Binciken Ƙari Game da Sharuɗɗan Hoto
Yayin da ba a kula da hyperthyroidism a cikin ciki, yana da alaka da matsaloli iri-iri, ciki har da rashin karuwa, hawan jini mai zurfi, da haihuwa, haihuwa marar haihuwa, ƙuntataccen ci gaban intrauterine, haihuwa, damuwa mai sanyi, da kuma rashin tausayi na mahaifa. Saboda haka, ganewar asali da maganin cututtuka na Graves da hyperthyroidism a lokacin daukar ciki yana da muhimmanci.
Bisa ga 2011 "Sharuɗɗa na Amurka Yourroid Association don ganowa da kuma Management na thyroid cuta a lokacin da juna biyu da kuma Postpartum," matan da ke da cutar Graves ya kamata suyi kawai bayan sun kasance euthyroid - bayyana matsayin ciwon al'ada thyroid matakan . Sharuɗɗa suna bada shawarar bada rigakafi har sai an sami wannan, kuma sun ba da shawara cewa likitoci suna ba da shawara ga mata game da abubuwan da ake yi akan maganin shirin tsarawa.
Musamman, Sharuɗɗa sun bada shawara cewa marasa lafiya na Graves sun karbi farfadowa mai mahimmanci tare da tiyata ko na Iyetine (RAI), ko maganin antithyroid .
Sharuɗɗa na bada shawara akan tiyata ga mace wanda ke da matakan TSH mai karfin TSH (TRAb) kuma yana shirin yin ciki cikin shekaru biyu. Dalilin shi ne cewa matakai na TRAb suna tasowa bayan RAI kuma suna da girma.
Idan an yi RAI, za a yi jarrabawar ciki cikin sa'o'i 48 kafin aikin GAI.
Bayan tiyata ko RAI, Jagoran Sharuɗɗa sun bada shawarar jiran watanni shida don yin ciki, don ba da damar mace ta sami matsayi na barga na maye gurbin thyroid hormone , tare da matakan TSH da ke tsakanin .3 da 2.5.
Don maganin antithyroid, dole ne a sanar da mata game da hadarin da ke hade da propylthiouracil (PTU) da kuma methimazole, kuma idan an yi amfani da kwayoyi, ana amfani da PTU a farkon farkon shekaru uku.
Methimazole (sunan suna: Tapazole) yana kawo hadari ga tayin idan aka yi amfani da shi a farkon farkon watanni. Sharuɗɗa kuma sun bada shawarar idan akai la'akari da dakatarwar PTU bayan farkon farkon watanni uku da sauyawa zuwa methimazole, don rage haɗarin cutar huhu da ke hade da PTU .
Yin gwagwarmaya da ciwon gwiwoyi a lokacin haihuwa
Babban magani na hyperthyroidism a lokacin daukar ciki shine maganin antithyroid , duk da haka, daga 3% zuwa 5% na marasa lafiya suna da nasaba da kwayoyi irin su rashin lafiyan halayen da kuma rashes.
Saboda magungunan antithyroid sun ƙetare ƙwayar cutar, suna bukatar kulawa tare da amfani da kwayoyi antithyroid lokacin daukar ciki. Musamman ma, babban damuwa shi ne iyawar methimazole don haifar da lalacewa ta jiki - waɗannan matsalolin ba su hade da amfani da PTU ba. PTU, duk da haka, yana ɗauke da hadarin hanta mai haɗari , kuma Sharuɗɗa sun bada shawarar cewa an yi amfani da PTU a farkon farkon watanni, kuma marasa lafiya ya kamata su canza zuwa methimazole bayan farkon farkon watanni.
Beta blockers ba yawanci da shawarar a lokacin da juna biyu, yayin da suke haɗuwa da ƙwayar cuta ta intrauterine, low fetal zuciya zuciya, da kuma hypoglycemia a cikin jarirai.
Antithyroid Drugs A lokacin da juna biyu
Sharuɗɗa sun bada shawarar cewa mace take daukar nauyin antithyroid a lokacin daukar ciki tana kulawa akai-akai game da T4 da TSH, don haka dabi'un T4 na kyauta ne, ko kuma sama da iyakacin al'ada, yayin da ake amfani da kwayoyin antithyroid mafi ƙasƙanci.
