Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Journal für Gynäkologische Endokrinologie/Österreich 4/2019

06.11.2019 | Schwangerschaft | Originalien

Schilddrüsenerkrankungen in der Schwangerschaft

verfasst von: PD Dr. med. Anca Zimmermann

Erschienen in: Journal für Gynäkologische Endokrinologie/Österreich | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten
share
TEILEN

Zusammenfassung

Während der Schwangerschaft findet eine Vielzahl an physiologischen Schilddrüsenveränderungen statt: Anstieg des thyroxinbindenden Globulins, Abfall des TSH, Zunahme der Gesamtthyroxinkonzentration und des Jodbedarfs. In der vorliegenden Übersichtsarbeit wird auf schwangerschaftsassoziierte pathologische Veränderungen der Schilddrüse eingegangen, mit Beleuchtung ihrer Bedeutung für Mutter und Kind sowie mit einer praxisorientierten Darstellung aktuellster Empfehlungen für Diagnostik und Therapie. Zur Definition und Behandlungsbedürftigkeit der Hypothyreose sind neue obere TSH-Werte und die Präsenz von Anti-TPO-Antikörpern zu beachten. Eine Behandlung ist bei manifester Schilddrüsenunterfunktion immer sowie bei latenter Hypothyreose in speziellen Situationen notwendig, um negative Folgen für Mutter und Kind zu verhindern. Bei positivem Anti-TPO-Titer und Euthyreose ist eine regelmäßige TSH-Kontrolle notwendig. Eine relevante Ursache für Hyperthyreose in der Schwangerschaft ist der Morbus Basedow. Differenzialdiagnostisch ist eine schwangerschaftsassoziierte Hyperthyreose abzugrenzen. Bei floridem Morbus Basedow kommen Thyreostatika in der niedrigsten effektiven Dosis zum Einsatz, mit dem Ziel, fT4 im oberen Normbereich und TSH supprimiert zu halten. Indikation und Risiken verschiedener Thyreostatika werden diskutiert. In bestimmten Fällen sind TRAK-Kontrollen, parallel zu regelmäßigen sonographischen Kontrollen des Fetus, notwendig. Die Postpartumthyreoiditis (PPT) verläuft oft biphasisch, mit einer selbstlimitierenden hyperthyreoten Phase in den ersten 6 Monaten, gefolgt von Hypothyreose und Euthyreose nach ca. 1 Jahr. Bei der Erstdiagnose eines differenzierten Schilddrüsenkarzinoms in der Schwangerschaft kann die Operation meistens bis postpartal verschoben werden. Weiterhin wird auf die Bedeutung und praktische Gewährleistung einer adäquaten Jodversorgung in der Schwangerschaft sowie auf die aktuellen Indikationen zum Schilddrüsenscreening eingegangen.
Literatur
1.
Zurück zum Zitat Glinoer D (2004) Increased TBG during pregnancy and increased hormonal requirements. Thyroid 14:479–480 PubMedCrossRef Glinoer D (2004) Increased TBG during pregnancy and increased hormonal requirements. Thyroid 14:479–480 PubMedCrossRef
2.
Zurück zum Zitat Alexander EK, Pearce EN, Brent GA et al (2017) 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 27(3):315–389 PubMedCrossRef Alexander EK, Pearce EN, Brent GA et al (2017) 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 27(3):315–389 PubMedCrossRef
3.
Zurück zum Zitat Soldin OP, Tractenberg RE, Holowell JG et al (2004) Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyreoglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid 14:1084–1090 PubMedCrossRef Soldin OP, Tractenberg RE, Holowell JG et al (2004) Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyreoglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid 14:1084–1090 PubMedCrossRef
4.
Zurück zum Zitat Abel HM, Korevaar TIM, Erlund I et al (2018) Iodine intake is associated with thyroid function in mild to moderately iodine deficient pregnant women. Thyroid 28(10):1359–1371 PubMedPubMedCentralCrossRef Abel HM, Korevaar TIM, Erlund I et al (2018) Iodine intake is associated with thyroid function in mild to moderately iodine deficient pregnant women. Thyroid 28(10):1359–1371 PubMedPubMedCentralCrossRef
5.
Zurück zum Zitat Casey BM, Dashe JS, Wells CE et al (2005) Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 105:239–245 PubMedCrossRef Casey BM, Dashe JS, Wells CE et al (2005) Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 105:239–245 PubMedCrossRef
6.
Zurück zum Zitat Allan WC, Haddow JE, Palomaki GE et al (2000) Maternal thyroid deficiency in pregnancy complications: implications for population screening. J Med Screen 7:127–130 PubMedCrossRef Allan WC, Haddow JE, Palomaki GE et al (2000) Maternal thyroid deficiency in pregnancy complications: implications for population screening. J Med Screen 7:127–130 PubMedCrossRef
7.
