How do thyroid diseases affect conception and pregnancy. Thyroid during pregnancy: hypothyroidism, hyperthyroidism. How does the thyroid gland affect pregnancy

Under normal conditions, during pregnancy, there is an increase in thyroid function and an increase in the production of thyroid hormones, especially in the first half of pregnancy, its early stages, when the fetal thyroid gland does not function.

Thyroid hormones during pregnancy are important for the development of the fetus, its growth processes and tissue differentiation. They affect the development of lung tissue, brain myelogenesis, ossification.

Subsequently, in the second half of pregnancy, the excess hormones bind to proteins and become inactive.

The thyroid gland of the fetus begins to function relatively early - at 14-16 weeks, and by the time of birth, the functional system of the pituitary - thyroid gland is fully formed. The thyroid-stimulating hormones of the pituitary gland do not cross the placental barrier, but thyroid hormones freely pass from the mother to the fetus and back through the placenta (thyroxine and triiodothyronine).

Most common during pregnancy diffuse toxic goiter(from 0.2 to 8%), the obligatory symptoms of which are hyperplasia and hyperfunction of the thyroid gland.

During pregnancy, it is difficult to assess the degree of dysfunction of the thyroid gland in its pathology and hyperactivity of the thyroid gland associated with pregnancy.

With diffuse toxic goiter, there is an increase in total free thyroxine, a higher content of protein-bound iodine. Typically, patients complain of palpitations (on the ECG, sinus tachycardia, increased voltage, increased systolic values), fatigue, nervousness, sleep disturbance, feeling hot, increased sweating, hand tremors, exophthalmos, enlarged thyroid gland, subfebrile condition. With diffuse toxic goiter in the first half of pregnancy, against the background of increased activity of the thyroid gland, all women experience an exacerbation of the disease, in the second half of pregnancy, due to the blockade of excess hormones, some patients with mild thyrotoxicosis improve.

But in most patients, there is no improvement, and in the period of 28 weeks due to hemocirculatory adaptation - an increase in BCC, cardiac output - cardiovascular decompensation may occur: tachycardia up to 120-140 beats per minute, rhythm disturbance by the type of atrial fibrillation, tachypnea .

In pregnant women with toxic goiter, the course of pregnancy is most often (up to 50%) complicated by the threat of abortion, especially in the early stages. This is due to an excess of thyroid hormones that disrupt implantation, placentation - negatively affect the development of the fetal egg.

The second most common complication of the course of pregnancy with thyrotoxicosis is early toxicosis of pregnant women, and its development coincides with an exacerbation of thyrotoxicosis, it is difficult and difficult to treat, and therefore pregnancy often has to be interrupted. Late toxicosis of pregnant women occurs less frequently, the dominant symptom is hypertension; The course of PTB is very severe and difficult to treat.

In childbirth, decompensation of the cardiovascular system can often occur, and in the postpartum and early postpartum periods - bleeding. Therefore, in childbirth, it is necessary to carefully monitor the state of the cardiovascular system, in the postpartum and early postpartum periods, apply the prevention of bleeding.

In the postpartum period, an exacerbation of thyrotoxicosis is also often observed - palpitations, weakness, general tremor, increased sweating. A sharp exacerbation of thyrotoxicosis in the postpartum period requires: 1) treatment with mercalilol, and since it passes through milk to the fetus and adversely affects it, 2) suppression of lactation.

Treatment of toxic diffuse goiter during pregnancy is a very responsible task. Only in 50-60% of patients with mild thyrotoxicosis can a sufficient therapeutic effect be obtained from the use of iodine preparations, in particular diiodotyrosine, against the background of a diet rich in vitamins and sedatives (valerian, motherwort). Mercalil treatment is dangerous because of its damaging effect on the organogenesis of the fetal thyroid gland - the risk of developing hypothyroidism in the newborn fetus.

