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Schilddrüsenerkrankungen in der Schwangerschaft

  • Anca ZimmermannEmail author
Originalien

Zusammenfassung

Während der Schwangerschaft findet eine Vielzahl an physiologischen Schilddrüsenveränderungen statt: Anstieg des thyroxinbindenden Globulins, Abfall des TSH, Zunahme der Gesamtthyroxinkonzentration und des Jodbedarfs. In der vorliegenden Übersichtsarbeit wird auf schwangerschaftsassoziierte pathologische Veränderungen der Schilddrüse eingegangen, mit Beleuchtung ihrer Bedeutung für Mutter und Kind sowie mit einer praxisorientierten Darstellung aktuellster Empfehlungen für Diagnostik und Therapie. Zur Definition und Behandlungsbedürftigkeit der Hypothyreose sind neue obere TSH-Werte und die Präsenz von Anti-TPO-Antikörpern zu beachten. Eine Behandlung ist bei manifester Schilddrüsenunterfunktion immer sowie bei latenter Hypothyreose in speziellen Situationen notwendig, um negative Folgen für Mutter und Kind zu verhindern. Bei positivem Anti-TPO-Titer und Euthyreose ist eine regelmäßige TSH-Kontrolle notwendig. Eine relevante Ursache für Hyperthyreose in der Schwangerschaft ist der Morbus Basedow. Differenzialdiagnostisch ist eine schwangerschaftsassoziierte Hyperthyreose abzugrenzen. Bei floridem Morbus Basedow kommen Thyreostatika in der niedrigsten effektiven Dosis zum Einsatz, mit dem Ziel, fT4 im oberen Normbereich und TSH supprimiert zu halten. Indikation und Risiken verschiedener Thyreostatika werden diskutiert. In bestimmten Fällen sind TRAK-Kontrollen, parallel zu regelmäßigen sonographischen Kontrollen des Fetus, notwendig. Die Postpartumthyreoiditis (PPT) verläuft oft biphasisch, mit einer selbstlimitierenden hyperthyreoten Phase in den ersten 6 Monaten, gefolgt von Hypothyreose und Euthyreose nach ca. 1 Jahr. Bei der Erstdiagnose eines differenzierten Schilddrüsenkarzinoms in der Schwangerschaft kann die Operation meistens bis postpartal verschoben werden. Weiterhin wird auf die Bedeutung und praktische Gewährleistung einer adäquaten Jodversorgung in der Schwangerschaft sowie auf die aktuellen Indikationen zum Schilddrüsenscreening eingegangen.

Schlüsselwörter

Hypothyreose Hyperthyreose Anti-TPO Postpartumthyreoiditis Struma nodosa 

Thyroid Diseases During Pregnancy

Abstract

Pregnancy is associated with various changes in thyroid metabolism: increase in thyroxin-binding globulin, decrease in thyroid-stimulating hormone (TSH), and increase in total thyroxin concentration as well as in iodine requirements. Here, we provide an overview of pregnancy-associated thyroid diseases with a focus on the risks for mother and child as well as current recommendations for diagnosis and treatment. There are new upper TSH values recommended for the definition and treatment indication of hypothyroidism during pregnancy, while the presence of anti-TPO antibodies plays a role in decision-making. Since hypothyroidism has been associated with adverse outcomes for both the mother and offspring, substitution is needed not only for manifest hypothyroidism but also for latent hypothyroidism in special situations. In the presence of anti-TPO antibodies with normal thyroid status, regular monitoring for TSH is required. A relevant cause of hyperthyroidism during pregnancy is Graves’ disease, which has to be differentiated from gestational hyperthyroidism. Antithyroid drugs are recommended in the lowest effective dose for Graves’ disease with overt hyperthyroidism, so that fT4 is kept in the upper normal range and TSH remains suppressed. The indication and risks of various antithyroid drugs are discussed here. In special situations, TRAK controls and sonographic monitoring of the fetus are mandatory. Postpartum thyroiditis (PPT) has a biphasic course, with a transient thyrotoxic phase in the first 6 months, followed by hypothyroidism and possible return to the euthyroid state 1 year postpartum. If a differentiated thyroid cancer is diagnosed during pregnancy, surgery can usually be safely postponed until after delivery. Furthermore, the importance of iodine deficiency and the recommendations for an optimal iodine intake during pregnancy, as well as current indications for thyroid screening, are highlighted.

Keywords

Hypothyroidism Hyperthyroidism Anti-TPO Postpartum thyroiditis Nodular goiter 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. Zimmermann gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.I. Medizinische Klinik und Poliklinik, Schwerpunkt Endokrinologie und StoffwechselerkrankungenUniversitätsmedizin der Johannes-Gutenberg-UniversitätMainzDeutschland

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