Zurück zum Zitat Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S (2013) High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country : a population based study. J Clin Endocrinol Metab 98(9):3694–3701 PubMedCrossRef Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S (2013) High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country : a population based study. J Clin Endocrinol Metab 98(9):3694–3701 PubMedCrossRef
8.
Zurück zum Zitat Pedersen IB, Knudsen N, Jorgensen T (2003) Thyroid peroxidase and thyroglobulin autoantibodies in a large survey of populations with mild and moderate iodine deficiency. Clin Endocrinol (Oxf) 58(1):36–42 CrossRef Pedersen IB, Knudsen N, Jorgensen T (2003) Thyroid peroxidase and thyroglobulin autoantibodies in a large survey of populations with mild and moderate iodine deficiency. Clin Endocrinol (Oxf) 58(1):36–42 CrossRef
9.
Zurück zum Zitat Andersen SL, Andersen S, Liew Z et al (2018) Maternal thyroid function in early pregnancy and neuropsychological performance of the child at 5 years of age. J Clin Endocrinol Metab 103(2):660–670 PubMedCrossRef Andersen SL, Andersen S, Liew Z et al (2018) Maternal thyroid function in early pregnancy and neuropsychological performance of the child at 5 years of age. J Clin Endocrinol Metab 103(2):660–670 PubMedCrossRef
10.
Zurück zum Zitat Haddow JE, Palomaki GE, Allan WC et al (1999) Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 341:549–555 PubMedCrossRef Haddow JE, Palomaki GE, Allan WC et al (1999) Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 341:549–555 PubMedCrossRef
11.
Zurück zum Zitat Negro R, Schwartz A, Gismondi R et al (2010) Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 95:1699–1707 PubMedCrossRef Negro R, Schwartz A, Gismondi R et al (2010) Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab 95:1699–1707 PubMedCrossRef
12.
Zurück zum Zitat Negro R, Schwartz A, Gismondi R et al (2010) Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 95:E44–E48 PubMedCrossRef Negro R, Schwartz A, Gismondi R et al (2010) Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 95:E44–E48 PubMedCrossRef
13.
Zurück zum Zitat Nazarpour S, Ramezani Tehrani S, Simbar M et al (2018) Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies. J Clin Endocrinol Metab 103(3):926–935 PubMedCrossRef Nazarpour S, Ramezani Tehrani S, Simbar M et al (2018) Effects of levothyroxine on pregnant women with subclinical hypothyroidism, negative for thyroid peroxidase antibodies. J Clin Endocrinol Metab 103(3):926–935 PubMedCrossRef
14.
Zurück zum Zitat Hales C, Taylor PN, Channon S et al (2018) Controlled antenatal thyroid screening II: effect of treating maternal suboptimal thyroid function on child cognition. J Clin Endocrinol Metab 103(4):1583–1591 PubMedCrossRef Hales C, Taylor PN, Channon S et al (2018) Controlled antenatal thyroid screening II: effect of treating maternal suboptimal thyroid function on child cognition. J Clin Endocrinol Metab 103(4):1583–1591 PubMedCrossRef
15.
Zurück zum Zitat Casey BM, Thom EA, Peaceman AM et al (2017) Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 376(9):815–825 PubMedPubMedCentralCrossRef Casey BM, Thom EA, Peaceman AM et al (2017) Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 376(9):815–825 PubMedPubMedCentralCrossRef
16.
Zurück zum Zitat Poppe K, Velkeniers B (2003) Thyroid disorders in infertile women. Ann Endocrinol (Paris) 64:45–50 Poppe K, Velkeniers B (2003) Thyroid disorders in infertile women. Ann Endocrinol (Paris) 64:45–50
17.
Zurück zum Zitat Consortium on Thyroid and Pregnancy—Study Group on Preterm Birth, Karevaar TIM, Derakhshan A, Taylor PN et al (2019) Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth : a systematic review and metaanalysis. JAMA 322(7):632–641 CrossRef Consortium on Thyroid and Pregnancy—Study Group on Preterm Birth, Karevaar TIM, Derakhshan A, Taylor PN et al (2019) Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth : a systematic review and metaanalysis. JAMA 322(7):632–641 CrossRef
18.
Zurück zum Zitat Ghassabian A, Bongers-Schokking JJ, de Rijke YB et al (2012) Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in childern : the generation R study. Thyroid 22:178–186 PubMedPubMedCentralCrossRef Ghassabian A, Bongers-Schokking JJ, de Rijke YB et al (2012) Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in childern : the generation R study. Thyroid 22:178–186 PubMedPubMedCentralCrossRef
19.
