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促甲状腺激素(TSH)异常的JMS共勉小区

 
楼主: lovedoudou
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谢赞,祝宝宝快乐家庭幸福!
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今天得到医院的检查结果,说我促甲状腺激素(TSH)高于正常值,查了一下是亚临床性加减(低)。有类似情况的姐妹,大家一起鼓励,一起加油,等待好孕降临. 有类似情况好孕的姐妹,诚恳邀您进来跟大家分享治疗经验和怀孕心得。


jms给我打打气呀~


[em05]


下面是我搜集的一些信息,希望对大家有帮助:


亚临床甲状腺疾病的定义为血清TSH异常升高(亚临床甲减)或降低(亚临床甲亢)而外周甲状腺激素浓度尚在实验室参考范围内的疾病。这种甲状腺功能检查的异常在人群中非常普遍,已经在教科书和评论文章中广泛讨论过。


亚临床甲减的常见病因




自发性亚临床甲减在人群中是比较普遍的,摄碘多的人更易罹患。病人可以分为两个主要的亚型:一部分在血清中可以检测到甲状腺抗体(TPO-Ab/或Tg-Ab),另一部分则不能检测到。

甲状腺抗体阳性的病人估计是自身免疫性甲状腺炎引起的,他们最可能发生进展性甲状腺功能不全,每年有5-10%的患者从亚临床状态发展成明显的甲状腺功能减退。

常见血清TSH升高而甲状腺抗体阴性的情况,其发病机制目前尚不清楚。这些患者可能患有以T-细胞应答占优势的不同亚型的自身免疫性疾病。尸检发现有甲状腺炎组织学改变的发生率明显高于在人群中血清标本的阳性率,然而其中可能还有其他发病机制。此亚型发展成明显甲状腺疾病的危险性比较低一些(每年大约有2%左右)。




了解到疾病有进展的危险性,因此必须定期复查,特别是对于那些尚未治疗的患者。另一方面我们不认为疾病有进展的危险性就应早期开始治疗。患者目前的状况应该是决定是否治疗的主要依据。如果目前的状况没有严重到要早期开始治疗,那么将在发现有病情进展时才开始。不管现在是否进行治疗都要进行随访。如果早期治疗能阻止甲状腺功能衰退的进展,并且能稳定甲状腺功能的部分生理调节状态,这将是早期治疗的重要理由。应用T4替代治疗后常可见到甲状腺抗体水平的下降,但是这方面尚缺少临床相关的对照研究。




亚临床甲亢的常见病因

亚临床甲亢重要和主要的原因基本上有赖于人群碘摄入的水平。在碘摄入轻到中度低下(尿碘排泄的中位值25-120ug/24h)人群或者最近几十年碘摄入如此低下的患者,亚临床甲亢的主要病因是功能自主性甲状腺结节。在这些地区亚临床甲亢比亚临床甲减的发生更多,在60岁以上老人中有5-10%的患病率。另一方面,自发性亚临床甲亢在高碘摄入区并不普遍,如有发生,主要是由于患者为治疗甲减或者为减小甲状腺结节的大小,或者为了防止以前的甲状腺癌的复发而服用大剂量的T4所导致。




支持和反对亚临床甲状腺疾病治疗的论点




赞成治疗的主要论点

1. 在亚临床甲状腺疾病中血清TSH的变化不能完全代偿甲状腺功能,在个别病人中,

外周甲状腺激素的作用并不正常。

2.亚临床甲状腺疾病可伴有其他器官的功能受损,而治疗甲状腺功能紊乱可以逆转这种损害。

3.亚临床甲状腺疾病可能增加发生各种严重功能紊乱的长期危险。

4.亚临床甲状腺疾病的治疗一般不复杂,而且,与观察对照一样,控制疾病负担的费用也不贵。

5.大多数类型亚临床甲状腺疾病自发性消除的可能性很小。

6.在妊娠期间母亲甲状腺功能受损增加胎儿的危险性。




反对治疗的主要论点

1. 相当大的比例的患者虽经治疗但并没感到健康状况比以前更好。

2. 治疗通常将涉及终身服药(亚临床甲减)。

3. 治疗可以引起明显的副作用(亚临床甲亢)。

4. 亚临床甲状腺疾病的长期危险可能取决于其它危险因素,在一些亚型患者中其危险

度是比较低的。

5. 需要大量的研究来明确这种疾病的重要性及相关的危险性以及长期治疗的益处。

6. 亚临床甲状腺疾病非常普遍,对如此普遍的功能紊乱,在治疗合法化之前应由充分

的证据证明治疗的必要性。


亚临床甲减是指血清TSH浓度增高而血清FT3及FT4水平正常大多数病人无临床症状。亚临床甲减一般不需治疗, 这种病并不是真正的甲减,所以等指标恢复正常,停药三个月后看情况可以考虑怀孕。


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51
四级宝宝 |

嘿嘿,国内的JMs 睡觉去了,轮到我们几个在这里热闹。有点“日不落”帖子的意思啊。[em09][em07]
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52
四级宝宝 |

阳光小溪66,呵呵,我的电脑有时候也是忽然中文输入出问题,英语没问题的。


希望你的MRI结果出来一切都好!