Therefore, with diffuse toxic goiter of moderate severity and nodular goiter, termination of pregnancy is indicated. However, if a woman does not agree to terminate the pregnancy, the surgical method of treatment remains, which is the safest (merkusalil cannot be treated). It is necessary to perform the operation during pregnancy within 14 weeks, since earlier operation increases the frequency of abortion.

Dysfunction of the thyroid gland in pregnant women adversely affects the fetus and the development of the child - with thyrotoxicosis, signs of hypothyroidism are detected in 12% of newborns, since an excess of maternal thyroid hormones inhibits the development of the thyrotropic function of the pituitary gland and thyroid function in the fetus. In newborns of this group, there are: dry and edematous skin, parchment of the bones of the skull, a constantly open oral fissure, a thickened tongue, muscle hypotonia and hyporeflexia, slow intestinal motility and a tendency to constipation. At the same time, replacement therapy with thyroid hormones was required in almost 50%.

The tactics of an obstetrician-gynecologist and an endocrinologist in the management of pregnant women with diffuse and nodular toxic goiter are as follows: hospitalization in the early stages up to 12 weeks to examine and resolve the issue of the possibility of carrying a pregnancy, especially since during this period there are complications specific to pregnancy (toxicosis and threat of interruption). Pregnancy is contraindicated in moderate diffuse goiter and nodular goiter if the woman does not intend to be operated on within 14 weeks. Pregnancy can be carried only with a mild degree of thyrotoxicosis of diffuse goiter and positive treatment with diiodothyrosine. Constant monitoring of an obstetrician-gynecologist and an endocrinologist will allow to identify pregnancy complications and evaluate the effect of thyrotoxicosis treatment. At the slightest complications, hospitalization is indicated. Childbirth is carried out in a specialized maternity hospital (regional) with control of the cardiovascular system and cardiotropic therapy, prevention of bleeding in the afterbirth and postpartum periods. Children are transferred under the supervision of a pediatric endocrinologist.

Combination of hypothyroidism and pregnancy

Such a condition is observed relatively rarely, since in such conditions the reproductive function is significantly damaged - infertility. Hypothyroidism is a disease caused by a decrease in the intake of thyroid hormones in the body. Expressed forms of hypothyroidism are called myxedema, with athyreosis cretinism develops.

By order of the Ministry of Health of the USSR No. 234, all forms of hypothyroidism are an indication for termination of pregnancy, since there is a high risk of getting damaged children and high perinatal mortality.

Uncompensated hypothyroidism, if pregnancy occurs, leads to its interruption, and in the case of the birth of a fetus, handicapped children: brain development anomalies, severe thyroid dysfunction, Down's disease, and further mental retardation. Combined with high perinatal mortality, of course, this is an unproductive economic cost to society for reproduction.

Hypothyroidism can be congenital (the most dangerous for pregnancy, as it causes severe perinatal complications) and acquired - after surgery on the thyroid gland of cerebro-pituitary origin.

The course of pregnancy in hypothyroidism is complicated by a severe form of PTB in the form of eclampsia and is accompanied by high maternal mortality, intrauterine fetal death, especially in uncompensated hypothyroidism. Even with a subcompensated form of hypothyroidism, the frequency of abortion increases sharply.

Pregnant women with hypothyroidism complain of lethargy, drowsiness, memory loss, dry skin, hair loss, brittle hair, and persistent constipation. There is pallor and swelling of the skin, bradycardia, high cholesterol in the blood.

During pregnancy, especially in the second half, there is some improvement in the course of hypothyroidism. This is due to an increase in the activity of the thyroid gland of the fetus (dangerous for him!) And the flow of fetal thyroid hormones into the mother's body. This is dangerous for the fetus, since the early activation of thyroid function leads to its depletion in the future.

Pregnancy can be carried with secondary hypothyroidism after thyroid surgery, provided that it is compensated for under the influence of specific therapy. Adequate hormone replacement therapy is with thyroidin or a combination of thyroidin and triiodothyronine. In the second half of pregnancy, the dose should be slightly reduced, but not canceled. The pregnant woman is observed by an obstetrician-gynecologist and an endocrinologist. Hospitalize for any complications of pregnancy. In congenital forms of hypothyroidism, pregnancy is contraindicated due to the birth of handicapped children (possibility of chromosomal aberrations).

