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Schilddrüsenerkrankungen und Schwangerschaft

Thyroid Diseases and Pregnancy

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Zusammenfassung

Der Umgang mit Schilddrüsenerkrankungen während der Schwangerschaft stellt eine besondere klinische Herausforderung dar. Jede Schwangerschaft verursacht physiologische Veränderungen des Schilddrüsenhormonmetabolismus, die von pathologischen Funktionszuständen abgegrenzt werden müssen. Eine Schilddrüsenerkrankung der Mutter mit tatsächlicher Störung der Schilddrüsenfunktion kann einen nachteiligen Einfluss auf den Schwangerschaftsverlauf ausüben und negative Auswirkungen auf die Entwicklung des Fetus bedingen. Insbesondere die Hypothyreose ist während einer Schwangerschaft wegen beeinträchtigter neurokognitiver Entwicklung des Ungeborenen unter allen Umständen zu vermeiden. Auch eine mütterliche Hyperthyreose kann zur Beeinträchtigung des Schwangerschaftsverlaufs und zur fetalen Schilddrüsendysfunktion führen.

Von klinischer Bedeutung sind per se auch Autoimmunerkrankungen der Schilddrüse, da sie Ursache von Fertilitätsstörungen und einer erhöhten Rate von Spontanaborten sein können und ein erhöhtes Risiko für die Entwicklung einer Post-partum-Thyreoiditis darstellen.

Das Management von Schilddrüsenknoten einschließlich Malignität unterscheidet sich nur unwesentlich vom Vorgehen beim allgemeinen Patienten. Nuklearmedizinische Diagnostik und Therapie verbieten sich allerdings während der Schwangerschaft und ebenso in der Stillperiode.

Dieser Übersichtsartikel befasst sich mit den unterschiedlichen Facetten thyreoidaler Erkrankungen und Funktionsstörungen in und nach der Schwangerschaft. Die hier dargestellten diagnostischen und therapeutischen Vorgehensweisen basieren auf der aktuellen Clinical Practice Guideline der Endocrine Society vom August 2007.

Abstract

Thyroid diseases in pregnancy must be recognized as a specific challenge for the clinician. Any pregnancy is causing alterations in thyroid hormone metabolism which have to be differentiated from pathologic states of thyroid function. Any thyroid disease of the mother with disturbances in the functional state of the gland could induce an adverse influence on the course of pregnancy. Furthermore, it can be associated with adverse consequences on fetal development. Especially hypothyroidism has to be avoided during pregnancy due to a danger of affected neurocognitive development of the offspring. Yet also maternal hyperthyroidism can lead to impairments in the course of pregnancy and to fetal thyroid dysfunction.

Further clinical attention should be given to thyroid autoimmunity. There is a clear relationship between autoimmune thyroid disease and decreased fertility and an increase in the rate of spontaneous miscarriages. Furthermore, it displays an increased risk for the manifestation of postpartum thyroiditis.

The management of nodular thyroid disease and malignancy does not differ from that of nonpregnant women/patients. Thyroid scintiscan and radioiodine therapy must be avoided during pregnancy and lactation.

This review deals with the broad variety of thyroid disorders and function disturbances during and after pregnancy. All described diagnostic and therapeutic procedures are based upon the recent Clinical Practice Guideline of the Endocrine Society published in August 2007.

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Authors and Affiliations

  1. Klinik für Endokrinologie, Diabetologie und Nephrologie, Department Innere Medizin, Universitätsklinikum Leipzig, Leipzig, Germany

    Dagmar Führer-Sakel

  2. Klinik für Endokrinologie, Diabetologie und Nephrologie, Department Innere Medizin, Universitätsklinikum Leipzig, Liebigstraße 18, 04103, Leipzig, Germany

    Dagmar Führer-Sakel

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Correspondence to Dagmar Führer-Sakel.

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Karger, S., Führer-Sakel, D. Schilddrüsenerkrankungen und Schwangerschaft. Med Klin 104, 450–456 (2009). https://doi.org/10.1007/s00063-009-1094-7

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