• Заболевания щитовидной железы при беременности
ru К содержанию

Заболевания щитовидной железы при беременности

HEALTH OF WOMAN. 2020.5-6(151-152):20-28
Клинические руководства для акушеров и гинекологов
Американская коллегия акушеров и гинекологов (ACOG)
Бюллетень практики ACOG. Номер 223 (Заменяет бюллетень по практике номер 148)
Obstet Gynecol. 2020 Jun; 135 (6): e261-e274. doi: 10.1097/AOG.0000000000003893.

В данной статье представлен обновленный бюллетень ACOG (Американской коллегии акушеров и гинекологов) относительно заболеваний щитовидной железы во время беременности.
Как тиреотоксикоз, так и гипотиреоз связаны с неблагоприятными последствиями во время беременности. Также существует обеспокоенность относительно влияния манифестного заболевания щитовидной железы у матери на развитие плода. В дополнение лекарственные средства, влияющие на щитовидную железу матери, могут проникать через плаценту и влиять на щитовидную железу плода. В этом документе представлен обзор патофизиологических изменений, связанных со щитовидной железой, возможных во время беременности, и влияния манифестного или субклинического заболевания щитовидной железы на последствия для матери и плода.
Ключевые слова: беременность, щитовидная железа, тиреотоксикоз, гипотиреоз, гипертиреоз, диагностика, алгоритм лечения.

ЛИТЕРАТУРА

1. Vannucchi G, Covelli D, Vigo B, Perrino M, Mondina L, Fugazzola L. Thyroid volume and serum calcitonin changes during pregnancy. J Endocrinol Invest 2017;40: 727-32. (Level II-3)

2. Huang SA. Physiology and pathophysiology of type 3 de- iodinase in humans. Thyroid 2005;15:875-81. (Level III)

3. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum [published erratum appears in Thyroid 2017;27:1212]. Thyroid 2017;27:315-89. (Level III)

4. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis [published erratum appears in Thyroid 2017;27:1462]. Thyroid 2016;26:1343- 421. (Level III)

5. Bemal J. Thyroid hormone receptors in brain development and function. Nat Clin Pract Endocrinol Metab 2007;3: 249-59. (Level III)

6. Calvo RM, Jauniaux E, Gulbis B, Asuncion M, Gervy C, Contemplé B, et al. Fetal tissues are exposed to biologically relevant free thyroxine concentrations during early phases of development. J Clin Endocrinol Metab 2002; 87:1768-77. (Level III)

7. Korevaar H, Muetzel R, Medici M, Chaker L, Jaddoe VW, de Rijke YB, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol 2016;4:35-43. (Level II-2)

8. Thorpe-Beeston J, Nicolaides KH, Snijders RJ, Felton CV, McGregor AM. Thyroid function in small for gestational age fetuses. Obstet Gynecol 1991;77:701-6. (Level II-3)

9. Ecker JL, Musci TJ. Thyroid function and disease in pregnancy. Curr Probl Obstet Gynecol Fertil 2000;23:109-22. (Level III)

10. Dong AC, Stagnaro-Green A. Differences in diagnostic criteria mask the true prevalence of thyroid disease in pregnancy: a systematic review and meta-analysis. Thyroid 2019;29:278-89. (Systematic Review and Meta-Analysis)

11. Davis LE, Lucas MJ, Hankins GD, Roark ML, Cunningham FG. Thyrotoxicosis complicating pregnancy. Obstet Gynecol 1989;160:63-70. (Level HI)

12. Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol 1994;84:946-9. (Level II-2)

13. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010;31:702-55. (Level III)

14. Pearce EN. Management of thyrotoxicosis: preconception, pregnancy, and the postpartum period. Endocr Pract 2019; 25:62-8. (Level III)

15. Uenaka M, Tanimura K, Tairaku S, Morioka I, Ebina Y, Yamada H. Risk factors for neonatal thyroid dysfunction in pregnancies complicated by Graves’ disease. Eur J Obstet Gynecol Reprod Biol 2014;177:89-93. (Level III)