Adrenal disease and pregnancy

The functional role of the hormones of the adrenal cortex during pregnancy is diverse. They participate in metabolic and adaptive mechanisms during pregnancy and childbirth, play a role in the synthesis of sex steroid hormones, the development of the lungs, liver, pancreas, and brain.

During pregnancy, the function of the adrenal cortex increases in a woman, as evidenced by the appearance of striae, Na and fluid retention, hypertension - an increase in vascular tone.

The adrenal glands in the fetus are formed and begin to function earlier than other endocrine glands - even in the first trimester at 10-11 weeks. For the synthesis of corticosteroids, the fetus uses placental progesterone. As noted above, corticosteroids affect the formation of tissues and organs in the fetus (in particular, the lungs, brain, liver, pancreas, heart). In addition, the synthesis of dehydroepiandrosterone, a precursor for the biosynthesis of estriol in the placenta, occurs in the adrenal glands of the fetus; this hormone ensures the optimal functioning of the uteroplacental system.

The placenta is passable depending on the concentration for corticosteroids. Therefore, in violation of the function of the adrenal glands in the mother, there are not only complications of the pregnancy itself, but also complications in the formation, first of all, of the adrenal glands in the fetus, complications in its development.

Pregnancy in combination with Itsenko-Cushing's disease or syndrome

In the pathogenesis of Itsenko-Cushing's disease, the increased production of corticotropin-releasing factor by the hypothalamus is important, leading to increased production of ACTH by the pituitary gland, and this in turn causes hyperplasia of the adrenal cortex and an increase in the synthesis of corticosteroids. Excess corticosteroids and causes the clinic of the disease. The disease can be caused by a violation of functional relations in the hypothalamus-pituitary-adrenal system, or by basophilic pituitary adenoma, which occurs in almost 5?% of all cases of Itsenko-Cushing's disease.

Itsenko-Cushing's syndrome occurs with tumors of the adrenal cortex - glucosteroma or glucoandrosteroma, as well as tumors of other organs that produce ACTH-like substances. Itsenko-Cushing's syndrome is caused and develops during long-term treatment with corticosteroids.

With Itsenko-Cushing's disease and syndrome, increased production

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Against the background of chronic adrenal insufficiency, crises of acute adrenal insufficiency may occur, caused by infection, intoxication, mental trauma, surgical trauma, pregnancy and childbirth. In the clinic of the crisis, the leading ones are increasing dehydration, vascular collapse, and impaired renal function.

In the treatment of chronic adrenal insufficiency, the main thing is steroid hormone replacement therapy: glucocorticoid action - dexametase and trimaciolum - and mineralocorticoid action - such as deoxycorticosterone acetate (DOXA). Hydrocortisone, prednisolone, prednisone are drugs with mainly glucocorticoid action, but with minimal mineralocorticoid properties.

Prior to the use of steroid hormones, pregnancy in patients with chronic adrenal insufficiency was rare and was accompanied by high maternal mortality due to the crisis.

In connection with the use of steroid hormones, the possibility of pregnancy has increased, as the generative function is restored. In addition, a large group consists of women who, before pregnancy, were treated for a long time with steroid hormones for extragenital diseases, which leads to a decrease in the function of the adrenal cortex. The number of women after bilateral adrenalectomy has increased. All this increases the contingent of pregnant women with chronic adrenal insufficiency. During pregnancy and especially during childbirth and the postpartum period, a crisis of acute renal failure can easily develop, especially with inadequate hormone replacement therapy or with latent, latent chronic adrenal insufficiency.

The most likely danger of a crisis: 1) in the early stages of pregnancy; 2) in childbirth; 3) in the early postpartum period.

