqaleni kokunyanga, kwaye emva kweeveki ezine ukuya ezintandathu emva kwee-target target blood. Ngokuqhelekileyo, kuba i-hyperthyroidism idla ngokuphindaphindiweyo ngexesha lokukhulelwa, izidakamizwa ze-antithyroid zingapheli ekupheleni kwekota yesithathu kwi-20% ukuya kwi-30% yezigulane.
Izikhokelo zincoma ukuba amabhinqa anamazinga aphezulu e-TSH antibody (TRAb) aqhubeka nokunyangwa kweziyobisi ze-antithyroid de kubekwe ukuziswa.
I-thyroidectomy kwiiNgcwaba zezifo ngexesha lokukhulelwa
Ukuba ibhinqa liyingozi kumachiza e-antithyroid, idinga amayeza aphezulu ukulawula i-hyperthyroidism, okanye ingayilandeli unyango lwakhe, izikhokelo zibonisa ukuba i-thyroidectomy ifanele iqwalaselwe.
Ukuba utyando lwe-thyroid - olubizwa ngokuba yi-thyroidectomy - lufunekayo, ixesha elifanelekileyo lixesha lekota yesibini yokukhulelwa.
Ngexesha lotyando, amazinga e-TRAb kufuneka alinganiswe ukuvavanya umngcipheko we-hyperthyroidism emntwaneni. Izikhokelo zicebisa ukulungiswa nge-beta blocker , kunye nekhosi emfutshane yekhambi le-iodine ye-potassium ngaphambi kokuba utyando lwe- thyroidectomy .
Ubungozi beNtlungu kuBhinqa abakhulelweyo abane-Active Graves 'Hyperthyroidism
Kukho ininzi yengozi kumntwana wesifazane ophethe ama-Graves 'hyperthyroidism esebenzayo , kuquka:
- i-fetal hyperthyroidism
- neonatalysis hyperthyroidism
- fetal hypothyroidism
- i-hypothyroidism ye-neonatal
- central hypothyroidism
Izinto ezinokuchaphazela umngcipheko kumntwana ziquka:
- Ukulawulwa kakubi kwe-hyperthyroidism ekukhulelweni, okubangela ukuba i-hypothyroidism ephakathi kwexesha elide ikhulelwe.
- Amanani aphezulu eziyobisi ze-antithyroid, ezinokubangela i-fetal ne-neonatal hypothyroidism.
- Izinga eliphezulu ze-TRAb ye-serAb phakathi kwama-22 no-26 amaviki angama-26, angabangela i- fetal okanye neonatal hyperthyroidism .
Ngokwezikhokelo, ngaphezulu kwama-95% wabasetyhini abaneSifo se-Graves banobungqina be-TRAb, nangona emva kokunyangwa kweyeza, kunye ne- TRAb kufuneka ihlolwe kwabasetyhini abakhulelweyo :
- nge-hyperthyroidism esebenzayo;
- ngubani owamkela unyango lwe-RAI ngaphambili ;
- kunye nembali yokunikela umntwana usana ne hyperthyroidism; kwaye
- owayephethe i-thyroidectomy ngexesha lokukhulelwa, ukuphatha i-hyperthyroidism.
I-fetal neonatalatal hyperthyroidism iyenzeka phakathi kwe-1% kunye no-5% kubo bonke abafazi abakhulelweyo abanomdla okanye owake waphila umlando we-Graves ' hyperthyroidism, kwaye unxulumene nenani leengxaki.
Kwindoda ekhulelwe enomlando osebenzayo okanye odlulileyo wezifo ze-Graves, i-TRAb kufuneka ilinganiswe ngeeveki ezingama-20 ukuya kuma-24 zesisu. Ngokutsho kweZikhokelo, ixabiso elingaphaya kathathu umda ophezulu weqhelekileyo uthathwa njengommakishi wokulandelelana kwefubus, echaphazelekayo ngokubandakanya ugqirha onobungcali bezonyango zomama.
Ukuba ukulandelwa kuyadingeka, kufuneka kwenziwe i-ultrasound ukujonga ukuphuhliswa komntwana.
Umthombo:
Stagnaro-Green, Alex, kunye. al. "Izikhokelo ze-American Thyroid Association ye-Diagnosis kunye nokuLawula izifo ze-Thyroid ngexesha lokukhulelwa kunye ne-Postpartum." Thyroid . Umqulu 21, iNombolo 10, 2011