16. Aggarawal N, Suri V, Singla R, Chopra S, Sikka P, Shah VN, et al. Pregnancy outcome in hyperthyroidism: a case control study. Gynecol Obstet Invest 2014;77:94-9. (Level II-2)

17. Sheehan PM, Nankervis A, Araujo Junior E, Da SC. Maternal thyroid disease and preterm birth: systematic review and meta-analysis. J Clin Endocrinol Metab 2015;100: 4325-31. (Systematic Review and Meta-Analysis)

18. Matsuura N, Harada S, Ohyama Y, Shibayama K, Fukushi M, Ishikawa N, et al. The mechanisms of transient hypo- thyroxinemia in infants bom to mothers with Graves’ disease. Pediatr Res 1997;42:214-8. (Level III)

19. McKenzie JM, Zakarija M. Fetal and neonatal hyperthyroidism and hypothyroidism due to maternal TSH receptor antibodies. Thyroid 1992;2:155-9. (Level III)

20. Weetman AP. Graves’ disease. N Engl J Med 2000;343: 1236-48. (Level III)

21. van der Kaay DC, Wasserman JD, Palmert MR. Management of neonates bom to mothers with Graves’ disease. Pediatrics 2016;137:e20151878. (Level III)

22. Casey BM, Dashe JS, Wells CE, Mclntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol 2006;107:337-41. (Level II-2)

23. Diéguez M, Herrero A, Avello N, Suarez P, Delgado E, Menéndez E. Prevalence of thyroid dysfunction in women in early pregnancy: does it increase with maternal age? Clin Endocrinol (Oxf) 2016;84:121-6. (Level II-3)

24. Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291:228-38. (Level III)

25. Tudela CM, Casey BM, Mclntire DD, Cunningham FG. Relationship of subclinical thyroid disease to the incidence of gestational diabetes. Obstet Gynecol 2012;119:983-8. (Level II-3)

26. Wilson KL, Casey BM, Mclntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol 2012;119: 315-20. (Level II-3)

27. Institute of Medicine. Dietary reference intakes: the essential guide to nutrient requirements. Washington, DC: National Academies Press; 2006. Available at: https:// www.nap.edu/catalog/11537/dietary-reference-intakes-the- essential-guide-to-nutrient-requirements. Retrieved January 10, 2020. (Level III)

28. Harding KB, Pena-Rosas JP, Webster AC, Yap CM, Payne BA, Ota E, et al. Iodine supplementation for women during the preconception, pregnancy and postpartum period. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011761. DOI: 10.1002/14651858.CD011761. pub2. (Systematic Review and Meta-Analysis)

29. Pearce EN, Lazarus JH, Moreno-Reyes R, Zimmermann MB. Consequences of iodine deficiency and excess in pregnant women: an overview of current knowns and unknowns. Am J Clin Nutr 2016;104(suppl 3):918S-23S. (Level III)

30. Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol 2006;108:1283-92. (Level III)

31. Yazbeck CF, Sullivan SD. Thyroid disorders during pregnancy. Med Clin North Am 2012;96:235-56. (Level III)

32. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 2002;12:63-8. (Level III)

33. Bryant SN, Nelson DB, Mclntire DD, Casey BM, Cunningham FG. An analysis of population-based prenatal screening for overt hypothyroidism. Obstet Gynecol 2015;213:565.el-6. (Level II-2)

34. Brown RS, Bellisario RL, Botero D, Fournier L, Abrams CA, Cowger ML, et al. Incidence of transient congenital hypothyroidism due to maternal thyrotropin receptorblocking antibodies in over one million babies. J Clin Endocrinol Metab 1996;81:1147-51. (Level II-3)

35. Casey BM, Dashe JS, Wells CE, Mclntire DD, Byrd W, Leveno KJ, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005;105:239-45. (Level II-2)

36. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol 2008;112:85-92. (Level II-3)

37. Fitzpatrick DL, Russell MA. Diagnosis and management of thyroid disease in pregnancy. Obstet Gynecol Clin North Am 2010;37:173-93. (Level III)

