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FOCUSED ISSUE OF THIS MONTHJ Korean Med Assoc 2018 April; 61(4):253-258
pISSN 1975-8456 / eISSN 2093-5951
https://doi.org/10.5124/jkma.2018.61.4.253
임신과 갑상선질환 253
서론
갑상선질환은 가임기 여성에서 흔한 내분비질환으로, 임
신 중 갑상선기능이상은 산모와 태아의 여러 합병증을 초래
할 수 있으며, 이러한 합병증은 산모의 갑상선기능이상을 치
료함으로써 예방할 수 있다고 알려져 있다[1]. 임신 중 갑상
선질환의 관리에 대한 관심이 높아짐에 따라 2007년 이후 미
국갑상선학회(American thyroid association, ATA)를 비롯
한 여러 학회의 지침이 발표되었고[2,3], 2014년 대한갑상선
학회에서도 지침을 발표하여 진료에 많은 도움을 주었다[4].
본 종설에서는 최근 ATA에서 발표한 개정된 지침을 바탕
으로 임신 중 갑상선기능이상 환자의 치료에 대해 소개하고
자 한다[5].
임신 중 갑상선기능의 변화
임신에 따른 다양한 호르몬의 변화와 신진대사의 증가
는 갑상선기능에 영향을 끼친다. 임신 동안의 호르몬의 주
요 변화는 에스트로겐 증가에 의한 티록신결합글로불린
(thyroxine binding globulin, TBG)의 증가와 인융모성선
자극호르몬(human chorionic gonadotropin, hCG)의 증
가에 의한 혈중 갑상선자극호르몬(thyroid stimulating
hormone, TSH)수용체의 자극이다[6]. 혈중 TBG는 임신에
따라 증가하여 20주에 약 2배로 증가하며 결과적으로 혈중
총 티록신(total thyroxine)과 총 트리요오드사이로닌(total
임신과 갑상선질환 임 창 훈 | 단국대학교 의과대학 제일병원 내과
Thyroid dysfunction during pregnancyChang Hoon Yim, MD
Department of Internal Medicine, Cheil General Hospital & Women’s Healthcare Center, Dankook University College of Medicine, Seoul, Korea
Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant. However, these complications can be prevented by the optimal treatment of overt maternal thyroid dysfunction. The serum thyroid-stimulating hormone (TSH) concentration is the most reliable measure of thyroid function during pregnancy. Due to the physiologic changes in TSH levels during pregnancy, the correct interpretation of thyroid function requires knowledge of the gestational week and the appropriate population-based reference interval. In addition to a TSH test, the measurement of thyroid peroxidase antibody helps determine whether to treat subclinical hypothyroidism during pregnancy. Since the use of antithyroid drugs during pregnancy is associated with birth defects, it is recommended to discontinue the medication and to perform repeated thyroid function testing during the first trimester. If therapy is needed during the first trimester, propylthiouracil is preferred over methimazole.
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임신과 갑상선질환 257
Yim CH·Thyroid dysfunction in pregnancy
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