In the early stages of pregnancy, the need for adrenal hormones increases, in addition, in patients with chronic adrenal insufficiency, early toxicosis often joins, which disrupts electrolyte metabolism, causes dehydration, hypoglycemia, and hypochlorenia, which cause a crisis.

In childbirth - the maximum energy expenditure in a relatively short period of time requires an increased amount of corticosteroids.

In the early postpartum period, the danger lies in the removal of the fetus and placenta, as they represent a hormonally active complex that produces steroids. In addition, increased diuresis after childbirth during the first day leads to the introduction of water and salts from the body.

During these critical periods, special attention and monitoring of the pregnant woman and an increase in hormone replacement therapy are necessary.

In the second half of pregnancy, there is some improvement in chronic adrenal insufficiency, which is associated with the participation of the fetus in the production of corticosteroids and the influence of placental hormones - progesterone and placental lactogen.

The course of pregnancy in chronic adrenal insufficiency is often complicated by early toxicosis of pregnant women, which is associated with impaired metabolic processes. Late toxicosis may be due to an overdose of steroid hormones. With an overdose of hormones, prolongation of pregnancy by 10-12 days can occur.

When managing pregnancy, critical periods should be taken into account, dangerous crises of acute adrenal insufficiency, as well as possible surgical interventions in childbirth, which requires adequate hormone replacement therapy. With hormone replacement therapy, it is necessary to monitor the patient's condition, her weight gain, blood pressure, blood sugar, excretion of 17-KS and 17-OKSR.

In the first half of pregnancy, prednisolone 10-15 mg per day and DOXA 5 mg intramuscularly are prescribed after 2 days; in the second half of pregnancy, prednisolone is reduced by 5 mg and DOXA is canceled. The diet should be rich in vitamins, especially C - up to 1 g per day. Sodium chloride - 10 g per day with potassium restriction. In childbirth, from the beginning they are prescribed hydrocortion up to 75 mg, DOXA 5 mg and, under the control of the condition, are repeated after 5-6 hours. With a decrease in blood pressure below 110/70, the dose is increased. 500 ml of 5% sodium chloride is injected intravenously with 1 ml of 0.6% korglucon and 10 ml of 5% vitamin C. In case of a planned operative delivery, hydrocortisone is prescribed 50 mg 3 times a day, in the morning on the day of surgery IM 75 mg hydrocortisone, during the operation intravenously 75-100 mg of hydrocortisone in saline.

In the first day after childbirth, the therapy is the same as in childbirth. An overdose of hormones is manifested by passing hypertension, edema, dyspepsia. Subsequently, in the postpartum and postoperative periods, the dose of hormones is gradually reduced under the control of blood pressure, 17-KS, 17-OKS. On the 3rd-4th day - hydrocortisone 50 mg 3 times and DOXA 5 mg; 5-6th day - hydrocortisone 50 mg 2 times and prednisal 10-15 mg; 7-8th day - hydrocortisone 50 mg and prednisolone 10-15 mg. In the future, they switch to the fixed doses of prednisolone used earlier. Due to the high sensitivity to infection, broad-spectrum antibiotics are prescribed, lactation is undesirable and dangerous (due to the load and the possibility of mastitis).

Termination of pregnancy is dangerous by the development of a crisis, therefore, in chronic adrenal insufficiency, abortion is performed according to strict indications (obstetric), the safest interruption is up to 12 weeks with the use of enhanced steroid therapy.

Children born to mothers with chronic adrenal insufficiency may develop adrenal insufficiency in the first day of life, which is transient and is due to the response to the overwhelming effect of large doses of steroid hormones used in childbirth. This is expressed to exicosis, collapse, respiratory failure. They are prescribed hydrocortisone 5-7.5 mg / m 2 times a day, isotonic sodium chloride solution and glucose. The dose of hydrocortisone is reduced, and by the 5-6th day the child's condition returns to normal.

Pregnant women with chronic adrenal insufficiency are observed by an obstetrician-gynecologist and an endocrinologist. Pregnancy is allowed to be carried only with adequate replacement therapy in moderate doses, since significant doses of corticosteroids lead to a decrease in the mass of the brain, lungs, liver, pancreas, heart, adrenal glands and an increase in the pituitary gland, subsequently to adrenal insufficiency.

