Treatment of diffuse toxic goiter during pregnancy

Cover Page

Abstract


We have studied an influence of diffuse toxic goiter on the flow and outcome pregnancy. 67 pregnant women with diffuse toxic goiter were examined. The group of comparison consisted of 38 pregnant women without thyroid pathology. The levels of free thyroxin, TSH, autoantibodies to TSH-receptors and autoantibodies to thyreoperoxidasis in the blood of pregnant women and umbilical cord blood and ultrasound of the thyroid gland of newborns were analyze. Pregnancy and childbirth of the women with unresolved thyrotoxicosis were more complicated by the threat of termination of pregnancy, preeclampsia, chronic placental insufficiency, preterm rupture of membranes, fetal hypotrophy and hypoxia. A high incidence of subclinical hypothyroidism (more 50%) in newborns is associated with the transplacental pass thyreostatic drugs. Subclinical hyperthyroidism in 17% of newborns should be associated with the transplacental transition from the mother to the fetus of autoantibodies to TSH-receptors.


Julia S. Lovkova

Author for correspondence.
juliadoktor@rambler.ru
FSBSI “The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott”
Russian Federation, 3, Mendeleevskaya line, Saint Petersburg, 199034

Endocrinologist. Reproductive Endocrinology

Vladimir V. Potin

iagmail@ott.ru
FSBSI “The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott”
Russian Federation, 3, Mendeleevskaya line, Saint Petersburg, 199034

Head of the Reproductive Endocrinology Department, Honored Scientist, Professor. Reproductive Endocrinology

Natalya N. Tkachenko

iagmail@ott.ru
FSBSI “The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott”
Russian Federation, 3, Mendeleevskaya line, Saint Petersburg, 199034

Head of hormone laboratory of the Reproductive Endocrinology Department, Senior Researcher, Candidate of biological science

Elisaveta V. Shelayeva

iagmail@ott.ru
FSBSI “The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott”
Russian Federation, 3, Mendeleevskaya line, Saint Petersburg, 199034

Senior Researcher of laboratory Physiology and Path physiology of fetal, Candidate of medical science. Reproductive Endocrinology

