June 5 Infertility is due to hyperthyroidism
Three years after our marriage, in early 2005, our work was gradually on track and we began to implement the "Human Creation Plan". However, I don't know whether it was too much work pressure or too heavy a mental burden, my menstruation began to become disordered, not only less menstruation than usual, but also prolonged menstruation, as short as more than thirty days, as long as two months to come again. Months later, my stomach is still empty, and I think it may be an endocrine disorder. When I went to the gynecology department, I did not expect that the examination of seven turns and eight turns, in the end, the doctor's diagnosis was a menstrual disorder caused by hyperthyroidism (referred to as hyperthyroidism). I suddenly understood a lot: for half a year, female colleagues have envied that I have "mouth blessings", both to eat and not to grow fat, in fact, this is one of the manifestations of hyperthyroidism leading to excessive metabolism. There is also my insomnia, fear of heat, impatience, I have always thought that the work pressure is too much, the mood is irritable, and now I know that it is also a ghost of hyperthyroidism. The doctor said that my thyroid gland is only I. enlarged, temporarily do not need surgery, it is recommended to take medication first, but the medication may be longer, it takes about 1-2 years, during which it is not advisable to get pregnant. The doctor's last words made me sad for a while, and I tossed and turned for several consecutive nights: two years later, I was 32 years old, and it was still a problem to be pregnant when I said it... In case I really can't be born, then how can it be worthy of being strong? The more I thought about it, the more terrible it became, and I didn't sleep all night. Later, under the continuous understanding of Qiang, I finally slowly accepted this fact, and according to the doctor's instructions, I took the medicine regularly and reviewed it regularly.
After two months, my thyroid function had largely returned to normal. Depending on the condition, the doctor helped me gradually adjust the type and dosage of the drug. After half a year, I only needed to take propyl thiouracil (PTU) maintenance therapy. My period gradually returned to normal, everything seemed to go according to expectations, and my mood was much calmer.
Comments: Hyperthyroidism tends to occur in women of childbearing age aged 20-40 years. In patients with hyperthyroidism, 85% are toxic diffuse goiter, known as Graves disease, and other rare toxic nodular goiter, functional autonomic thyroid adenomas, and subacute thyroiditis. Graves disease is an autoimmune disease caused by the immune dysfunction in the patient's body, producing thyroid-stimulating antibodies (TSAb), stimulating and exciting the thyroid gland, making it hyperactive, hyperfunctional, producing and secreting too much thyroid hormone. Clinically, it is manifested as goiter, irritability, insomnia, shaking of the hands, fear of heat, hyperhidrosis, hyper appetite and weight loss, rapid heartbeat, and endocrine disorders. Currently, antithyroid drugs are the main treatment of hyperthyroidism, the most common of which is propyl thiouracil.
September 5 Hyperthyroid treatment encounters pregnancy
In the third month of maintenance treatment, I suddenly found that my menstruation had not come for more than ten days, could it be that the lack of medication led to repeated diseases? The next day, I ran into the hospital. As a result, the two eye-catching words "positive" on the pregnancy test made my heart feel like fifteen buckets of water - seven up and eight down. Should this unexpected "gift" be gladly accepted? Will antithyroid drugs adversely affect your baby? Does hyperthyroidism worsen after pregnancy? Do you want to continue taking your medication?
The doctor said that my condition was stable, and if I had a pregnancy plan, I would choose to continue my pregnancy, and I would still be treated with propylthiopyrimidine during pregnancy. Usually, pregnancy has little effect on hyperthyroidism. Conversely, during pregnancy, hyperthyroidism can often be alleviated or even disappeared during pregnancy because the patient's own immune system is suppressed, especially in the first trimester of pregnancy.
After some explanation from the doctor, I finally gladly accepted the "good news" that came early. Qiang was even more excited. Since then, I have been like a fragile glass doll, no matter where I go, Qiang always has to guard it carefully.
Reviews: Pregnant women have a higher incidence of hyperthyroidism and pregnancy during hyperthyroid treatment. The timing of pregnancy depends mainly on the control of hyperthyroidism. If hyperthyroidism is not adequately treated and the condition is not stable, miscarriage, preterm birth, fetal growth restriction, fetal distress and other conditions are prone to occur after pregnancy. Moreover, maternal thyroid-stimulating antibodies can enter the fetus through the placenta, causing hyperthyroidism in newborns. Hyperthyroidism is exacerbated if the dose is insufficient or unsolicited during pregnancy, while an overdose can cause hypothyroidism in newborns. Therefore, doctors always remind those women of childbearing age that if they have hyperthyroidism before pregnancy, they need to be treated first, and then choose to become pregnant after 1-2 years of disease control.
For patients with hyperthyroidism during pregnancy, many antithyroid drugs in treatment can pass through the placenta and affect the fetus. However, propyl thiouracil binds to protein in pregnant women with a large molecular weight, passes through the placenta slowly, and enters the fetal blood in small amounts, so it has become the preferred drug during pregnancy.
May 25 Hyperthyroidism expectant mother
October 21, 2006 , the 53rd day of pregnancy , I suddenly felt some blood flowing from my lower body, just like the usual menstrual cramps, and my lower abdomen was faintly swollen and painful. Qiang rushed to accompany me to the hospital, and after the examination, the doctor said that it was a "threatened miscarriage" and suggested that I be hospitalized. In the ward, the nurse gave me fetal protection injections every day and told me to stay in bed. Because there were fluctuations in thyroid function in the re-examination, the doctor increased the amount of PTU for me. After two days in the hospital, my lower body was no longer bleeding and my lower abdomen was no longer painful. After a week, ultrasound B reported "embryonic development". After two weeks, thyroid function was rechecked and returned to normal.