Zurück zum Zitat Negro R, Formoso G, Mangieri T et al (2006) Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 91:2587–2591 PubMedCrossRef Negro R, Formoso G, Mangieri T et al (2006) Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 91:2587–2591 PubMedCrossRef
20.
Zurück zum Zitat Krassas GE, Poppe K, Glinoer D (2010) Thyroid function and human reproductive health. Endocr Rev 31:702–755 PubMedCrossRef Krassas GE, Poppe K, Glinoer D (2010) Thyroid function and human reproductive health. Endocr Rev 31:702–755 PubMedCrossRef
21.
Zurück zum Zitat Niebyl JR (2010) Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 363:1544–1550 PubMedCrossRef Niebyl JR (2010) Clinical practice. Nausea and vomiting in pregnancy. N Engl J Med 363:1544–1550 PubMedCrossRef
22.
Zurück zum Zitat Millar LK, Wing DA, Leung AS et al (1994) Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol 84:946–949 PubMed Millar LK, Wing DA, Leung AS et al (1994) Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol 84:946–949 PubMed
23.
Zurück zum Zitat Min Z, Min W, Juming L et al (2019) Effects of thyroid diseases on pregnancy outcomes. Exp Ther Med 18(3):1807–1815 Min Z, Min W, Juming L et al (2019) Effects of thyroid diseases on pregnancy outcomes. Exp Ther Med 18(3):1807–1815
24.
Zurück zum Zitat Casey BM, Dashe JS, Wells CE et al (2006) Subclinical hyperthyroidism and clinical outcomes. Obstet Gynecol 107:337–341 PubMedCrossRef Casey BM, Dashe JS, Wells CE et al (2006) Subclinical hyperthyroidism and clinical outcomes. Obstet Gynecol 107:337–341 PubMedCrossRef
25.
Zurück zum Zitat Besancon A, Beltrand J, Le Gac I et al (2014) Management of neonates born to women with Graves’ disease: a cohort study. Eur J Endocrinol 170:855–862 PubMedCrossRef Besancon A, Beltrand J, Le Gac I et al (2014) Management of neonates born to women with Graves’ disease: a cohort study. Eur J Endocrinol 170:855–862 PubMedCrossRef
26.
Zurück zum Zitat Hamburger JI (1992) Diagnosis and management of Graves’ disease in pregnancy. Thyroid 2:219–224 PubMedCrossRef Hamburger JI (1992) Diagnosis and management of Graves’ disease in pregnancy. Thyroid 2:219–224 PubMedCrossRef
27.
Zurück zum Zitat Laurberg P, Bournaud C, Karmisholt J et al (2009) Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol 160:1–8 PubMedCrossRef Laurberg P, Bournaud C, Karmisholt J et al (2009) Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol 160:1–8 PubMedCrossRef
28.
Zurück zum Zitat Azizi F (2006) The safety and efficacy of antithyroid drugs. Expert Opin Drug Saf 5:107–116 PubMedCrossRef Azizi F (2006) The safety and efficacy of antithyroid drugs. Expert Opin Drug Saf 5:107–116 PubMedCrossRef
30.
Zurück zum Zitat Seo GH, Kim TH, Chung JH (2018) Antithyroid drugs and congenital malformations: a nationwide Korean cohort study. Ann Intern Med 168(6):405–413 PubMedCrossRef Seo GH, Kim TH, Chung JH (2018) Antithyroid drugs and congenital malformations: a nationwide Korean cohort study. Ann Intern Med 168(6):405–413 PubMedCrossRef
32.
33.
Zurück zum Zitat Azizi F, Amouzegar A (2011) Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol 164:871–876 PubMedCrossRef Azizi F, Amouzegar A (2011) Management of hyperthyroidism during pregnancy and lactation. Eur J Endocrinol 164:871–876 PubMedCrossRef
35.
Zurück zum Zitat Azizi F, Hedayati M (2002) Thyroid function in breast-fed infants whose mothers take high doses of methimazole. J Endocrinol Invest 25:493–496 PubMedCrossRef Azizi F, Hedayati M (2002) Thyroid function in breast-fed infants whose mothers take high doses of methimazole. J Endocrinol Invest 25:493–496 PubMedCrossRef
36.
Zurück zum Zitat Amino N, Mori H, Iwatani Y et al (1982) High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. N Engl J Med 306:849–852 PubMedCrossRef Amino N, Mori H, Iwatani Y et al (1982) High prevalence of transient post-partum thyrotoxicosis and hypothyroidism. N Engl J Med 306:849–852 PubMedCrossRef
37.
Zurück zum Zitat Stagnaro-Green A (2004) Postpartum thyreoiditis. Best Pract Res Clin Endocrinol Metab 18:303–316 PubMedCrossRef Stagnaro-Green A (2004) Postpartum thyreoiditis. Best Pract Res Clin Endocrinol Metab 18:303–316 PubMedCrossRef
38.