Za a auna T4 da TSH kowane mako biyu zuwa hudu a farkon jiyya, kuma kowane mako hudu zuwa shida, don cimma matakan jini. Yawanci, saboda hyperthyroidism yakan sabawa al'ada a lokacin daukar ciki, magungunan antithyroid zai iya ƙare da aka dakatar da shi a cikin uku na uku a cikin kashi 20 zuwa 30% na marasa lafiya.
Sharuɗɗa sun bada shawarar cewa matan da ke da matakan TSH masu karba na TSH (TRAb) suna ci gaba da maganin maganin miyagun ƙwayoyi ta antithyroid har sai da bayarwa.
Thyroidectomy don Ciwon Ƙunƙwata a lokacin da juna biyu
Idan mace tana shan damuwa ga magungunan antithyroid, yana buƙatar manyan dogaro don sarrafa hyperthyroidism, ko kuma baya bin tsarin maganin miyagun ƙwayoyi, Jagoran ya nuna cewa thyroidectomy ya kamata a yi la'akari.
Idan ana tilasta tiyata - wanda aka sani da thyroidectomy - yana da kyau, lokaci mafi kyau shine a lokacin bana na biyu na ciki.
A lokacin tiyata, dole ne a auna matakan TRAb don tantance yiwuwar hawan hyperthyroidism a cikin tayin. Sharuɗɗa masu bada shawara sun bada shawara tare da beta blocker , da kuma gajeren hanya na potassium iodine bayani a gaba na tiyata thyroidectomy .
Rikicin Ruwa a cikin matan da suke da ƙwayar cuta masu maƙalli 'Hyperthyroidism
Akwai haɗari ga ƙwayar mace wadda ke da ciwon gurguntaccen cututtukan Graves , ciki har da:
- Tashin hankalin dan tayi
- neonatal hyperthyroidism
- fetal hypothyroidism
- neonatal hypothyroidism
- tsakiya hypothyroidism
Abubuwan da zasu iya rinjayar haɗarin tayin sun hada da:
- rashin kulawa da rashin daidaituwa a cikin ciki, wanda zai iya haifar da hypothyroidism na tsakiya a cikin tayin.
- high doses na antithyroid kwayoyi, wanda zai iya haifar da fetal da kuma neonatal hypothyroidism.
- babban matakin kwayar TRAb a tsakanin makonni 22 da 26, wanda zai iya haifar da tayi ko kuma rashin tsauraran tsaka .
Bisa ga Sharuɗɗa, fiye da kashi 95 cikin dari na matan da ke fama da cutar Graves suna da shaida na TRAb, koda bayan maganin abral , kuma TRAb ya kamata a kula da mata masu juna biyu :
- tare da matsakaicin matsakaici;
- wanda a baya ya karbi magani na RAI ;
- tare da tarihin ba da jariri tare da hyperthyroidism; da kuma
- wanda yana da thyroidectomy a lokacin daukar ciki, don bi da hyperthyroidism.
Harkokin maganin tsirrai da tayar da hankalin neonatal yana faruwa a tsakanin 1% da 5% na dukkan matan masu ciki da wani aiki ko tarihin tarihin '' Graves ' hyperthyroidism, kuma yana hade da wasu matsaloli.
A cikin mace mai ciki da ke da tarihin cututtuka na Graves, TRAb ya kamata a auna shi ta tsawon makonni ashirin zuwa 24 na gestation. Bisa ga Sharuɗɗa, darajar da take fiye da sau uku mafi yawan iyaka na al'ada an dauke shi alama don biyo bayan tayin, wanda ya dace ya haɗa da likita mai kwarewa a cikin maganin mata-tayi.
Idan ana buƙatar biyan buƙatar, dole ne a yi amfani da ultrasounds don saka idanu na ci gaban tayi.
Source:
Stagnaro-Green, Alex, et. al. "Sharuɗɗa na Ƙungiyar Karoid ta Amurka da ke Kula da Ciwon Bincike da Gudanar da Ciwon Thyroid a Cikin Ciki da Cikin Gida." Thyroid . Volume 21, Lamba 10, 2011