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Schilddrüsenentzündungen in Schwangerschaft und Stillzeit

Inflammation of the thyroid gland during pregnancy and breast feeding

  • Leitthema
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Die rechtzeitige Erkennung und adäquate Therapie einer Thyreoiditis ist in der Schwangerschaft von besonderer Bedeutung, da andernfalls ein negativer Einfluss auf den Verlauf der Schwangerschaft zu befürchten ist. So ist eine hypothyreote Stoffwechsellage mit einer erhöhten Inzidenz von Fehl- und Frühgeburten sowie mit Einschränkungen der intellektuellen Entwicklung während Kindheit und Schulzeit assoziiert. Die Hauptursache einer Schilddrüsenunterfunktion in der Schwangerschaft ist die Autoimmunthyreoiditis Hashimoto, eine Autoimmunerkrankung mit hohen Konzentrationen an Antikörpern gegen thyreoidale Peroxidase (TPO) und Thyreoglobulin (TG). Die Anwesenheit von Schilddrüsenautoantikörpern ist auch bei euthyreoter Stoffwechsellage mit einem erhöhten Risiko für Fehlgeburten assoziiert. Die postpartale Thyreoiditis hat Ähnlichkeit mit der Hashimoto-Thyreoiditis und tritt v. a. bei Patientinnen mit anti-TPO-Antikörpern auf. Bei der subakuten granulomatösen Thyreoiditis (de Quervain) handelt es sich um eine schmerzhafte Schilddrüsenaffektion, für die eine Virusätiologie vermutet wird. Da nichtsteroidale Antiphlogistika in der Schwangerschaft kontraindiziert sind, werden therapeutisch Glukokortikoide eingesetzt. Äußerst seltene Formen der Thyreoiditis sind die akute eitrige Schilddrüsenentzündung sowie die fibröse Thyreoiditis (Riedel).

Abstract

Thyroiditis during pregnancy can adversely effect development of the fetus, making early recognition and adequate treatment of paramount importance. In women with both clinical and subclinical hypothyroidism the miscarriage rate was found to be higher than in euthyroid women. In addition, hypothyroidism during early pregnancy may impair the subsequent mental development of the offspring. The major reason for hypothyroidism during pregnancy is Hashimoto’s thyroiditis, an autoimmune disease with high levels of antibodies against thyroid peroxidase (TPO) and thyroglobulin (TG). Even in euthyroid patients, the risk of miscarriage may be higher if anti-thyroid antibodies are present. Postpartum thyroiditis is similar to Hashimoto’s thyroiditis and is associated with the development of antibodies against TPO and TG. Subacute granulomatous thyroiditis (de Quervain) is a painful inflammation of the thyroid gland presumably associated with a viral infection. Non-steroidal anti-inflammatory drugs (NSAIDs) are the treatment of choice in non-pregnant women and in men but are contraindicated during pregnancy so that glucocorticoids are used instead. Extremely rare forms of thyroiditis are acute suppurative thyroiditis and Riedel’s thyroiditis, a chronic fibrotic disorder of the thyroid gland.

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  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    B. Harbeck, H. Lehnert &  H. Mönig

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  1. B. Harbeck
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  2. H. Lehnert
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  3. H. Mönig
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Correspondence to H. Mönig.

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Harbeck, B., Lehnert, H. & Mönig, H. Schilddrüsenentzündungen in Schwangerschaft und Stillzeit. Gynäkologische Endokrinologie 7, 224–230 (2009). https://doi.org/10.1007/s10304-009-0307-8

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