Ukubheka ngokucophelela izinkombandlela zomtholampilo
Uma i-hyperthyroidism ingalawulwa ekukhulelweni, ihlotshaniswa nezinkinga ezihlukahlukene, kuhlanganise nokukhulelwa kwesisu, ukukhulelwa komfutho wokukhulelwa, ukubeletha ngaphambi kwesikhathi, ukuzala okuphansi, ukuvimbela ukukhula kwe-intrauterine, ukubeletha, isiphepho se-thyroid, kanye nokuhluleka kwenhliziyo yokubeletha komama. Ngakho-ke, kubalulekile ukuxilongwa nokuphathwa kahle kwe-Graves's disease kanye ne-hyperthyroidism ngesikhathi sokukhulelwa.
Ngokusho "Imihlahlandlela ye-American Thyroid Association ka -2011 yokuHlola nokuPhathwa kwezifo ze-Thyroid ngesikhathi sokukhulelwa kanye ne-Postpartum," abesifazane abanesifo sikaGraves kufanele bacabange kuphela emva kokuba be-euthyroid - kuchazwa njengamazinga avamile wegciwane . Lezi ziqondiso zincoma ngokuqinile ukukhulelwa kwemithi kuze kube yilapho kufezwa, futhi sincoma ukuthi odokotela banikeze ukwelulekwa kwabesifazane mayelana nokushiwo kokwelashwa kumalungiselelo okukhulelwa.
Ngokuyinhloko, le mihlahlandlela iphakamisa ukuthi iziguli ze- Graves zithola ukwelashwa okunamandla ngokuhlinzwa noma ioday i- radioactive (RAI), noma izidakamizwa ze-antithyroid .
Lezi ziqondiso zincoma ukuhlinzekwa owesifazane onamazinga aphezulu we-TSH receptor (TRAb) futhi ohlela ukukhulelwa engakapheli iminyaka emibili. Isizathu sokuthi amazinga e-TRAb avame ukuphakama ngemva kwe-RAI futhi ahlale ephakanyisiwe.
Uma i-RAI yenziwa, ukuhlolwa kokukhulelwa kufanele kwenziwe emahoreni angu-48 ngaphambi kokuphathwa kwe-RAI.
Ngemuva kokuhlinzwa noma i-RAI, izinkombandlela zincoma ukuthi zilinde izinyanga eziyisithupha ukukhulelwa, ukuvumela owesifazane ukuba abe nesilinganiso esiphezulu se- hormone ye- thyroid esikhundleni sakhe , ngamanethi e-target TSH phakathi kuka -3 no-2.5.
Ngezidakamizwa ze-antithyroid, abesifazane kufanele baziswe ngezingozi ezihlobene nepropylthiouracil (PTU) ne-methimazole, futhi uma lezi zidakamizwa zisetshenzisiwe, i-PTU kufanele isetshenziswe ku-trimester yokuqala yokukhulelwa.
I-Methimazole (igama lomuthi: Tapazole) lifaka izingozi kumntwana uma isetshenziswe ku-trimester yokuqala. Lemikhombandlela iphinde iphakamise ukucatshangwa kokuyeka kwe-PTU emva kokuqala kwe-trimester nokushintshela ku-methimazole, ukunciphisa ubungozi besifo sesibindi esihambisana ne-PTU .
Ukuphatha i-Hyperthyroidism yamathuna ngesikhathi sokukhulelwa
Ukwelashwa okuyinhloko kwe-hyperthyroidism ngesikhathi sokukhulelwa yizidakamizwa ze-antithyroid , noma kunjalo, kusuka ku-3% kuya ku-5% weziguli ezinezimo ezihlobene nezidakamizwa ezifana nokuphendula okubangelwa yizidakamizwa nokuhlukumeza.
Ngenxa yokuthi izidakamizwa ze-antithyroid zidlula i-placenta, ukunakekelwa kudinga ukuthathwa ngokusetshenziswa kwezidakamizwa ze-antithyroid ngesikhathi sokukhulelwa. Ikakhulukazi, ukukhathazeka okuyinhloko ikhono le-methimazole elibangela ukungalungi kokuzalwa kwangempela - lezi zinkinga azihlobene nokusetshenziswa kwe-PTU. Kodwa-ke, i-PTU ibeka ingozi yobuthi besibindi , futhi izinkombandlela zincoma ukuthi i-PTU isetshenziswe ku-trimester yokuqala, nokuthi iziguli kufanele zishintshele ku-methimazole ngemuva kwe-trimester yokuqala.
Abavimbeli be-Beta abavame ukuphakanyiswa ngesikhathi sokukhulelwa, njengoba bahlotshaniswa nokuvimbela ukukhula kwe-intrauterine, izinga lokushaya kwenhliziyo eliphansi, ne-hypoglycemia ezinsana ezisanda kuzalwa.
