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1、妊娠期甲状腺功能减退症产科隋霜甲状腺激素的生理作用对于全身器官有广泛的影响TheThyroidIncreasedLDLcholesterol2Elevated triglycerides2TheLiverTheIntestinesConstipation4DecreasedGImotility4Decreasedfertility6Menstrualabnormalities6TheReproductiveSystemDepression1Decreasedconcentration1Generallackofinterest1Impai
2、redfetalintellectualdevelopment7TheBrainDecreasedfunction5Fluidretentionandedema5TheKidneysDecreasedheartrate3Increasedbloodpressure3Decreasedcardiacoutput3Diastolicdysfunction3TheHeart1.NemeroffCB.Clinicalsignificanceofpsychoneuroendocrinologyinpsychiatry:focusonthethyro
3、idandadrenal.JClinPsychiatry.1989;50(suppl):13-20.2.KlausenIC,NielsenFE,HegedüsL,GerdesLU,CharlesP,FaergemanO.Treatmentofhypothyroidismreduceslow-densitylipoproteinsbutnotlipoprotein(a)Metabolism.1992;41:911-914.3.PolikarR,BurgerAG,ScherrerU,NicodP.Thethyroidandtheheart.C
4、irculation.1993;87:1435-1441.4.Vassilopoulou-SellinR,SellinJH.Thegastrointestinaltractandliverinhypothyroidism.In:BravermanLE,UtigerRD,eds.WernerandIngbar’sTheThyroid.7thed.Philadelphia,Pa:Lippincott-RavenPublishers;1996:816-820.5.MosesAM,ScheinmanSJ.Thekidneysandelectrol
5、ytemetabolism.In:BravermanLE,UtigerRD,eds.WernerandIngbar’sTheThyroid.7thed.Philadelphia,Pa:Lippincott-RavenPublishers;1996:812-815.6.EmersonCH.Thyroidfunctionanddiseaseinthefemale.In:GoldJJ,JosimovichJB,eds.GynecologicEndocrinology.4thed.NewYork,NY:PlenumPublishingCorp;1
6、987:109-133.7.HaddowJE,PalomakiGE,AllanWC,etal.Maternalthyroiddeficiencyduringpregnancyandsubsequentneuropsychologicaldevelopmentofthechild.NEnglJMed.1999;341:549-555.甲状腺激素的生物学作用一、对代谢的影响1.产热效应：使组织耗氧量和产热量增加；2.对蛋白质、糖、脂肪代谢影响：加速蛋白质和各种酶的生成、促进糖的吸收，增强糖原分解；促进脂肪氧化；二、对生长与发育的影响：促进组织
7、分化、生长与发育成熟三、对神经系统的影响：影响神经系统的发育，兴奋交感神经系统；四、其他:心血管系统、水和电解质甲状腺功能的调节肝脏下丘脑垂体甲状腺TRHT4/T3TBG雌激素卵巢TSH碘化物结合FT4负反馈FT4/FT30.04%0.5%TRH（促甲状腺素释放激素）TSH（促甲状腺素）T4（甲状腺素）T3（三碘甲状腺原氨酸）FT4（游离T4）FT3（游离T3）TBG（甲状腺素结合球蛋白）正反馈研究背景妊娠期甲状腺的生理变化：妊娠期间母体血容量增加1/5-1/4，造成激素容池扩大和血清碘稀释；肾脏血流增加，肾小球滤过功能增强，肾排碘量增加
8、，血清无机碘浓度下降—碘饥饿；妊娠妇女的碘需要量显著增加，足够碘摄入才能保证甲状腺内充足的碘储备。碘缺乏会导致甲状腺激素缺乏，流产、死产、新生儿死亡率增加，新生儿智力低下、体格发育落后等不良后