  • Аржанова О.Н. Заболевание щитовидной железы и беременность / Серов В.Н., ред // Проблемы эндокринологии в акушерстве и гинекологии: материалы 2-го съезда Российской ассоциации акушеров-гинекологов. – М.,1997. – С. 127–128. [Arzhanova ON. Zabolevanie shhitovidnoj zhelezy i beremennost’. Ed by Serov VN. Problemy jendokrinologii v akusherstve i ginekologii: materialy 2-go s’’ezda Rossijskoj associacii akusherov-ginekologov. Moscow; 1997. P. 127-128. (In Russ.)]
  • Логутова Л.С., и др. Динамическое наблюдение за беременными с диффузным токсическим зобом и аутоиммунным тиреоидитом // Российский вестник акушера-гинеколога. – 2002. – № 4. – С. 62–67. [Logutova LS, et al. Dinamicheskoe nabljudenie za beremennymi s diffuznym toksicheskim zobom i autoimmunnym tireoiditom. Rossijskiy vestnik akushera-ginekologa. 2002;(4):62-7. (In Russ.)]
  • Айламазян Э.К., Потин В.В., Крихели И.О., и др. Щитовидная железа и репродукция // Медицинский академический журнал. – 2008. – № 1. – С. 22–28. [Ajlamazjan JeK, Potin VV, Kriheli IO, et al. Shhitovidnaja zheleza i reprodukcija. Medicinskij akademicheskij zhurnal. 2008;(8):22-8. (In Russ.)]
  • Bartalena L, Pinchera A, Marcocci L. Management of Graves’ ophthalmopathy: reality and perspectives. Endocr Rev. 2000;21:168-99.
  • Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol. 2009;160(1):1-8. doi: 10.1530/EJE-08-0663.
  • Шидловская Н.В., и др. Врожденная патология у новорожденных, родившихся у матерей с диффузным токсическим зобом // Российский вестник акушера-гинеколога. – 2008. – № 6. – С. 40–44. [Shidlovskaja NV, et al. Vrozhdennaja patologija u novorozhdennyh, rodivshihsja u materej s diffuznym toksicheskim zobom. Rossijskiy vestnik akushera-ginekologa. 2008;(6):40-4. (In Russ.)]
  • Перминова С.Г., Фадеев В.В., Конееева И.Е. Репродуктивная функция женщин с патологией щитовидной железы // Проблемы репродукции. – 2006. – № 1. – С. 70–77. [Perminova SG, Fadeev VV, Koneeeva IE. Reproduktivnaja funkcija zhenshhin s patologiej shhitovidnoj zhelezy. Problemy reprodukcii. 2006;(10):70-7. (In Russ.)]
  • Фадеев В.В., Лесникова С.В. Аутоиммунные заболевания щитовидной железы и беременность // Пробл. эндокринол. – 2003. – № 2. – С. 23–31. [Fadeev VV, Lesnikova SV. Autoimmunnye zabo levanija shchitovidnoj zhelezy i beremennost’. Problems of Endocrinology. 2003;(2):23-31. (In Russ.)]
  • Luton D, et al. Management of Graves’ Disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab. 2005;90(11):6093-8.
  • Каширова Т.В., и др. Болезнь Грейвса и репродуктивная функция женщины // Клиническая экспериментальная тиреоидология. – 2007. – Т. 3. – № 2. – С. 19–25 [Kashirova TV, et al. Bolezn’ Grejvsa i reproduktivnaja funkcija zhenshhiny. Klinicheskaja jeksperimental’naja tireoidologija. 2007;3(2):19-25. (In Russ.)]
  • Yoshihara A, et al. Treatment of Graves’ Disease with anithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. J Clin Endocrinol Metab. 2012;97:2396-2403. doi: 10.1210/jc.2011-2860.
  • Phoojaroenchanachai M, et al. Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight. Clin Endocrinol. 2001;54:365.
  • Lo JC, et al. Gestational thyrotoxicosis. Antithyroid drug use and neonatal outcome within an integrated healthcare delivery system. Thyroid. 2012,25:698-705
  • Мельниченко Г.А., Фадеев В.В., Дедов И.И. Заболевания щитовидной железы во время беременности: диагностика, лечение, профилактика: пособие для врачей. – М.: МедЭкспертПресс, 2003. – 48 c. [Mel’nichenko GA, Fadeev VV, Dedov II. Zabolevanija shhitovidnoj zhelezy vo vremja beremennosti: diagnostika, lechenie, profilaktika: posobie dlja vrachej. Moscow: MedJekspertPress; 2003. 48 p. (In Russ.)]
  • Andersen SL, Lauberg P. Antithyroid drugs and congenital heart defects: ventricular septal defect is part of the methimazole/carbimazole embryopathy. Eur J Endocrinol. 2014;170(5):C1-3. doi: 10.1530/EJE-14-0524.
  • Andersen SL, et al. Antithyroid drug side effects in the population and in pregnancy. J Clin Endocrinol Metab. 2016;101:1606-14. doi: 10.1210/jc.2015-4274.
  • Andersen SL, et al. Severity of birth defects after propylthyouracil exposure in early pregnancy. Thyroid. 2014;24:1533-154. doi: 10.1089/thy.2014.0150.
  • Bliddal S, et al. Antithyroid drug-induced fetal goitrous hypothyroidism. Nat Rev Endocrinol. 2011;7:396-406. doi: 10.1038/nrendo.2011.34.
  • Foulds N, et al. Carbimazole embryopathy: an emer ging phenotype. Am J Med Genet A. 2005,132A(2):130-5. doi: 10.1002/ajmg.a.30418.
  • Karlsson F, Axelsson O, Melhus H. Severe embryopathy and exposure to methimazole in early pregnancy. J Clin Endocrinol Metab. 2002;87(2):947-8. doi: 10.1210/jcem.87.2.8120.
  • Nakamura H, et al. Comparison of methimazole and propylthyouracil in patient with hyperthyroidism caused by Graves’ Disease. J Clin Endocrinol Metab. 2007;92: 2157-62. doi: 10.1210/jc.2006-2135.
  • Brunn J, Block U, Ruf G, et al. Volumetrie der Schild driise mittels Real time-Sonogrophie. Dtsch Med Wochenschr. 1981;106:1338-40.
  • Потин В.В., и др. Щитовидная железа и репродуктивная система женщины: пособие для врачей. – СПб., 2008 [Potin VV, et al. Shhitovidnaja zheleza i reproduktivnaja sistema zhenshhiny: posobie dlja vrachej. Saint Petersburg, 2008. (In Russ.)]
  • Ловкова Ю.С., Потин В.В., Ткаченко Н.Н., и др. Влияние диффузного токсического зоба на течение и исход беременности // Журнал акушерства и женских болезней. – 2012. – № 4. – С. 67–74. [Lovkova YS, Potin VV, Tkachenko NN, et al. The influence of diffuse toxic goiter on the course and outcome of pregnancy. Journal of Obstetrics and Women’s Diseases. 2012;(4):67-74. (In Russ.)]

Supplementary files

There are no supplementary files to display.

Views

Abstract - 98

PDF (Russian) - 50


Copyright (c) 2017 ECO-vector LLC

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.