甲状腺、蝴蝶状腺位于your neck, regulates your metabolism. When problems occur in the thyroid it can throw your whole body off balance. Women are statistically more likely to suffer from it than men, and for women looking to get pregnant, thyroid problems could be dangerous for pregnancy.
HealthCentral covered some frequently asked questions about thyroid and pregnancy with Elizabeth Pearce, MD. Elizabeth is currently co-chairing the American Thyroid Association‘s Thyroid and Pregnancy Clinical Guidelines Task Force. She is also an endocrinologist and Associate Professor of Medicine at the Boston University School of Medicine.
HealthCentral (HC): What should a first-time mother with a known thyroid disease be concerned about regarding her thyroid?** Elizabeth Pearce, MD:** The most common form of thyroid disease is hypothyroidism, or underactive thyroid. Women of child-bearing age who are being treated with thyroid hormone for hypothyroidism prior to pregnancy should be aware that their dose of thyroid hormone almost always needs to increase once they become pregnant. Thyroid hormone is essential for normal neuro-development of the fetus. Increasing the dose as early in pregnancy as possible is vital. Many doctors recommend that a woman who is treated with thyroid hormone prior to pregnancy should automatically increase the thyroid hormone dose by two tablets a week (if she usually takes one tablet a day). It’s important that women contact their care provider as soon as they find out they are pregnant.
HC: What about first-time mothers who may not know that they have a thyroid problem? How is the thyroid affected during pregnancy, exactly?**伊丽莎白·皮尔斯，MD：**甲状腺怀孕期间自然增加它的功能，所以通常情况下，假设一个女人是健康的，她的甲状腺是否正常工作，她将增加她的甲状腺激素生产了约50％在怀孕早期开始。因此，妊娠充当甲状腺压力测试。
这是有争议的，是否所有健康的妇女应在怀孕初期或不会筛查甲状腺功能。在话题当前准则不一，一些医疗社会提倡无测试，一些倡导万能试验，有的主张只有在高风险的妇女测试。如果我们在每个孕妇都来检验甲状腺功能，我们将在他们中的一些检测轻度甲状腺功能低下。
HC: What is mildly low thyroid function?** Elizabeth Pearce, MD:** Mildly low thyroid function is called subclinical hypothyroidism. It is diagnosed on the basis of laboratory testing: in subclinical hypothyroidism the blood thyroid stimulating hormone (TSH) level is elevated but the actual thyroid hormone levels are normal. Outside the setting of pregnancy, it's controversial whether or not treatment is required. Most people who have mildly low thyroid function don't have symptoms, although, there may be subtle symptoms if you look at enough people and ask the questions carefully enough.
慧聪网：有没有其他的方法甲减如何影响母亲和胎儿发育，如果一个女人怀了甲减？**伊丽莎白·皮尔斯，MD：在怀孕**甲状腺机能严重衰退肯定有不利影响;有早产，流产和先天畸形率较高，并有对儿童的认知发展产生不利影响。甲减应始终处理。待处理无论轻度甲状腺功能减退症的产妇需要更多的争议。
HC: I see. Are there efforts being made to conduct more in-depth studies about how interventional methods might benefit or might not benefit?** Elizabeth Pearce, MD:** Results of the Controlled Antenatal Thyroid Screening (CATS) were published in the New England Journal of Medicine in 2012. In that study, some women with mildly low thyroid function in pregnancy were randomly assigned to treatment with thyroid hormone. Child IQ was assessed at the age of three, and there was no difference in IQ between the children of the treated and untreated mothers. There's a very similar study currently ongoing in the U.S. – a big NIH multi-center study. The results of the NIH study will be announced in 2016. There is currently also a large clinical trial examining the effects of testing for and treating mild maternal hypothyroidism which is ongoing in China.
慧聪网：这你认为重要的是如何对女人来说，谁试图怀孕，检查他们的甲状腺工作正常？你认为这是一个重要的测试，或者如果他们没有任何症状，他们只是不应该得到它的检查？你对那个想法吗？**伊丽莎白·皮尔斯，MD：**从美国甲状腺协会的最新指引对甲状腺和怀孕日期从2011年我在这些指导方针的作者。目前，我们正在编写修订这些准则，这将是明年。
In the previous guidelines, we recommended a case finding strategy. We felt that there wasn't really enough evidence to recommend for testing thyroid function in every single pregnant woman, unless she had risk factors.
从以前的准则危险因素包括：
- 妇女的甲状腺问题的已知历史
- 女性甲状腺疾病家族史
- Women with thyroid enlargement
- Women who have detectable antibodies against the thyroid in the blood
- Women with symptoms that suggest hypothyroidism
- Women with Type 1 Diabetes, because the risk of hypothyroidism is higher
- 妇女流产或早产史，因为甲减可以用这些东西有关
- Women with other autoimmune disorders
- Women with a history of infertility should have screenings because thyroid problems can be one cause of infertility that might be treatable
- Women with a history of morbid obesity (A BMI greater than 40)
- 女性30岁以上的老年人
慧聪网：你知道节育的使用都将影响甲状腺？** Elizabeth Pearce, MD:** Birth control use does not affect thyroid function. However, when a woman starts or stops a birth control pill and she's also taking thyroid hormone replacement, it can affect her thyroid hormone dose requirements so she should have her thyroid hormone level tested.
“外怀孕，有些女性采取其他形式的甲状腺激素，甲状腺素一样（T3）和dessicated甲状腺，但这些不应该在怀孕期间使用，因为它们不会穿过胎盘，以提供所需的甲状腺激素对胎儿。”
HC: Do other forms of contraception affect women who are taking thyroid medication?** Elizabeth Pearce, MD:** No, this only applies to estrogen-containing medications.
HC:有什么副作用,服用甲状腺hormone during pregnancy?**伊丽莎白·皮尔斯，MD：**甲减的治疗是左旋甲状腺素。没有其他的治疗方法，建议孕妇。外怀孕，有些女性采取其他形式的甲状腺激素，甲状腺素一样（T3）和dessicated甲状腺，但这些不应该在怀孕期间使用，因为它们不会穿过胎盘，以提供所需的甲状腺激素对胎儿。
There are no side effects of levothyroxine if the dose is correct, and it does not pose any risk to the baby or the pregnancy. As noted already, it's important for a woman to know that the dose needs to be increased as soon as she's pregnant.
HC: After birth, what should women do to take care of their thyroid?**伊丽莎白·皮尔斯，MD：**如果甲状腺功能减退妇女在怀孕期间，如果她的剂量服用甲状腺激素已被适当地增加，而她怀孕了，她通常可以回到她的孕前剂量只要她提供。她应该有她的血液测试了大约六或八周后分娩，以确保她的甲状腺激素剂量仍是正确的，她是很重要的。
在分娩后的前6个月，妇女在一个条件称为产后甲状腺炎的开发风险。这是在其中有甲状腺炎症，和预先形成的甲状腺激素泄漏进入循环，并导致了几个星期轻度甲亢（高甲状腺激素水平）的自身免疫病症。有时，这之后是甲状腺机能减退的阶段时，预先形成的激素已经耗尽，但甲状腺还没有痊愈足以产生新的激素。在大多数女性来说，这种情况是自限性，并解决无需治疗。然而，谁的经验无论是甲状腺功能亢进症的新的症状（如心悸，震颤，或感觉大部分时间太热）或甲状腺功能减退（疲劳，便秘，感觉太冷的大部分时间）在首个月的妇女在分娩后应咨询护理提供者。