[em01][em01][em01]


“Your TSH 6.15 is not that bad, it should go back to normal after 1-2 months if you continue on meds.


I have a good friend she is in Germany too and she just got pregnant at the age of 37. She'd been tried some Chinese meds after being TTC for almost 2 years and then she got the good news. It seems that Chinese meds have some magic things on infertility.”


如果这么快能调过来就太好了,我是个急性子,呵呵。本来按照我的计划,现在应该已经怀着宝宝,开始写毕业论文了。现在这么一搞,都不知道接下来怎么办好了。唉,计划不如变化快啊,我要赶紧搞个planB出来才行。


我也听说一个朋友37岁怀孕了呢,不会正好是你的这个朋友吧?我认识的这个在柏林。不知道是因为最近开始关注这个,还是现在在德国的中国人都在考虑宝宝的问题,最近总能听到别人的好消息。她是在德国看的中医,开的中药吗?


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53
十四级宝宝 |

以下是引用lovedoudou在2007-08-08 00:55:39的发言:

In US, some medical insurance plans require a family doctor, whichmeans everything has to go through from the family doctor.For example,if you have stomach problem, you need to see the family doctor first,then she/he will refer you to the specialist, you can't just pick upthe phone to book the appointment yourself. That's might be the reasonLovedoudou has to wait for her OB's referral.







Hi, 阳光小溪66, my insurance is PPO, I can make an appointment with anydoctor directly. The reason I am waiting for their call is I think myOB will refer me to a good doctor, Cause I have no idea which doctor isgood or not.

Lovedoudou,


Sorry , I was wrong.


Yes, it's a problem to find out which doctor is good in US. Do not always trust the doctors' referral coz sometimes they do business to each other.


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54
十四级宝宝 |

以下是引用Angelou在2007-08-08 02:37:56的发言:

阳光小溪66,呵呵,我的电脑有时候也是忽然中文输入出问题,英语没问题的。


希望你的MRI结果出来一切都好!


[em01][em01][em01]


“Your TSH 6.15 is not that bad, it should go back to normal after 1-2 months if you continue on meds.


I have a good friend she is in Germany too and she just got pregnant at the age of 37. She'd been tried some Chinese meds after being TTC for almost 2 years and then she got the good news. It seems that Chinese meds have some magic things on infertility.”


如果这么快能调过来就太好了,我是个急性子,呵呵。本来按照我的计划,现在应该已经怀着宝宝,开始写毕业论文了。现在这么一搞,都不知道接下来怎么办好了。唉,计划不如变化快啊,我要赶紧搞个planB出来才行。


我也听说一个朋友37岁怀孕了呢,不会正好是你的这个朋友吧?我认识的这个在柏林。不知道是因为最近开始关注这个,还是现在在德国的中国人都在考虑宝宝的问题,最近总能听到别人的好消息。她是在德国看的中医,开的中药吗?



Thank you Angelou!


My laptop could not load the local profile after I entered my ID and Pwd, it only allowed me to log on a temperary account on which some of the softwares I installed including the Chinese input one were no longer able to be used. This morning I tried to install the Chinese input software in my working computer but failed, the Anti-virus system always gave a Warning, I had to give up.


My friend lives in the suburb of Frankfurt, we may talk about the different person. She told me that she didn't see many Chinese in the area she lives, let alone the Chinese doctors. She went to see the Chinese doctor in Toronto, Canada when she was visiting her family there early this year.


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55
四级宝宝 |

呵呵,那就是有两个37岁的JM都好孕了,更加有信心啦!加油!


我这边倒是有中医诊所,不过多半是搞针灸的。等打听下看看,不行都想回国调养一阵子了。


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lovedoudou (楼主)
56
六级宝宝 |

以下是引用阳光小溪66在2007-08-08 02:47:09的发言:

以下是引用lovedoudou在2007-08-08 00:55:39的发言:

In US, some medical insurance plans require a family doctor, whichmeans everything has to go through from the family doctor.For example,if you have stomach problem, you need to see the family doctor first,then she/he will refer you to the specialist, you can't just pick upthe phone to book the appointment yourself. That's might be the reasonLovedoudou has to wait for her OB's referral.