It should be noted that the possibility of meeting with latent forms of chronic adrenal insufficiency has recently increased due to the widespread use of steroid hormones in various diseases, while a decrease in the function of the adrenal cortex develops. This manifests itself during pregnancy at critical times with crises of acute adrenal insufficiency.

In conclusion, it should be noted that endocrine pathology in combination with pregnancy requires special care when deciding on the possibility of carrying a pregnancy. There is a very high risk of transmission of an endocrine disease from mother to fetus in embryoorganofunctional genesis according to the “organ to organ” principle.

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The thyroid gland is one of the most important human endocrine organs. It is located on the front surface of the neck, and in an adult it has a weight of no more than 20 g. But, even despite its small size, the thyroid gland plays a huge role in the functioning of the whole organism. Its main function is the production of the hormones thyroxine and triiodothyronine. The main composition of these hormones is iodine, and it is necessary in order to control the optimal amount of these components in the human body. In turn, thyroxine and triiodothyronine take an active part in the metabolism of such useful substances in the body as proteins, fats and carbohydrates, and also control the amount of vitamins and minerals necessary for a person. In other words, thanks to the thyroid gland, all life-important processes in the body are regulated.

If we take into account the period of pregnancy, then all organs and systems in a woman's body work differently, including the thyroid gland. In almost all women who are expecting a baby, the thyroid gland increases, because it feels a double load. In general, this is considered normal, but it is very important to monitor the condition of this organ throughout pregnancy. Because even if you have some violations, usually they do not manifest themselves in any way, and the expectant mother will not feel any discomfort.

For the fetus, a healthy thyroid gland plays an important role, because it is responsible for the normal development of the cardiovascular, reproductive, nervous and musculoskeletal systems. In the child himself, the formation of the thyroid gland begins at the end of the first month of pregnancy (4–5 weeks). Already at the end of the third month of pregnancy, this organ begins to accumulate iodine in the body and synthesize hormones (thyroxine and triiodothyronine). And at 5–6 months, the thyroid gland functions intensively inside a small organism.

It is in the first trimester of pregnancy that the expectant mother should consume a sufficient amount of iodine in her food. After all, if her body experiences a deficiency of this component, the thyroid gland will produce an insufficient amount of hormones. This, in turn, can affect both the physical and mental development of the child.

Causes of an enlarged thyroid gland

Despite the fact that during pregnancy an increase in the thyroid gland is considered normal in some cases, there are also other reasons why this problem may appear and be pathological:

• iodine deficiency in the body due to unbalanced nutrition;
• hormonal failure in the body;
• stay in an area with a polluted environment or exposure to radiation;
• violation of the functioning of the thyroid gland as a result of operations in this area;
• complete or partial absence of the thyroid gland (congenital pathologies or surgery);
• malignant and benign tumors.

Treatment and prevention of an enlarged thyroid gland

Often pregnant women think that any ailments in their condition are normal, including an enlarged thyroid gland. They are convinced that it is worth a little rest and take care of yourself and everything will pass. Unfortunately, this is a very erroneous opinion, because during pregnancy it is necessary to carefully monitor your health.

If your doctor suspects that you have an enlarged thyroid problem, then he is obliged to send you for an additional examination in order to accurately confirm the diagnosis. Also in this case, it is necessary to consult an endocrinologist. Diagnosis of the thyroid gland is carried out using a blood test and ultrasound. There is also an easier way to check if you have thyroid problems, namely, whether there is iodine deficiency in the body. This diagnostic method is safe and can be done very simply at home. It is necessary to dip a cotton swab in iodine and draw 2-3 strips on the elbow or wrist. If during the day these strips disappear - this is a clear sign of a lack of iodine in the body. Other disorders in the functioning of the thyroid gland must be diagnosed in a medical institution under the supervision of doctors.

