Diseases of the thyroid gland during pregnancy. What’s new.

May 25 was World Thyroid Day.

I would like to note it somehow 🙂 Therefore, this article is dedicated to the “hero of the occasion of the thyroid gland” and the most important event in a woman’s life – pregnancy. 🙂 I will present you with updated data on this topic.

Believe me, it will be interesting.

The concept of absolute hypothyroxinemia has been put into practice again, that is, in the 1st trimester of pregnancy at 0-12 weeks with an obvious two-fold decrease in the level of free T4, with normal TSH – this condition is an indication for correction with L Thyroxine preparations. The decrease in T4 St. in the 2nd and 3rd trimester – is physiological.
During the IVF protocol, against the background of ovulation stimulation with gonadotropin preparations, subclinical hypothyroidism very often develops (associated with a sharp increase in the level of blood estrogens), especially with the carriage of antibodies to TPO and TG, and this condition is also an indication for correction with L Thyroxine preparations.
To diagnose AIT in a woman during pregnancy, it is mandatory to take blood for only TSH, T4 and T3, but also take blood for all types of antibodies – antibodies to TPO and TG.
The question of prescribing L Thyroxine preparations during pregnancy with a TSH level above 2.5 is decided in favor of L Thyroxine in the presence of positive antibodies to TPO and TG in the blood; in the absence of a history of thyroid disease in the past and the achievement of a TSH level not higher than the upper reference value typical for this laboratory) Previously, this point of pregnancy management was considered much more stringent – with a TSH level above 2.5, L Thyroxine preparations were given to everyone.
Dedicated to gynecologists
There is no indication in any study for termination of pregnancy if a woman has uncompensated or overt hypothyroidism, even with TSH -100 mIU / ml. The main thing is to immediately prescribe a full replacement dose of L Thyroxine in the identified period. And not titrate it, as is done outside of pregnancy.
Iodine preparations are indicated for all women during pregnancy and lactation, even with AIT (especially since the woman is “under the cover” of L Thyroxine) at an average dose of 300 μg / day.
In the 1st trimester of pregnancy, to determine absolute hypothyroxinemia, the determination of free T4 is shown, and in the 2-3 trimester of T4 total and T3 total.
The first appearance during pregnancy of an increased titer of antibodies to TPO and TG with normal TSH is a risk factor for postpartum thyroiditis.
For pregnancy and beyond, subclinical hypothyroidism is a condition in which the TSH is in the range of 4-10, and the manifest hypothyroidism with TSH is above 10 mIU / ml.
Levels of TSH for compensation of LT with thyroxine already with existing and treated hypothyroidism, 1st trimester – TSH = 0.1-2.5, 2nd trimester TSH = 0.2-3.0, 3rd trimester 0.3-3.5 mIU / ml.
The replacement dose of L thyroxine in case of hypothyroidism manifestation is 2.3 μg / kg of body weight. Outside of pregnancy, 1.6-1.8 μg / kg body weight:!: With subclinical hypothyroidism during pregnancy, 1.2 μg / kg body weight.
An overdose of L Thyroxine during pregnancy is not a cause of miscarriage; one should not be afraid of large replacement doses.
After childbirth, keep the same dose of LTyroxine that was before pregnancy.
After childbirth, in the case of newly diagnosed subclinical hypothyroidism in this pregnancy, L thyroxine is canceled.
Pregnancy – after surgery for thyroid cancer without RIT, you can plan in 6-8 months. provided that euthyroidism is achieved with hormone replacement therapy. With RIGHT – planning is allowed in a year.
If thyroid cancer https://en.wikipedia.org/wiki/Thyroid_cancer is detected during pregnancy and there is no indication for urgent removal of the thyroid gland (only after childbirth), the appointment of suppressive doses of L Thyroxine is indicated for this pregnancy.
When nodular goiter is detected for the first time, blood sampling for hormones and necessarily calcitonin (a marker of thyroid cancer) is shown.
DTZ and pregnancy nothing new has appeared DTZ (diffuse toxic goiter) is not an indication for pregnancy and the best way to treat it during pregnancy is Tyrozol, in maximum doses of 30 mg / day.