Zurück zum Zitat Nicholson WK, Robinson KA, Smallridge RC et al (2006) Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 16:573–582 CrossRefPubMed Nicholson WK, Robinson KA, Smallridge RC et al (2006) Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid 16:573–582 CrossRefPubMed
39.
Zurück zum Zitat Jinyuan M, Pop VJ, Bath SC et al (2016) Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr 55:55–61 Jinyuan M, Pop VJ, Bath SC et al (2016) Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr 55:55–61
40.
Zurück zum Zitat Glinoer D, Soto MF, Bourdoux P et al (1991) Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab 73:421–427 PubMedCrossRef Glinoer D, Soto MF, Bourdoux P et al (1991) Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab 73:421–427 PubMedCrossRef
41.
Zurück zum Zitat Brander A, Viikinkoski P, Tuuhea J et al (1992) Clinical versus ultrasound examination of the thyroid gland in common clinical practice. J Clin Ultrasound 20:37–42 PubMedCrossRef Brander A, Viikinkoski P, Tuuhea J et al (1992) Clinical versus ultrasound examination of the thyroid gland in common clinical practice. J Clin Ultrasound 20:37–42 PubMedCrossRef
42.
Zurück zum Zitat Russ G, Bonnema SJ, Erdogan MF et al (2017) European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J 6(5):225–237 PubMedPubMedCentralCrossRef Russ G, Bonnema SJ, Erdogan MF et al (2017) European Thyroid Association guidelines for ultrasound malignancy risk stratification of thyroid nodules in adults: the EU-TIRADS. Eur Thyroid J 6(5):225–237 PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat Smith LH, Danielsen B, Allen ME et al (2003) Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 189:1128–1135 PubMedCrossRef Smith LH, Danielsen B, Allen ME et al (2003) Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 189:1128–1135 PubMedCrossRef
44.
Zurück zum Zitat American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214 CrossRef American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214 CrossRef
45.
Zurück zum Zitat Pacini F, Schlumberger M, Dralle H et al (2006) European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803 PubMedCrossRef Pacini F, Schlumberger M, Dralle H et al (2006) European Thyroid Cancer Taskforce. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803 PubMedCrossRef
46.
Zurück zum Zitat Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133 PubMedPubMedCentralCrossRef Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133 PubMedPubMedCentralCrossRef
47.
Zurück zum Zitat Rosário PW, Barroso AL, Purisch S (2007) The effect of subsequent pregnancy on patients with thyroid carcinoma apparently free of the disease. Thyroid 17:1175–1176 PubMedCrossRef Rosário PW, Barroso AL, Purisch S (2007) The effect of subsequent pregnancy on patients with thyroid carcinoma apparently free of the disease. Thyroid 17:1175–1176 PubMedCrossRef
48.
Zurück zum Zitat World Health Organization, International Council for the Control of Iodine Deficiency Disorders, United Nations Children’s Fund (2007) Assessment of the iodine deficiency disorders and monitoring their elimination. WHO, Geneva World Health Organization, International Council for the Control of Iodine Deficiency Disorders, United Nations Children’s Fund (2007) Assessment of the iodine deficiency disorders and monitoring their elimination. WHO, Geneva
49.
Zurück zum Zitat Vermiglio F, Lo Presti VP, Moleti M et al (2004) Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 89:6054–6060 PubMedCrossRef Vermiglio F, Lo Presti VP, Moleti M et al (2004) Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 89:6054–6060 PubMedCrossRef
50.
Zurück zum Zitat DeLong GR, Leslie PW, Wang SH et al (1997) Effect on infant mortality of iodination of irrigation water in a severely iodine-deficient area of China. Lancet 350:771–773 PubMedCrossRef DeLong GR, Leslie PW, Wang SH et al (1997) Effect on infant mortality of iodination of irrigation water in a severely iodine-deficient area of China. Lancet 350:771–773 PubMedCrossRef
51.
Zurück zum Zitat Haldimann M, Alt A, Blanc A et al (2005) Iodine content of food groups. J Food Compost Anal 18:461–471 CrossRef Haldimann M, Alt A, Blanc A et al (2005) Iodine content of food groups. J Food Compost Anal 18:461–471 CrossRef
Metadaten
Titel
Schilddrüsenerkrankungen in der Schwangerschaft
verfasst von
PD Dr. med. Anca Zimmermann
Publikationsdatum
06.11.2019
Verlag
Springer Vienna
Erschienen in
Journal für Gynäkologische Endokrinologie/Österreich / Ausgabe 4/2019
Print ISSN: 1997-6690
Elektronische ISSN: 1996-1553
DOI
https://doi.org/10.1007/s41974-019-00113-y