Schilddrüse und Schwangerschaft

 

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Zusammenfassung

Der nachfolgende Übersichtsartikel soll fokussiert umfangreiche Leitlinien zur Diagnostik und Therapie von Schilddrüsenerkrankungen vor, während und nach einer Schwangerschaft zusammenfassen. Bei unerfülltem Kinderwunsch soll auf das Vorliegen einer Autoimmunthyreopathie untersucht werden, eine präkonzeptionelle TSH-Modulation kann das Eintreten einer Schwangerschaft günstig beeinflussen. Die Schwangerschaft ist ein Stresstest für die mütterliche Schilddrüse. Es besteht ein erhöhter Iodbedarf während der Schwangerschaft und Stillzeit. Es gibt Trimenon-spezifische TSH-Referenzwerte. Eine Hypothyreose muss aufgrund möglicher neurokognitiver Schäden beim Neugeborenen rechtzeitig erkannt und behandelt werden. Ein mütterlicher TSH-Wert<2,5 µU/l wird empfohlen. TPO-Antikörper sind ein Risikofaktor für Früh- und Fehlgeburten und auch die Entwicklung einer postpartalen Thyreoiditis. Bei der Hyperthyreose muss die häufigere hGC-induzierte Gestationshyperthyreose vom M. Basedow differenziert werden. Die Gestationshyperthyreose wird symptomatisch ggf. mit Betablockern behandelt. Der M. Basedow wird im 1. Trimenon mit PTU wegen des geringeren Missbildungsrisikos, im 2. und 3. Trimenon mit MMI (oder CBZ) monothyreostatisch wegen der PTU-assoziierten Hepatotoxizität behandelt. Eine postpartale Thyreoiditis betrifft im Mittel ca. 8% der Frauen, im Falle erhöhter TPO-Antikörper entwickelt etwa jede zweite eine substitutionspflichtige Hypothyreose.

Abstract

The following review article aims to summarise extensive guidelines for diagnosis and therapy of thyroid disorders before, during and after pregnancy. In case of difficulties to realise pregnancy thyroid autoimmune disorders must be excluded. Preconceptionel TSH modulation may increase the likelihood to realise pregnancy. Pregnancy is a thyroid stress test with an increased demand for iodine intake. There are trimenon-specific TSH-reference values. Hypothyroidism must be diagnosed and substituted because of potential neurocognitive deficits of the newborn. A maternal TSH<2.5 µU/l is recommended. TPO-antibodies are a risk factor for preterm and miscarriage and also for the development of postpartum thyroiditis. In case of hyperthyroidism hCG-induced gestational hyperthyroidism must be differentiated from Graves’ disease. Gestational hyperthyroidism is treated according to symptoms with betablockers. In the 1. trimenon Graves’ disease is treated with PTU because of the lower likelihood for congenital anomalies and in the 2. and 3. trimenon monothyreostatic MMI (or CBZ) is used because of PTU-associated hepatopathy. Postpartum thyroid disease occurs in about 8% of women, in case of increased TPO antibodies hypothyroidism with the need for levothyroxine supplemenation develops in about every second women.

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