育龄女性分化型甲状腺癌患者的妊娠全周期管理
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南方医科大学附属广东省人民医院(广东省医学科学院) 内分泌科,广东 广州 510080

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关海霞,南方医科大学附属广东省人民医院(广东省医学科学院)主任医师,主要从事内分泌代谢疾病方面的研究。

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广东省人民医院高层次全职引进人才配套科研资助项目(KJ012020629)。


Full-pregnancy-cycle management for women of childbearing age with differentiated thyroid cancer
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Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou510080, China

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    摘要:

    随着甲状腺癌发病率的不断攀升,我国育龄女性分化型甲状腺癌(DTC)患者的数量增幅明显。这个群体中的很多人承担繁育后代的使命,故而对DTC的临床管理有更高要求。因此,对育龄女性DTC患者开展妊娠全周期(贯穿备孕、妊娠和产后三个阶段)管理是符合中国国情及时代特征的肿瘤健康管理新模式,对守护母亲和子代围产期以及远期健康意义重大,能切实提高DTC的规范化管理水平和改善患者的生活质量。笔者根据现有的文献和指南,梳理从备孕期到妊娠期和产后期践行妊娠全周期管理的具体做法—在备孕期,避免不必要的延期妊娠,结合生育计划制定DTC的个体化治疗方案,做好孕前指导;在妊娠期,继续做好促甲状腺激素(TSH)抑制治疗,指导妊娠期间的甲状腺激素治疗用药,适度进行甲状腺功能和DTC病情的监测和随访;在产后期,理解TSH抑制治疗在哺乳期的安全性,关注产后甲状腺炎的发生及其对甲状腺激素治疗的影响。期待这个领域能够被多学科的更多学者所关注,共同行动,做好数据积累和长期随访,优化妊娠全周期管理的具体策略和路径,与时俱进地为目标人群提供最佳医疗服务。

    Abstract:

    With the rising incidence of thyroid cancer, the number of women of childbearing age diagnosed with differentiated thyroid cancer (DTC) in China has significantly increased. Many in this group bear the responsibility of reproduction, which necessitates higher standards for the clinical management of DTC. Therefore, implementing full-pregnancy-cycle management (encompassing preconception, pregnancy, and postpartum phases) for women of childbearing age with DTC represents a new model of cancer health management tailored to China's national conditions and contemporary characteristics. This approach is of great significance in safeguarding the perinatal and long-term health of mothers and offspring, improving the standardization of DTC management, and enhancing patients' quality of life. Based on existing literature and guidelines, the authors outline specific practices for implementing full-pregnancy-cycle management, spanning the preconception, pregnancy, and postpartum phases. During the preconception phase, unnecessary delays in conception should be avoided, individualized treatment plans for DTC should be developed in alignment with reproductive goals, and thorough pre-pregnancy counseling should be provided. In the pregnancy phase, the focus is on continuing thyrotropin (TSH) suppressive therapy, guiding appropriate thyroid hormone medication use during pregnancy, and monitoring and following up on thyroid function and DTC progression. In the postpartum phase, it is essential to understand the safety of TSH suppressive therapy during lactation, monitor for the occurrence of postpartum thyroiditis, and address its impact on thyroid hormone therapy. It is hoped that this field will garner greater attention from multidisciplinary scholars, fostering collaboration to accumulate data, conduct long-term follow-up, and optimize specific strategies and pathways for full-pregnancy-cycle management, thereby promptly ensuring the best medical services to the target population.

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高日丽,关海霞.育龄女性分化型甲状腺癌患者的妊娠全周期管理[J].中国普通外科杂志,2024,33(11):1759-1765.
DOI:10.7659/j. issn.1005-6947.2024.11.002

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  • 收稿日期:2024-10-10
  • 最后修改日期:2024-11-19
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  • 在线发布日期: 2024-12-18