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Schilddrüse und Schwangerschaft

Thyroid gland and pregnancy

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Gynäkologische Endokrinologie Aims and scope

An Erratum to this article was published on 19 January 2013

Zusammenfassung

Die Diagnostik und Therapie von Schilddrüsenerkrankungen während der Schwangerschaft bedürfen infolge physiologischer Änderungen der Schilddrüsenfunktion besonderer Beachtung. Eine L-Thyroxinsubstitution ist bei manifester, aber auch bei latenter Hypothyreose mit erhöhten Thyreoperoxidaseantikörpern (TPO-AK) obligat. Aufgrund des Risikos für Fertilitätsstörungen und Aborte sowie wegen des erhöhten Morbiditätsrisikos für das Kind sollte sie bereits präkonzeptionell – spätestens bei Bekanntwerden der Schwangerschaft – eingeleitet werden. Eine suffiziente Jodversorgung ist Therapiebestandteil.

Die Hyperthyreose erfordert eine Differenzierung zwischen Immunhyperthyreose und Schwangerschaftshyperthyreose. In seltenen Fällen liegt ein autonomes Schilddrüsenadenom vor. Bei manifester Immunhyperthyreose muss eine niedrig dosierte thyreostatische Therapie eingeleitet und so angepasst werden, dass die freien Schilddrüsenhormonspiegel im oberen Normbereich liegen.

Frauen, die ein erhöhtes Risiko für eine Schilddrüsenerkrankung aufweisen, profitieren von einem Thyreotropin(TSH)-Screening. Risikofaktoren sind ein Abort, eine Frühgeburt oder eine Schilddrüsenerkrankung in der Anamnese, ein Alter > 30 Jahre, eine Struma, erhöhte TPO-AK-Werte und Autoimmunerkrankungen wie Diabetes mellitus Typ 1.

Abstract

Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function. Both overt and subclinical hypothyroidism have adverse effects on the course of pregnancy and development of the fetus. Hypothyroidism should be diagnosed and corrected before initiation of pregnancy. If hypothyroidism is diagnosed during pregnancy, thyroid function should be normalized as rapidly as possible. Adequate iodine intake is important.

By hyperthyroidism differentiation of Graves’ disease from gestational thyrotoxicosis is possible by evidence of autoimmunity (morphologic change of goiter and TSH-receptor antibodies). For overt hyperthyroidism due to Graves’ disease or hyperfunctioning thyroid nodules antithyroid drug therapy should be either initiated or adjusted to maintain the maternal thyroid hormone levels for free T4 in the upper reference range for nonpregnant women.

TSH screening should be obtained of patients who are at increased risk (such as miscarriage, preterm deliver miscarriage or history of thyroid disease, Age > 30 years, goiter, autoimmune disease such as diabetes mellitus type 1).

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  1. Klinik für Innere Medizin III, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    W. Hunger-Battefeld

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Correspondence to W. Hunger-Battefeld.

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Hunger-Battefeld, W. Schilddrüse und Schwangerschaft. Gynäkologische Endokrinologie 10, 168–175 (2012). https://doi.org/10.1007/s10304-012-0487-5

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