Schilddrüsenerkrankungen in der Schwangerschaft

Schilddrüsenerkrankungen sind die zweithäufigste Endokrinopathie in der Schwangerschaft [1]. 2–3 % der Schwangeren sind von einer Schilddrüsenfunktionsstörung betroffen [2]. Die frühe Diagnose und Therapieeinleitung sind aufgrund möglicher Komplikationen bei Mutter und Fötus bedeutend. Dieser Beitrag zeigt einen Überblick über aktuelle Empfehlungen bezüglich der Schilddrüsendiagnostik und therapiebedürftiger Konstellationen in der Schwangerschaft.

Abstract

Thyroid disease is the second most endocrinopathy during pregnancy [1]. Thyroid dysfunction affects 2–3 % of pregnant women [2]. Early diagnosis and initiation of therapy are important due to the potential complications in both mother and fetus. This article provides an overview of current recommendations regarding thyroid diagnostics and constellations during pregnancy that require therapy.

Schlüsselwörter

Schilddrüsenknoten - Schwangerschaft - Gestationshyperthyreose - Schilddrüsenhormone

Key words

pregnancy - gestational hyperthyreodism - hypothyreoidsm

• Literatur

• 1 Negro R, Mestman JH. Thyroid disease in pregnancy. Best Pract Res Clin Endocrinol Metab 2011; 25: 927-943
• 2 Baloch Z, Carayon P, Conte-Devolx B. et al. Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13: 3-3
• 3 Barthel A, Keck C, Janssen OE. et al. Schilddrüse und Schwangerschaft: Aktuelle Entwicklungen zur leitliniengerechten Diagnostik und Therapie. Dtsch Med Wochenschr 2012; 137: 171-174
• 4 Yassa L, Marqusee E, Fawcett R. et al. Thyroid Hormone Early Adjustment in Pregnancy (The THERAPY) Trial. J Clin Endocrinol Metab 2010; 95: 3234-3241
• 5 Okosieme OE, Khan I, Taylor PN. Preconception management of thyroid dysfunction. Clin Endocrinol (Oxf) 2018; 89: 269-279
• 6 Verga U, Bergamaschi S, Cortelazzi D. et al. Adjustment of L-T4 substitutive therapy in pregnant women with subclinical, overt or post-ablative hypothyroidism. Clin Endocrinol (Oxf) 2009; 70: 798-802
• 7 Velasco I, Taylor P. Identifying and treating subclinical thyroid dysfunction in pregnancy: Emerging controversies. Eur J Endocrinol 2018; 178: D1-D12
• 8 Hales C, Taylor PN, Channon S. et al. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Behavior. J Clin Endocrinol Metab 2020; 105
• 9 Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol 2006; 108: 1283-1292
• 10 Andersen SL, Knøsgaard L. Management of thyrotoxicosis during pregnancy. Best Pract Res Clin Endocrinol Metab 2020; 34: 101414
• 11 Ross DS, Burch HB, Cooper DS. et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26: 1343-1421
• 12 Andersen SL, Andersen S. Antithyroid drugs and birth defects. Thyroid Res 2020; 13: 11
• 13 van Dijk MM, Smits IH, Fliers E. et al. Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review. Thyroid 2018; 28: 257-264
• 14 Alexander EK, Pearce EN, Brent GA. et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid 2017; 27: 315-389
• 15 Bliddal S, Feldt-Rasmussen U, Rasmussen ÅK. et al. Thyroid Peroxidase Antibodies and Prospective Live Birth Rate: A Cohort Study of Women with Recurrent Pregnancy Loss. Thyroid 2019; 29: 1465-1474
• 16 Cooper DS, Doherty GM. The American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2009; 19: 1167-1214
• 17 Haugen BR, Alexander EK, Bible KC. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26: 1-133
• 18 O’Connell TB, O’Doherty MJ. Differentiated thyroid cancer and pregnancy. Nucl Med Commun 2000; 21: 127-128
• 19 Korevaar TIM, Derakhshan A, Taylor PN. et al. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity with Preterm Birth: A Systematic Review and Meta-analysis. JAMA 2019; 322: 632-641
• 20 Dhillon-Smith RK, Middleton LJ, Sunner KK. et al. Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception. N Engl J Med 2019; 380: 1316-1325
• 21 van Dijk MM, Vissenberg R, Fliers E. et al. Levothyroxine in euthyroid thyroid peroxidase antibody positive women with recurrent pregnancy loss (T4LIFE trial): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. lancet Diabetes Endocrinol 2022; 10: 322-329