38. Haddow JE, Palomaki GE, Allan WC, Wilhams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999;341:549-55. (Level II-2)

39. Pop VJ, Kuijpens JL, van Baar AL, Verkerk G, van Son MM, de Vijlder JJ, et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf) 1999;50:149-55. (Level II-3)

40. Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, et al. Antenatal thyroid screening and childhood cognitive function [published erratum appears in N Engl J Med 2012;366:1650], N Engl J Med 2012;366:493-501. (Level I)

41. Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. N Engl J Med 2017;376:815-25. (Level I)

42. Hales C, Taylor PN, Channon S, Paradice R, McEwan K, Zhang L, et al. Controlled antenatal thyroid screening H: effect of treating maternal suboptimal thyroid function on child cognition. J Clin Endocrinol Metab 2018;103:1583- 91. (Level II-2)

43. Korevaar TI, Derakhshan A, Taylor PN, Meima M, Chen L, Bliddal S, et al. Association of thyroid function test abnormalities and thyroid autoimmunity with preterm birth: a systematic review and meta-analysis. Consortium on Thyroid and Pregnancy—Study Group on Preterm Birth [published erratum appears in JAMA 2019;322:1718], JAMA 2019;322:632-41. (Systematic Review and Meta- Analysis)

44. Casey BM, Dashe JS, Spong CY, Mclntire DD, Leveno KJ, Cunningham GF. Perinatal significance of isolated maternal hypothyroxinemia identified in the first half of pregnancy. Obstet Gynecol 2007;109:1129-35. (Level II- 3)

45. Cappola AR, Casey BM. Thyroid function test abnormalities during pregnancy. JAMA 2019;322:617-9. (Level III

46. Fister P, Gaberscek S, Zaletel K, Krhin B, Gersak K, Hojker S. Thyroid volume changes during pregnancy and after delivery in an iodine-sufficient Republic of Slovenia. Eur J Obstet Gynecol Reprod Biol 2009;145:45-8. (Level III)

47. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012;97:2543-65. (Level III)

48. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. American Association of Clinical Endocrinologists and American Thyroid Association Task- force on Hypothyroidism in Adults [published errata appear in Thyroid 2013;23:251; Thyroid 2013;23:129], Thyroid 2012;22:1200-35. (Level III)

49. Yoshihara A, Noh J, Yamaguchi T, Ohye H, Sato S, Sekiya K, et al. Treatment of Graves’ disease with antithyroid thugs in the first trimester of pregnancy and the prevalence of congenital malformation. J Clin Endocrinol Metab 2012; 97:2396-403. (Level II-3)

50. Brent G A. Clinical practice. Graves’ disease. N Engl J Med 2008;358:2594-605. (Level III)

51. Abalovich M, Alcaraz G, Kleiman-Rubinsztein J, Pavlove MM, Comelio C, Levalle O, et al. The relationship of preconception thyrotropin levels to requirements for increasing the lévothyroxine dose during pregnancy in women with primary hypothyroidism. Thyroid 2010;20:1175-8. (Level III)

52. Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in lévothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 2004;351:241-9. (Level III)

53. Arafah BM. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. N Engl J Med 2001;344:1743-9. (Level II-3)

54. Thangaratinam S, Tan A, Knox E, Kilby MD, Franklyn J, Coomarasamy A. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ 2011;342:d2616. (Systematic Review and Meta-Analysis)

55. Stagnaro-Green A, Pearce E. Thyroid disorders in pregnancy. Nat Rev Endocrinol 2012;8:650-8. (Level III)

56. Wang H, Gao H, Chi H, Zeng L, Xiao W, Wang Y, et al. Effect of lévothyroxine on miscarriage among women with normal thyroid function and thyroid autoimmunity undergoing in vitro fertilization and embryo transfer: a randomized clinical trial. JAMA 2017;318:2190-8. (Level I)

57. Dhillon-Smith R, Middleton U, Sunner KK, Cheed V, Baker K, Farrell-Carver S, et al. Lévothyroxine in women with thyroid peroxidase antibodies before conception. N Engl J Med 2019;380:1316-25. (Level I)

