Thyroid disease may have existed prior to pregnancy or develop in it. Pregnancy does not change the symptoms of hypothyroidism or hyperthyroidism or normal values ??and scattering regions of the free serum thyroxine (T4) and thyroid stimulating hormone (TSH).
(Presentation of thyroid function.) Thyroid diseases may already have passed before you become pregnant or develop in her. Pregnancy does not change the symptoms of hypothyroidism or hyperthyroidism or normal values ??and scattering regions of the free serum thyroxine (T4) and thyroid stimulating hormone (TSH). The effects on the fetus depending on the disease and the drugs used for the treatment are different. Generally lead an untreated and treated inappropriately hyperthyroidism fetal growth, pre-eclampsia and stillbirth, and an untreated hypothyroidism can lead to miscarriage and imbecility of the child. The most common causes of maternal hypothyroidism is Hashimoto’s thyroiditis and treatment of Graves’ disease. When the pregnant women have thyroid disease or have had, should be used during pregnancy and after the health of the thyroid in mother and child be monitored closely. Are goiter and thyroid nodules discovered during pregnancy, they should as with other patients (diagnosis and treatment of patients with thyroid nodules and Professional.heading on page Simple Nontoxic Goiter: Diagnosis) be clarified. Graves ‘disease A Graves’ disease of the nut is clinically as well as by free T4 and highly sensitive TSH assay (Radioligand Assay) monitored. The treatment is different. Usually, the pregnant women get the lowest possible dose of oral propylthiouracil (50-100 mg every 8 h). The therapeutic effect sets in after 3-4 weeks. If necessary, the dose is then adjusted. Propylthiouracil crosses the placenta and can cause the fetus to goiter and hypothyroidism. Co-administration of L-thyroxine or L-triiodothyronine is contraindicated since these hormones may mask the signs of an overdose of propylthiouracil in pregnant women and lead to hypothyroidism of the fetus. Methimazole is an alternative for propylthiouracil. The Graves’ disease is improving in general, during the third trimester and often permits dose reduction or even discontinuation of the drug. Although very rare, so you can but in the second quarter, after having set a euthyroid during therapy, move to centers with experienced thyroid surgeon thyroidectomy into consideration. After thyroidectomy, beginning 24 h after surgery, the women receive a complete substitution of L-thyroxine (0.15-0.2 mg 1 time / day). Radioactive iodine (diagnostic or therapeutic) and iodide solutions are contraindicated in pregnancy because of possible side effects on the thyroid gland of the fetus. ?-blockers are only at a thyrotoxic crisis or severe maternal symptoms apply. If pregnant or have a Graves’ disease, had hyperthyroidism the fetus can develop. Whether these women euthyroid clinically hyperthyroid or hypothyroid are, thyroid stimulating immunoglobulins happen (IgG) and (if available) thyroid blocking IgG the placenta. The current fetal thyroid function reflects the relative amount of these stimulating and blocking IgG. Hyperthyroidism can (> 160 beats / minute) cause fetal tachycardia, growth retardation and a goiter; rarely the Struma then leads to the loss of fetal swallowing movements, polyhydramnios and premature birth. The ultrasound is used to assess the size, thyroid and heart of the fetus. Congenital Graves ‘If pregnant women have taken propylthiouracil, a Graves’ disease of the fetus up to 7-10 days after birth if abate the effects of the drug remain masked. Maternal hypothyroidism women with mild or mäßiggradiger hypothyroidism often have normal menstrual cycles and may become pregnant. During pregnancy, the usual L-thyroxine dose is maintained. With the pregnancy progresses, smaller dose adjustments, which TSH provisions are ideally in several weeks of distance based, may be necessary. If hypothyroidism is diagnosed for the first time during pregnancy, the initial L-thyroxine dose at 0.1 mg is administered p.o. 1 time / day. Hashimoto’s thyroiditis The maternal immunosuppression during pregnancy often improves this disease; nevertheless, sometimes requiring therapy hypo- or hyperthyroidism develops. Acute (subacute) thyroiditis during pregnancy, this disease causes mild goiter often during or after a respiratory infection. There may be a transient symptomatic hyperthyroidism with elevated T4, which then leads to misdiagnosis of Graves’ disease. Treatment is usually not necessary. Postpartum maternal thyroid dysfunction experience 4-6% of women during the first 6 months after birth, a hypo- or hyperthyroid dysfunction. The incidence appears to be higher among pregnant women with goiter Hashimoto’s thyroiditis autoimmune thyroid disease in the Familienananmnese type 1 (insulin-dependent) diabetes mellitus in women with one of these risk factors TSH and the level of free T4 during the first trimester should gradually birth can be determined. The disorder is usually temporary, but can require therapy. A Graves’ disease recurs sometimes after birth passager or remains. In a painless thyroiditis with short-term hyperthyroidism is how only recently realized was probably an autoimmune disease. She suddenly enters the first postpartum weeks, only shows a low uptake of radioactive iodine and is characterized by lymphocytic infiltration. The diagnosis is made by symptoms, thyroid function tests and by excluding other diseases. This disease can persist, temporarily recur or progress.