In this way, when I was pregnant early, I drew blood every two weeks to check thyroid function. After three months, doctors began to gradually reduce the amount of PTU, and the interval between blood draws was extended from two weeks to four weeks. Four months later, I was transferred to a high-risk clinic for an obstetric examination. In the meantime, my blood pressure and pulse have been maintained normally, and my weight, abdominal circumference, and uterine height have also been growing step by step, thinking that the baby is growing healthily day by day, and my heart is full of pride and satisfaction that I have never had before, which may be the happiness of motherhood that people often say. After six months, the PTU has been reduced to a small maintenance. At 37 weeks, the doctor stopped my medication and I was hospitalized with peace of mind.
Comments: During pregnancy, thyroid function will have physiological changes in early elevation, mid-term remission, and late decline. Therefore, the pregnancy process requires close monitoring of thyroid function, timely adjustment of PTU dose, so that thyroid function is maintained at 1/3 of the upper limit of normal values. Especially in the last trimester of pregnancy is the stage of rapid development of the fetal brain, PTU must not be overdose, if the control goal has been reached, in the last few weeks of pregnancy, discontinuation of the drug may be considered.
If hyperthyroidism is developed before pregnancy, it has been well controlled, or if hyperthyroidism has been reasonably treated in the first trimester of pregnancy, it generally does not increase pregnancy complications, and the mother and newborn have a good prognosis. If the secretion of thyroxine during pregnancy is excessive, inhibiting the secretion of gonadotropin, it is easy to cause miscarriage, premature birth, in addition, hyperthyroidism in pregnant women is hypermetabolic, can not provide enough nutrition and oxygen for the fetus, can lead to fetal growth restriction, fetal distress. When these conditions occur, in addition to the usual obstetric management, attention needs to be paid to the control of thyroid function and, if necessary, the dose of antithyroid drugs is increased. Therefore, pregnant women with hyperthyroidism should be examined and followed up at high risk outpatient visits to enhance fetal monitoring and antenatal care.
During pregnancy, we should pay attention to the growth of maternal weight, uterine height, and abdominal circumference, and conduct a fetal ultrasound examination every 1-2 months to understand the fetal growth; in the third trimester, 1-2 fetal heart rate monitoring is carried out every week, paying attention to whether there is fetal distress, fetal heart rate is too fast or too slow; 37-38 weeks of pregnancy should be admitted to the hospital for supervision and waiting for delivery. At the same time, nutrition should be strengthened during pregnancy, attention should be paid to rest, the left side should be taken, and infection, mental stimulation and mood swings should be avoided to avoid hyperthyroidism. Because hyperthyroid pregnant women are prone to complications with "gestational hypertension syndrome", it is especially important to pay attention to early calcium supplementation and observe whether there is edema, increased blood pressure and egg urine.
June 10 Defeat hyperthyroidism to welcome baby
Since my blood pressure, pulse and thyroid function have been maintained within the normal range throughout the pregnancy, the doctor said that I have the conditions for vaginal trial delivery, in order to fully experience the process of being a mother, I and Qiang decided to give birth naturally. The baby's fetal heartbeat has always been normal, and he, like me, quietly waits for the moment to give orders.
Ten days before the due date, one evening, I suddenly felt a sharper pain coming from my lower abdomen, and at 3:17 a.m., my dear little baby announced its birth with a loud cry.
Back in the ward, the doctor told me that everything was fine for the baby. Three days later, the cord blood came out, the baby's thyroid function was within the normal range, and my hanging heart finally let go. Looking at the little elf attached to my chest, the sweet sense of happiness spread to every cell of my body, and all the pain and tiredness disappeared in an instant.
Review: Most pregnant women with hyperthyroidism can have vaginal delivery. During labor, attention should be paid to supplementing energy, encouraging eating, appropriate infusion, whole-process oxygen inhalation and fetal heart rate monitoring, monitoring blood pressure, heart rhythm, and body temperature. If abnormalities are found during childbirth, caesarean section surgery is switched to avoid hyperthyroid crisis. In addition, hyperthyroid pregnant women generally have strong contractions, small fetuses, relatively short labor, and a high neonatal asphyxia rate, so newborn rescue preparations should be made.
When a newborn is born, cord blood should be left to check thyroid function and related antibodies, and pay attention to check the size of the thyroid gland and whether the heart has a murmur. Neonatal hyperthyroidism occurs within a few days or a week after childbirth, manifested as goiter, protruding or enlarged eyes, high skin temperature, crying, large amount of food, frequent stools, not long weight, severe cases accompanied by hyperthermia, heart rate, rapid breathing and other hyperthyroid crisis manifestations; and when the nail is low, children often manifest as poor response, no crying, less eating, delayed bowel movements, and short weight.
It should not be ignored that hyperthyroid women may recur or worsen due to the release of postpartum immunosuppression. Therefore, it is necessary to continue to take the drug after childbirth, and appropriately increase the dose of the drug, while monitoring thyroid function.
According to studies, PTU is safe for babies. On the other hand, to reduce the content of the drug in the milk, the nursing mother can take the drug after breastfeeding, breastfeed after 3-4 hours, and regularly monitor the baby's thyroid function.