58. Yeo CP, Khoo DH, Eng PH, Tan HK, Yo SL, Jacob E. Prevalence of gestational thyrotoxicosis in Asian women evaluated in the 8th to 14th weeks of pregnancy: correlations with total and free beta human chorionic gonadotrophin. Clin Endocrinol (Oxf) 2001;55:391-8. (Level II-3)

59. Kinomoto-Kondo S, Umehara N, Sato S, Ogawa K, Fuji- wara T, Arata N, et al. The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case-control study. Arch Gynecol Obstet 2017;295:87-93. (Level II-2)

60. Niemeijer MN, Grooten D, Vos N, Bais JM, van der Post JA, Mol BW, et al. Diagnostic markers for hyperemesis gravidarum: a systematic review and metaanalysis. Obstet Gynecol 2014;211:150.el-15. (Systematic Review and Meta-Analysis)

61. Sheffield JS, Cunningham FG. Thyrotoxicosis and heart failure that complicate pregnancy. Obstet Gynecol 2004; 190:211-7. (Level III)

62. Siu C, Zhang X, Yung C, Kung AW, Lau C, Tse H. Hemodynamic changes in hyperthyroidism-related pulmonary hypertension: a prospective йchocardiographie study. J Clin Endocrinol Metab 2007;92:1736^12. (Level II-3)

63. Vydt T, Verhelst J, De Keulenaer G. Cardiomyopathy and thyrotoxicosis: tachycardiomyopathy or thyrotoxic cardiomyopathy? Acta Cardiol 2006;61:115-7. (Level III)

64. Brand F, Liégeois P, Langer B. One case of fetal and neonatal variable thyroid dysfunction in the context of Graves’ disease. Fetal Diagn Ther 2005;20:12-5. (Level III)

65. Cohen O, Pinhas-Hamiel O, Sivan E, Dolitski M, Lipitz S, Achiron R. Serial in utero ultrasonographic measurements of the fetal thyroid: a new complementary tool in the management of maternal hyperthyroidism in pregnancy. Prenat Diagn 2003;23:740-2. (Level III)

66. Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, et al. Management of Graves’ disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 2005;90:6093-8. (Level III)

67. Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764-71. (Level HI)

68. Kwong N, Medici M, Angell TE, Liu X, Marqusee E, Cibas ES, et al. The influence of patient age on thyroid nodule formation, multinodularity, and thyroid cancer risk. J Clin Endocrinol Metab 2015;100:4434-40. (Level II-2)

69. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Assoda- zione Mediri Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules —2016 update. Endocr Pract 2016;22:622-39. (Level III)

70. Bartolazzi A, Gasbarri A, Papotti M, Bussolati G, Lucante T, Khan A, et al. Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions. Thyroid Cancer Study Group. Lancet 2001;357:1644-50. (Level II-3)

71. Nathan N, Sullivan SD. Thyroid disorders during pregnancy. Endocrinol Metab Clin North Am 2014;43:573- 97. (Level III)

72. Stagnaro-Green A, Glinoer D. Thyroid autoimmunity and the risk of miscarriage. Best Pract Res Clin Endocrinol Metab 2004;18:167-81. (Level III)

73. Muller AF, Drexhage HA, Berghout A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev 2001;22:605- 30. (Level II-3)

74. Bergink V, Pop VJ, Nielsen PR, Agerbo E, Munk-Olsen T, Liu X. Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study. Psychol Med 2018;48:1291-8. (Level II-2)

75. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al, editors. Wilhams obstetrics. 25th ed. New York, NY: McGraw-Hill Education; 2018. (Level III)

76. Lucas A, Pizarro E, Granada ML, Salinas I, Roca J, San- martl A. Postpartum thyroiditis: long-term follow-up. Thyroid 2005;15:1177-81. (Level III)

77. Premawardhana LD, Parkes AB, Amman F, John R, Darke C, Adams H, et al. Postpartum thyroiditis and long-term thyroid status: prognostic influence of thyroid peroxidase antibodies and ultrasound echogenicity. J Clin Endocrinol Metab 2000;85:71-5. (Level II-3)