After the diagnosis is confirmed, the treatment of a pregnant woman should be carried out under the strict supervision of doctors in a hospital. If iodine deficiency is observed with an enlarged thyroid gland, then the patient is prescribed drugs containing iodine, and the menu of the pregnant woman is also necessarily corrected. The diet should contain foods that are rich in iodine, such as seafood, seaweed, fruits and vegetables (especially tomatoes, eggplant and potatoes).
Adhering to all the recommendations, it is also necessary to replace ordinary water with iodized water. And you should cook meals only with the addition of iodized salt. But it is important to remember that very salty foods are harmful for pregnant women. Therefore, it is important to observe a certain dose, since an excess of iodine in the body of a future mother can cause hyperthyroidism.

If a woman has this pathology, then with the timely diagnosis of this problem, pregnancy can be saved. In order to suppress the active production of hormones, special medications are prescribed with a minimal threat to the fetus. In the case when such treatment does not work, an operation may be performed to remove part of the thyroid tissue. But this type of surgery is possible only in the second trimester of pregnancy.

Consequences of an enlarged thyroid gland during pregnancy

If you control the state of the thyroid gland throughout pregnancy, then the expectant mother and baby will have a completely favorable outcome. Unfortunately, often women in anticipation of a baby do not even suspect that an increase in the thyroid gland can be pathological in nature and cause such phenomena as:

• detachment of the placenta and, as a result, premature birth;
• frozen pregnancy and spontaneous miscarriage;
• stillborn fetus;
• intrauterine or postpartum bleeding;
• heart failure in a child;
• increased blood pressure and arterial hypertension in the mother;
• the birth of a child with mental or physical disabilities.

In addition to the above problems, a pregnant woman can be expected, and other troubles are provoked by an enlarged thyroid gland, among which are hyperthyroidism and hypothyroidism.

Hyperthyroidism is an excessive activity of the thyroid gland, as a result of which there is a high risk of violations, both in the health of the expectant mother and in the development of the fetus. Quite often there are cases when a child is born with various diseases of the thyroid gland.

With this diagnosis, the following changes can occur in a woman’s condition: disturbances in the work of the heart, lowering blood pressure, general weakness, stomach pain, insomnia, weight loss and severe hair loss.

American scientists conducted a lot of research, where they proved that an excess of hormones that the thyroid gland secretes during pregnancy is very dangerous, since the body is poisoned from the inside. This can certainly affect the fetus, since often women with such a diagnosis give birth to babies with various pathologies. As a rule, in dangerous situations, doctors recommend terminating the pregnancy.

Hypothyroidism is a disorder in the thyroid gland, in which an insufficient amount of the hormones thyroxine and triiodothyronine is produced. With this diagnosis, pregnant women can often experience miscarriages, premature births, or cases of stillbirth. In addition, children are born with mental or physical disabilities.

With such disorders, a pregnant woman feels weakness, pain in the joints and muscles, skin problems, as well as frequent constipation and nausea.

Unlike hyperthyroidism, this diagnosis can be corrected with the help of medications, since a lack of iodine is easier to eliminate than its excess. To do this, the attending physician prescribes special preparations for pregnant women containing potassium iodide.

If the treatment was successful, and the pregnancy and childbirth ended favorably for both the mother and the baby, then this, unfortunately, may not be the end. Often, after being discharged home, an unpleasant phenomenon called “postpartum thyroidin” can occur. During the recovery process after childbirth, the immune system may not be able to cope and begin to produce antibodies, which, in turn, can destroy thyroid cells. There is a slight increase in the thyroid gland, which is generally not dangerous for mom and baby. As a rule, this condition resolves on its own without treatment within 4-6 months. However, even after childbirth, it is very important to be regularly examined by an endocrinologist, which will help eliminate the problem in time. After all, any disturbances in the functioning of the thyroid gland do not manifest themselves internally, where there is a danger of triggering the disease. Also, always stick to proper nutrition, which will contain all the necessary components for your health.

