Schilddrüsenerkrankungen und Schwangerschaft

Zusammenfassung

Schilddrüsenerkrankungen sind bei Frauen im reproduktionsfähigen Alter häufig anzutreffen. Schilddrüsenfehlfunktionen wie Hypo- oder Hyperthyreose können sich negativ auf den Schwangerschaftsverlauf und insbesondere auf die kognitive Entwicklung des Kindes auswirken. – Für therapeutische Überlegungen ist das Wissen um die physiologischen Veränderungen der mütterlichen Schilddrüsenfunktion entscheidend, um sie von pathologischen Funktionszuständen abzugrenzen. Autoimmunthyreopathien, insbesondere die Autoimmunthyreoiditis sind mit einem höheren Abort-Risiko verbunden. Im Falle einer Hypothyreose ist der Bedarf an Schilddrüsenhormonen bereits in der Frühschwangerschaft erhöht. Von einer physiologischen TSH-Erniedrigung in der Frühschwangerschaft ist die selten auftretende manifeste Hyperthyreose, die zu 85% der Fälle eine Autoimmunhyperthyreose (Morbus Basedow) ist, abzugrenzen. Die frühe Schwangerschaft und die Postpartalzeit sind bei allen bekannten Autoimmunthyreopathien vulnerable Phasen.

Abstract

Benign thyroid disorders are common in fertile women. Hypothyroidism and Hyperthyroidism adversely affect development of pregnancy and fetal brain development. For therapeutic options knowledge of the physiological changes during pregnancy is essential. Autoimmune thyroiditis is associated with a higher risk of fetal loss. In hypothyroid women a higher dosage adaptation of levothyroxine in early pregnancy is necessary. Graves disease is the most common cause of thyroid hyperthyroidism in pregnancy. Manifestation of thyroid disorders is common in early pregnancy and postpartal.

Schlüsselwörter

Schilddrüse - Schwangerschaft - Schilddrüsenüberfunktion - Schilddrüsenunterfunktion

Key words

thyroid - pregnancy - hyperthyroidism - hypothyroidism

• Literatur

• 1 Abalovich M, Amino N, Barbour LA et al. Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007; 92: 1-47
• 2 Alexander EK, Marqusee E, Lawrence J et al. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 2004; 351: 241-249
• 3 Berbel P, Obregon MJ, Berrnal J et al. Iodine supplementation during pregnancy: a public health challenge. Trends Endocinol Metab 2007; 18: 338-343
• 4 Cooper DS, Revkees SA. Putting Propylthiouracil in perspective. J Clin Endocrinol Metab 2009; 94: 1881-1882
• 5 Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaption from physiology to pathology. Endocr Rev 1997; 18: 404-433
• 6 Glinoer D. Management of hypo- and hyperthyroidism during pregnancy. Growth Horm IGF Res 13 (Suppl A) 2003; 45-54
• 7 Glinoer D. Clinical and biological consequences of iodine deficiency during pregnancy. Endocr Rev 2007; 10: 62-85
• 8 Haddow JE, Knight GJ, Palomki GE et al. The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen 2004; 11: 170-174
• 9 Haddow JE, Palomaki GE, Allan WC et al. Maternal thyroid deficiency and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549-555
• 10 Johnsson E, Larsson G, Ljunggren M. Severe malformations in infant born to hyperthyroid women on methimazole. Lancet 2004; 350: 1502
• 11 Kloos RT, Eng C, Evand DB et al. American Thyroid Association Guidelines Task Force, Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19: 565-612
• 12 Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31: 701-755
• 13 Negro R, Greco G, Mangieri T et al. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab 2007; 92: 1263-1268
• 14 Negro R, Schwartz A, Gismondi R et al. Universal screening vs. case-finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 2010; 95: 1699-1707
• 15 Panesar NS, Li CY, Rogers MS. Preference intervals to thyroid hormones in pregnant Chinese women. Ann Clin Biochem 2001; 38: 329-332
• 16 Rodien P, Bremont C, Sanson ML et al. Familial gestational hyperthyroidism caused by a mutant thyrotropin receptor hypersensitive to human chorionic gonadotropin. N Engl J Med 1998; 339: 1823-1826
• 17 Sam S, Molitch ME. Timing and special concerns regarding endocrine surgery during pregnancy. Endocrinol Metab Clin North Am 2003; 32: 337-354
• 18 Stricker R, Echenard M, Eberhart R et al. Evaluation of maternal thyroid function during pregnancy: the importance of using gestational age-specific reference intervals. Eur J Endocrinol 2007; 157: 509-514
• 19 WHO Secretariat. Andersson M, Benoist Bde et al. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutr 2008; 10: 1606-1611
• 20 Yassa L, Marqusee E, Fawcett R et al. Thyroid hormone early adjustment in pregnancy (the THERAPY) trial. J Clin Endcrinol Metab 2010; 95: 3234-3241
• 21 Momotani M, Ito K, Hamada N et al. Maternal hyperthyroidism and congenital malformation in the offspring. Clin Endocrinol 1984; 20: 695-700
• 22 Reiners C, Wegscheider K, Schicha H et al. Prevalence of thyroid disorders in the working population of Germany: Ultrasonography screening in 96 278 unselected employees. Thyroid 2004; 11: 926-932
• 23 Roti E, Uberti E. Post-partum thyroiditis – a clinical update. Eur J Endocrinol 2002; 146: 275-279
• 24 Wang W, Teng W, Shan Z et al. The prevalence of thyroid disorders early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur J Endocrinol 2011; 164: 263-268
• 25 Karger S, Schötz S, Stumvoll M et al. Impact of pregnancy on prevalence of goitre and nodular thyroid disease in women living in a region of borderline sufficient iodine supply. Horm Metab Res 2010; 42: 137-142
• 26 Gärtner R. Thyroid diseases in pregnancy. Curr Opin Obstet Gynecol 2009; 21: 501-507
• 27 Reid SM, Middleton P, Cossich MC et al. Interventions for clinical and subclinical hypothyroidism in pregnancy. Cochrane Database Syst Rev 2010; 7: CDOO752
• 28 Hirsch D, Levy S, Tsevtov G et al. Impact of pregnancy on outcome and prognosis of survivors of papillary thyroid cancer. Thyreoid 2010; 20: 1179-1185
• 29 Negro R, Schwartz A, Gismondi R et al. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5–5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 2010; 95: 44-48