Izidakamizwa ze-Antithyroid Ngesikhathi sokukhulelwa
Imikhombandlela iphakamisa ukuthi owesifazane osebenzisa izidakamizwa ze-antithyroid ngesikhathi sokukhulelwa ahlolisiswa ngokujwayelekile kwe-Free T4 ne-TSH, ukuze amanani wamahhala we-T4 ahlale, noma ngaphezulu nje komkhawulo ongaphezulu wejwayelekile, ngenkathi ethatha isilinganiso esincane kunazo zonke izidakamizwa ze-antithyroid.
I-T4 yamahhala ne-TSH kufanele ilinganiswe njalo ngemva kwamasonto amabili kuya kwangu-4 ekuqaleni kokulashwa, futhi ngemva kwamasonto amane kuya kwamasonto ayisithupha, ukufezekisa amazinga wegazi okubhekiswe kuwo. Ngokuvamile, ngoba i-hyperthyroidism ivame ukujwayelekile ngesikhathi sokukhulelwa, izidakamizwa ze-antithyroid zingagcina ziphelile ku-trimester yesithathu kuma-20% kuya ku-30% weziguli.
Lezi ziqondiso zincoma ukuthi abesifazane abanamazinga aphakeme we-TSH receptor (TRAb) baqhubeka nokuphathwa kwezidakamizwa ze-antithyroid kuze kube sekulethwa kwezidingo.
I-Thyroidectomy yezifo zamathuna ngesikhathi sokukhulelwa
Uma owesifazane ephikisana nezidakamizwa ze-antithyroid, kudinga ukulinganisa okuphezulu ukulawula i-hyperthyroidism, noma ungalandeli ukwelapha kwakhe izidakamizwa, imihlahlandlela ibonisa ukuthi i-thyroidectomy kufanele icatshangelwe.
Uma ukuhlinzwa kwe-thyroid - eyaziwa ngokuthi i-thyroidectomy - kuyadingeka, isikhathi esiphezulu sisesigabeni sesibili sokukhulelwa.
Ngesikhathi sokuhlinzwa, amazinga we-TRAb kufanele alinganiswe ukuhlola ingozi engaba khona ye-hyperthyroidism emntwaneni. Imihlahlandlela iphakamisa ukulungiselela nge-bloa ye-beta , kanye neklasi elifushane lekhambi le-i-potassium iodine ngaphambi kokuhlinzwa kwe- thyroidectomy .
Izingozi Zomfutho Emantombazaneni Akhulelwe Ngama-Active Graves 'Hyperthyroidism
Kunezinhlobo eziningi zezingozi ezinganeni zomntwana one-Graves 'hyperthyroidism esebenzayo , okufaka:
- i-hyperthyroidism yesisu
- i-neonatal hyperthyroidism
- fetal hypothyroidism
- i-neonatal hypothyroidism
- central hypothyroidism
Izici ezingathinta ingozi yengane zifaka:
- ukulawulwa kabi kwe-hyperthyroidism phakathi nokukhulelwa, okungaholela esikhathini esincane phakathi kwe-hypothyroidism emntwaneni.
- ukuphakama okuphezulu kwezidakamizwa ze-antithyroid, ezingabangela i-fetothy ne-neonatal hypothyroidism.
- amazinga aphezulu we-TRAb ye-serum emkhatsini wamaviki angu-22 no-26 ukubeletha, okungabangela i- fetal noma i-neonatal hyperthyroidism .
Ngokweziqondiso, abesifazane abangaphezu kwama-95% abanezifo ze-Graves 'banebufakazi bokuthi i-TRAb, ngisho nangemva kokwelashwa okuphelele , ne- TRAb kufanele ihlolwe kwabesifazane abakhulelwe :
- nge-hyperthyroidism esebenzayo;
- ngubani owake wathola ukwelashwa kwe-RAI ;
- nomlando wokuletha usana olune-hyperthyroidism; futhi
- owayene-thyroidectomy ngesikhathi sokukhulelwa, ukuphatha i-hyperthyroidism.
I-fetal ne-neonatal hyperthyroidism kwenzeka phakathi kuka-1% no-5% wabo bonke abesifazane abakhulelwe abanomlando osebenzayo noma owedlule we-Graves ' hyperthyroidism, futhi uhlotshaniswa nezinkinga eziningana.
Owesifazane okhulelwe onomlando osebenzayo noma owedlule we-Graves 'isifo, i-TRAb kufanele ilinganiswe ngamaviki angu-20 kuya kwangu-24 wokubeletha. Ngokwezinkombandlela, inani eliphindwe kathathu umkhawulo ophezulu wokujwayelekile kubhekwa njengumaka wokulandelwa kwe-fetus, okubandakanya udokotela onguchwepheshe obuthakathaka bokubeletha komama.
Uma ukulandelwa kuyadingeka, kufanele kwenziwe ama-ultrasound ukuqapha ukuthuthukiswa komntwana.
Umthombo:
I-Stagnaro-Green, i-Alex, ne-. al. "Imihlahlandlela ye-American Thyroid Association ye-Diagnosis kanye nokuphathwa kwezifo ze-Thyroid ngesikhathi sokukhulelwa kanye ne-Postpartum." I-Thyroid . Umqulu 21, Inombolo 10, 2011