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題 名 | Recurrent Fetal Thyrotoxicosis in a Woman with Graves' Disease: Case Report=覆發性的胎兒甲狀腺功能亢進:病例報告 |
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作 者 | 丁明國; 許瑞旭; 黃禹堯; 林仁德; 陳澤卿; | 書刊名 | 長庚醫學 |
卷 期 | 22:3 1999.09[民88.09] |
頁 次 | 頁492-497 |
分類號 | 417.343 |
關鍵詞 | 胎兒甲狀腺毒血症; 臍帶穿刺; 甲狀腺刺激素接受體抗體; Fetal thyrotoxicosis; Cordocentesis; Thyrotropin-binding inhibitor immunoglobulin; |
語 文 | 英文(English) |
中文摘要 | 葛雷氏疾病所引起的甲狀腺功能亢進,一般認為是由甲狀腺刺激性免疫球蛋白所 造成的。對一個患有自體免疫甲狀腺疾病的母親而言,這些抗體可以經由胎盤到胎兒血中, 而干擾胎兒甲狀腺功能;在此我們報告一病例是有關於一個31歲的年輕婦女,之前被診斷 為葛雷氏疾病,目前吃甲狀腺素治療因甲狀腺切除後所造成之甲狀腺功能低下症,手術後2 年她懷第一胎,但很不幸,在妊娠中期發生胎死腹中。胎兒在經病理解剖發現甲狀腺腫大及 具有甲狀腺功能亢進的特徵。1年之後,她懷了第二胎,在第26週妊娠期,經由臨床表徵(胎 心過速及心臟肥大)及賀爾蒙分析(抽臍帶血)(T4:18 μg/dl, T3:63.5ng/dl, TSH: <0.03μU/ml)。 發現胎兒甲狀腺功能亢進,因此母親開始口服Methimazole及Propranolol來治療胎兒甲狀腺 機能亢進,在母親及胎兒血中同時測到高濃度的甲狀腺刺激素結合抑制免疫球蛋白(TB)(母 親:85.9%,胎兒:77.6%正常:低於15%)抗微溶體抗體在母親及胎兒皆測不到,第二胎在 35週時早產,在此病例分析發現,即使在做過甲狀腺切除後高濃度的TBII在懷孕過程中 (86.5%, 8.9%, 81.6%)及產後(83.9%)持續存在,此抗體通過胎盤造成胎兒甲狀腺毒血症,我 們建議在妊娠期規則的監測患在自體免疫甲狀腺疾病的孕婦的甲狀腺刺激素接受體抗體,同 時例行性的測量胎心跳及胎兒生長情形,對於早期偵測胎兒甲狀腺異常將有所助益;抽臍胎 血測胎兒甲狀腺功能,對於診斷及做為治療指引更有幫助。 |
英文摘要 | The thyroid stimulating immunoglobulins are generally believed to be the cause of hyperthyroidism in Graves' disease. Placental transfer of these antibodies from a mother with autoimmune thyroid disease can result in fetal thyroid disorders. We report the case of a 31-year-old woman who had a history of Graves' disease. She received thyroxine therapy for post thyroidectomy hypothyroidism. Two years after the thyroidectomy. She became pregnant. Unfortunately intrauterine fetal death occurred in midgestation. One year later, she became pregnant again. In the 26th week of gestation, fetal thyrotoxicosis was diagnosed using clinical pictures, including fetal tachycardia and cardiomegaly, and a hormonal evaluation of a periumbilical blood sampling (T4:18 μg/dl, T3:63.5ng/dl, TSH: <0.03μU/ml) was performed. Antimicrosomal antibodies were not detectable in either the maternal of fetal blood. In this case, high levels of TBII were detected during pregnancy and crossed the placenta to result in a thyrotoxic fetus in the second pregnancy. We recommend that both the regular monitoring of the thyrotropin receptor antibodies of prenant women with a history of autoimmune thyroid disease, and routine measurements of the fetal heart rate and intrauterine growth during gestation be mandatory for the early detection of fetal thyroid disorders. Cordocentesis for measuring fetal thyroid function is helpful in reaching a definite diagnosis and for guiding therapy. |
本系統中英文摘要資訊取自各篇刊載內容。