As you can see, both deficiency and excess of iodine are very dangerous for the body, especially when it comes to pregnancy. Therefore, as soon as you see two strips on a pregnancy test, immediately consult a doctor. After all, the sooner you discover some kind of ailment, the greater the likelihood that you and your baby will be healthy. Even better, at least once a year, undergo a mandatory medical examination of the main specialists, because if you take care of yourself before pregnancy, you will not have any health problems!

For more information about changes in thyroid size during pregnancy, see here:

Pregnancy is a special condition for a woman. This condition is physiological (that is, normal), but at the same time it requires a lot of expenses from the body and involves all organs and systems. Today we will talk about how pregnancy proceeds against the background of thyroid diseases and how pregnancy can provoke conditions such as hypothyroidism and thyrotoxicosis.

What is a thyroid gland?

The thyroid gland, despite its small size, is an extremely important organ of internal secretion (hormonal organ). The thyroid gland consists of two lobes and an isthmus, located on the front surface of the neck. The functions of the thyroid gland include the synthesis and secretion of hormones.

Thyroid hormones: thyroxine (T4) and triiodothyronine (T3). The hormone that regulates the production of these hormones is synthesized in a special part of the brain (pituitary gland) and is called TSH (thyroid stimulating hormone).

Thyroid hormones are involved in almost all types of metabolism (especially protein and energy metabolism), the synthesis of vitamins (vitamin A in the liver), and also take part in the regulation of the production of other hormones. All thyroid hormones contain iodine atoms, so iodine appears in many drugs used for treatment (prophylactic administration of potassium iodide preparations, radioactive iodine for the treatment of thyroid tumors).

The effect of pregnancy on the thyroid gland

The thyroid gland during pregnancy increases in size and enhances its functions. Thyroxine is produced by 30 - 50% more compared to the initial level. The physiological function of the thyroid gland begins from the earliest dates, since a sufficient level of thyroid hormones drastically affects the growth and development of the fetus (we will tell you more about the effect of thyroid hormones on the development of the baby below), and the laying of all life systems occurs in the first 12 weeks. Therefore, it is very important to approach pregnancy with a healthy gland, or a compensated state if there is any disease.

In areas endemic for goiter and hypothyroidism, it is necessary to receive iodine prophylaxis even in preparation for pregnancy, and then the entire period of gestation and lactation. An endemic area is an area in which certain diseases predominate, the presence of diseases is not associated with the migration of the population or the introduction of the disease from outside. For example, in our case, endemic regions will be: Krasnoyarsk Territory, the Republic of Sakha, Buryatia, Tyva, Perm and Orenburg regions, Altai, Transbaikalia (iodine deficiency is detected in 80% of the population).

The enlargement of the thyroid gland in size is due to the increased blood supply that is required to provide increased function. In ancient Egypt, a thin silk thread was tied around the neck of a girl who had just entered into marriage and observed. When the thread broke, it was considered a sign of pregnancy.

Thyroid diseases are divided into those that occur with a decrease in function and, conversely, with excessive production of hormones. Separately, oncological diseases of the thyroid gland are taken into account, these are cancer and thyroid cysts.

Diagnosis of thyroid diseases

First of all, a pregnant woman with suspicion of any thyroid disease should be examined by an endocrinologist. He conducts a patient survey to collect characteristic complaints, a general examination (skin color, moisture or, conversely, dry skin and mucous membranes, hand tremor, swelling, size of the palpebral fissure and the degree of its closure, visual enlargement of the thyroid gland and the front of the neck), palpation thyroid gland (an increase in its size, an isolated thickening of the isthmus of the gland, consistency, soreness and mobility, the presence of large nodes).

1. The level of thyroid hormones. TSH (thyroid stimulating hormone) is an indicator that is used to screen for thyroid diseases, if this indicator is normal, then further research is not indicated. This is the earliest marker of all dishormonal thyroid diseases.

