Patients with hyperthyroidism and breastfeeding notes

Author: Mei Yan, the third hospital affiliated to Guangzhou Medical University, Guangzhou Medical University

Cousin is a patient with hyperthyroidism. Last year, she married her Prince Baima happily. This year she wanted to upgrade to be a mother, so she had a series of questions and asked me. Can I get pregnant?What should I pay attention to when I get pregnant?Can I breastfeed after giving birth?Well, let’s get to know hyperthyroidism today.

The abbreviation of hyperthyroidism is "hyperthyroidism", which is due to the release of too much thyroid hormone due to thyroid synthesis, which causes the body’s metabolism and sympathetic nerve excitement, causing palpitations, sweating, eating, and weight loss.

Patients with hyperthyroidism can be pregnant, but not at any time, the best pregnancy is to consider pregnancy after the thyroid function is restored to normal.So I suggest that my cousin go to see the doctor to check the level of thyroid hormones. The good news is that the cousin’s thyroid hormone is basically normal, so she is happy to prepare for pregnancy.Note that 131 patients with hyperthyroidism need to be pregnant at least 6 months after the end of iodine therapy.

The treatment of hyperthyroidism is mainly to block the synthesis of thyroid hormones. The main drugs are propyl oxyraine (PTU) and methylimazole (MMI). These two drugs have risks to mothers and fetuses. It has been reported that MMI may cause causing MMIFetal skin defects may produce other teratogenic effects, such as nostrils, esophageal locks, trachea, esophageal baskets or facial malformations. Therefore, it is recommended to stop MMI before pregnancy and change to PTU, that is, the PTU is given priority in early pregnancy.Antinerine is still needed to be performed in the middle and late pregnancy. my country Guide is recommended for MMI because PTUs may cause liver damage.Antinerine can pass the placenta barrier.To avoid adverse effects on the fetus.The minimum dose of drugs should be used to achieve its control target, that is, the serum FT4 value of pregnant women is close or mild than the reference value limit.Note that radioactive iodine treatment is prohibited during pregnancy, because iodine can be absorbed by the fetal thyroid and can destroy the fetal thyroid gland in the developmental stage.Some expectant mothers are worried that taking anti -noronal gland drugs affect the fetus, they stop the drug without authorization, knock on the blackboard, and do not stop the anti -thyroid drugs casually, because in the early pregnancy, the placenta secretes HCG.The thyroxine (FT4) increases by about 10%compared with non -pregnancy, which means that the thyroxine in the early pregnancy is higher. If the drug is discontinued, the increase in hyperthyroidism will adversely affect the pregnant woman and the fetus.

A hyperthyroidism that can be controlled by mild or treatment can usually have little effect on pregnancy.Hyperthyroidism, which is not controlled by severe illnesses or treatment, has excessive secretion of thyroid hormones and inhibit the secretion of gonads to promote glandular hormones, which can easily cause miscarriage and premature birth.Patients with hyperthyroidism have metabolic hyperthyroidism and cannot provide sufficient nutrition for the fetus, causing fetal thyroid dysfunction and metalia.

Anti -noria -shaped drugs should be taken after breastfeeding. It is best to breastfeed after 4 hours of medication. The Chinese guide recommends the preferred MMI. The dose of 20 to 30 mg/d is safe. PTUs are second -line drugs, and 300 mg/d is also safe.U.S. guidelines are recommended to use MMI (maximum dose 20 mg/d) and PTU (maximum dose 450 mg/d) during lactation. Considering that a small amount of PTU and MMI can enter milk, it is recommended to use the minimum effective dose."China Obstetrics and Gynecology Science" also mentioned that taking PTUs does not affect breastfeeding. Only a small amount of drugs will enter milk. Only 0.07%of mothers can take PTU during breastfeeding.Therefore, breastfeeding is considered safe to take PTU (<300mg/d) and MMI (<20 mg/d) for breastfeeding.

In short, patients with hyperthyroidism can be pregnant and breastfeed, but it is best to consider pregnancy after the thyroid function is restored to normal. In the early pregnancy, the first anthology drugs are the preferred aoprotesulopymine.Enter milk, take PTU (<300mg/d) and MMI (<20 mg/d), you can breastfeed. It is recommended to take medicine after breastfeeding.

First instance: Tan Xiangping, the Third Hospital of Guangzhou Medical University, Guangdong Medical University

Second trial: Luluwen, the People’s Hospital of Nanhai District, Foshan City, Guangdong Pharmaceutical Society

The above is the original work of the "Drug Safety Cooperation Alliance" volunteer. If you reprint, please indicate the author and source!

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