Hi, 阳光小溪66, my insurance is PPO, I can make an appointment with anydoctor directly. The reason I am waiting for their call is I think myOB will refer me to a good doctor, Cause I have no idea which doctor isgood or not.

Lovedoudou,


Sorry , I was wrong.


Yes, it's a problem to find out which doctor is good in US. Do not always trust the doctors' referral coz sometimes they do business to each other.



Thanks for your care, don't feel sorry for this, hehe


I think you are right. I will make a new appointment with another doctor by myself after August 15, cause I changed my insurance plan which is better than the current one.


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lovedoudou (楼主)
57
六级宝宝 |

以下是引用阳光小溪66在2007-08-08 03:15:44的发言:


Thank you Angelou!


My laptop could not load the local profile after I entered my ID and Pwd, it only allowed me to log on a temperary account on which some of the softwares I installed including the Chinese input one were no longer able to be used. This morning I tried to install the Chinese input software in my working computer but failed, the Anti-virus system always gave a Warning, I had to give up.


My friend lives in the suburb of Frankfurt, we may talk about the different person. She told me that she didn't see many Chinese in the area she lives, let alone the Chinese doctors. She went to see the Chinese doctor in Toronto, Canada when she was visiting her family there early this year



Hi, 阳光小溪, you can directly input Chinese on some websites, such as www.inputking.com or go to www.dict.cn and then click 拼音输入法, either way you can write as long as you want, and then copy and paste to wherever you want.


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lovedoudou (楼主)
58
六级宝宝 |

以下是引用Angelou在2007-08-08 16:23:03的发言:

呵呵,那就是有两个37岁的JM都好孕了,更加有信心啦!加油!


我这边倒是有中医诊所,不过多半是搞针灸的。等打听下看看,不行都想回国调养一阵子了。



I also have a 36 years old friend who is in US got her second pregnant and will have her baby boy in september
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lovedoudou (楼主)
59
六级宝宝 |

以下是引用Angelou在2007-08-08 02:09:20的发言:

我做的是卵巢囊肿手术。本来也不大的囊肿,就是2月的时候忽然有些充血了,所以不得不手术。肚子也不是特别疼,就是隐隐地坠着的感觉。


我也怀疑TSH高跟手术有关系。我的抗体也是阳性的。


唉,想要BB了才发现毛病一堆啊。做了手术以后变成隔一个月一次月经了,我都担心左边的卵巢是不是手术的时候弄出毛病来了。上个周期中间(6月底)有一天去医生那里检查,她正好看见左边有一个卵泡,说应该差不多要排卵了,让我回去赶紧加油。可是后来既没有当上中队长也没有红色大军。我想,那岂不是还是没有排卵呢。(我用排卵试纸只测到弱弱阳)


于是我又开始寄希望于下一次排卵(希望是右边的),可是用德国的试纸,还是只能测到淡淡的水印。看来这次还是没什么指望。


[em03][em03]

再次抱抱!~~


看来你TSH高,跟你手术有关,不过,这样的话,等手术慢慢恢复了,一边吃药,应该就会好了。


关于不孕,我觉得我其实没什么大的问题,更重要的是在我老公,问题多多,少精弱精外加不射精,可他还迟迟不去看医生,威逼利诱,依然如故,我这心里简直要苦死了。


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60
十四级宝宝 |

以下是引用lovedoudou在2007-08-09 00:31:59的发言:

以下是引用阳光小溪66在2007-08-08 03:15:44的发言:


Thank you Angelou!


My laptop could not load the local profile after I entered my ID and Pwd, it only allowed me to log on a temperary account on which some of the softwares I installed including the Chinese input one were no longer able to be used. This morning I tried to install the Chinese input software in my working computer but failed, the Anti-virus system always gave a Warning, I had to give up.


My friend lives in the suburb of Frankfurt, we may talk about the different person. She told me that she didn't see many Chinese in the area she lives, let alone the Chinese doctors. She went to see the Chinese doctor in Toronto, Canada when she was visiting her family there early this year



Hi, 阳光小溪, you can directly input Chinese on some websites, such as www.inputking.com or go to www.dict.cn and then click 拼音输入法, either way you can write as long as you want, and then copy and paste to wherever you want.



Lovedoudou,


非常感谢你告诉我这样一个有用的网站,这样我在上班时也可以回中文了。我今天上班时才看到你的留言, 我已经给你回了, 请查收。


[em07][em07]
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