Guidelines of the American Thyroid Association
for the Diagnosis and Management of Thyroid Dia
During Pregnancy and Postpartum
美国甲状腺协会妊娠期和产后甲状腺疾病的诊断和治疗指南
The American Thyroid Association Taskforce on Thyroid Dia During Pregnancy and Postpartum
美国甲状腺协会妊娠期和产后甲状腺疾病特别工作组
Translated by Wang Xinjun Binzhou people’s hospital,Binzhou Medical College
王新军译 滨州医学院附属滨州市人民医院
INTRODUCTION
前言
Pregnancy has a profound impact on the thyroid glandand thyroid function. The gland increas 10% in size during pregnancy in iodine-replete countries and by 20%–40% in areas of iodine deficiency. Production of thyroxine(T4) and triiodothyronine (T3) increas by 50%, along with a 50% increa in the daily iodine requirement. The physiological changes may result in hypothyroidism in the later stages of pregnancy in iodine-deficient women who were euthyroid in the first trimester.
sbt是什么标准
妊娠对甲状腺和甲状腺功能具有明显影响。在点充足地区，妊娠期间甲状腺腺体大小增加10％，在碘缺乏地区，增加约20对不起的英语怎么写％~40％。甲状腺素（T4）和三碘甲状腺原氨酸（T3）增加50％，每天碘需求量增加50％。这些生理的变化可能导致妊娠前三个月甲状腺功能正常的碘缺乏妇女在妊娠后期发生甲减。
The range of thyrotropin (TSH), under the impact of placental human chorionic gonadotropin (hCG), is decread throughout pregnancy with the lower normal TSH level in the first trimester being poorly defined and an upper limit of 2.5 mIU/L. Ten percent to 20% of all pregnant women in the first trimester of pregnancy are thyroid peroxida (TPO) or thyroglobulin (Tg) antibody positive and euthyroid.
促甲状腺激素（TSH）的范围在胎盘绒毛膜促性腺激素（hCG）的影响下，在整个妊娠期间均下降，在妊娠前三个月正常低限但尚未充分界定，上限为2.5 MIU/ L。妊娠前三个月大约10%到八卦天后第二季20％的妇女甲状腺过氧化物酶（TPO）或甲状腺球蛋白（Tg）抗体阳性且甲状腺功能正常。
Sixteen percent of the women who are euthyroid and positive for TPO or Tg antibody in the first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester, and 33%–50% of women who are positive for TPO or Tg antibody in the first trimester will develop postpartum thyroiditis. In esnce, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal rerve or iodine deficiency, and postpartum thyroiditis in women with underlying Hashimoto’s dia who were euthyroid prior to conception.
妊娠前三个月甲状腺功能正常a beautiful mindTPO或TG抗体阳性的妇女中，约16老友记第二季下载％在妊娠后三个月其促甲状腺激素会超过4.0 mIU/ L，妊娠前三个月TPO或Tg抗体阳性的妇女有33％~50％会发生产后甲状腺炎。从本质上讲，妊娠是甲状腺的应激试验，在甲状腺功能储备有限或碘缺乏
的妇女会发生甲状腺功能减退，而在怀孕前甲状腺功能正常但有潜在桥本甲状腺疾病的妇女会发生产后甲状腺炎。
Knowledge regarding the interaction between the thyroid and pregnancy/the postpartum period is advancing at a
rapid pace. Only recently has a TSH of 2.5 mIU/L been accepted as the upper limit of normal for TSH in the first trimester. This has important implications in regards to interpretation of the literature as well as a critical impact for the clinical diagnosis of hypothyroidism.
关于甲状腺和妊娠/产后期相互作用的只是进展很快。直到最近，促甲状腺激素 2.5 MIU/ L，为怀孕前三个月TSH的正常上限才被接受。这对于文献的解释及甲状腺功能减退的临床诊断的关键影响具有重要意义。
阿拉伯语培训班
Although it is well accepted that overt hypothyroidism and overt hyperthyroidism have a deleterious impact on pregnancy, studies are now focusing on the potential impact of sub
clinical hypothyroidism and subclinical hyperthyroidism on maternal and fetal health, the association between miscarriage and preterm delivery in euthyroid women positive for TPO and/or Tg antibody, and the prevalence and long-term impact of postpartum thyroiditis. Recently completed prospective randomized studies have begun to produce critically needed data on the impact of treating thyroid dia on the mother, fetus, and the future intellect of the unborn child.
虽然显性甲状腺功能减退和显性甲状腺功能亢进症对妊娠具有不利影响已被广泛接受，目前研究集中在亚临床甲状腺功能减退症和亚临床甲状腺功能亢进症对产妇和胎儿健康的潜在影响、在甲状腺功能正常TPO和/或Tg抗体阳性的妇女流产和早产之间的关系，产后甲状腺炎的流行病学和长期影响方面。最近完成的前瞻性随机研究已经开始给出关于治疗甲状腺疾病对母亲、胎儿的影响，未出生的孩子将来智力的影响方面急需的数据。
It is in this context that the American Thyroid Association (ATA) charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid dia during pregnancy and the postpartum. The task force consisted of international experts in the fie
ld of thyroid dia and pregnancy, and included reprentatives from the ATA, Asia and Oceania Thyroid Association, Latin American Thyroid Society, American College of Obstetricians and Gynecologists, and the Midwives Alliance of North America. Inclusion of thyroidologists, obstetricians, and midwives on the task force was esntial to ensuring widespread acceptance and adoption of the developed guidelines.
正是在这种背景下，美国甲状腺协会（ATA）成立了一个特别工作组负责制定妊娠和产后甲状腺疾病诊断和治疗的临床指南。特别工作组由甲状腺疾病和妊娠领域的国际专家、ATA的代表、亚洲和大洋洲甲状腺协会的代表、拉丁美洲甲状腺协会的代表、美国妇产科学院的代表和北美助产士联盟的代表组成。工作组包括甲状腺疾病专家、妇产科医生和助产士以确保新指南被广泛的接受和采用。
& RECOMMENDATION 1
Trimester-specific reference ranges for TSH, as defined in populations with optimal iodine intake, should be applied. Level B-USPSTF
辅音
1 应该应用最佳的碘摄入量的人群中妊娠早、中、晚期特定的TSH参考值范围。B级证据
新年快乐的英文
& RECOMMENDATION 2
If trimester-specific reference ranges for TSH are not available in the laboratory, the following reference ranges are recommended: first trimester, 0.1–2.5 mIU/L; cond trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L. Level I-USPSTF
2
如果实验室无妊娠早、中、晚期特异的TSH具体参考值范围，建议参考以下参考值范围：妊娠前三月0.1~2.5 mIU/ L；妊娠中期三个月，0.2-3.0 MIU / L；孕晚期三个月，0.3-3.0 MIU/ L。I级证据
& RECOMMENDATION 3宝马英文缩写
The optimal method to asss rum FT4 during pregnancy is measurement of T4 in the dialysate or ultrafiltrate of
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