The norm of TSH in pregnant women is 0.2 - 3.5 μIU / ml

T4 (thyroxine, tetraiodothyronine) circulates in plasma in two forms: free and bound to plasma proteins. Thyroxine is an inactive hormone, which in the process of metabolism is converted into triiodothyronine, which already has all the effects.

Norm T4 free:

I trimester 10.3 - 24.5 pmol / l
II, III trimester 8.2 - 24.7 pmol / l

T4 general norm:

I trimester 100 - 209 nmol/l
II, III trimesters 117 - 236 nmol / l

The norm of TSH, free T4 and total T4 in pregnant women differ from the general norms for women.

Tz (triiodothyronine) is formed from T4 by splitting off one iodine atom (there were 4 iodine atoms per 1 molecule of the hormone, and now there are 3). Triiodothyronine is the most active thyroid hormone, it is involved in plastic (tissue building) and energy processes. T3 is of great importance for metabolism and energy exchange in the tissues of the brain, heart tissue and bone.

Norm T3 free 2.3 - 6.3 pmol / l
Norm T3 total 1.3 - 2.7 nmol / l

2. The level of antibodies to various components of the thyroid gland. Antibodies are protective proteins that the body produces in response to the ingress of an aggressive agent (virus, bacterium, fungus, foreign body). In the case of thyroid diseases, the body exhibits immune aggression towards its own cells.

For the diagnosis of thyroid diseases, indicators of antibodies to thyroglobulin (AT to TG) and antibodies to thyroperoxidase (AT to TPO) are used.

Norm of AT to TG up to 100 IU / ml
AT norm to TPO up to 30 IU/ml

Of the antibodies for diagnosis, it is advisable to investigate antibodies to thyroid peroxidase or both types of antibodies, since the isolated carriage of antibodies to thyroglobulin is rare and has less diagnostic value. Carriage of antibodies to thyroid peroxidase is a very common situation that does not indicate a specific pathology, but carriers of these antibodies develop postpartum thyroiditis in 50% of cases.

3. Ultrasound of the thyroid gland. Ultrasound examination determines the structure of the gland, the volume of the lobes, the presence of nodes, cysts and other formations. With doplerometry, the blood flow in the gland, in individual nodes, is determined. Ultrasound is performed during primary diagnosis, as well as in dynamics to monitor the size of the lobes or individual nodes.

4. Puncture biopsy - this is taking an analysis exactly from the focus (nodule or cyst) with a thin needle under ultrasound control. The resulting fluid is examined microscopically to look for cancer cells.

Radionuclide and radiological methods during pregnancy are strictly prohibited.

Pregnancy due to hypothyroidism

Treatment

Treatment is carried out with thyreostatic drugs of two types, imidazole derivatives (thiamazole, mercasolil) or propylthiouracil (propicil). Propylthiouracil is the drug of choice during pregnancy, as it penetrates the placental barrier to a lesser extent and affects the fetus.

The dose of the drug is selected in such a way as to maintain the level of thyroid hormones at the upper limit of the norm or slightly above it, since in large doses, which lead to normal T4 values, these drugs cross the placenta and can lead to suppression of fetal thyroid function and the formation of goiter at the fetus.

If a pregnant woman receives thyreostatics, then breastfeeding is prohibited, since the drug penetrates into milk and will have a toxic effect on the fetus.

The only indication for surgical treatment (removal of the thyroid gland) is intolerance to thyreostatics. Surgical treatment in the first trimester is contraindicated, according to vital indications, the operation is performed starting from the second trimester. After the operation, the patient is prescribed hormone replacement therapy with levothyroxine for life.

As concomitant therapy, beta-blockers (betaloc-ZOK) are often prescribed with the selection of an individual dose. This drug slows down the heartbeat by blocking adrenaline receptors, and thereby reduces the load on the heart and prevents the development of heart failure and arterial hypertension.

Pregnant women with developed on the background of thyrotoxicosis cardiac pathology are subject to joint management by an obstetrician - gynecologist, endocrinologist and cardiologist.

Prevention

Unfortunately, it is impossible to prevent this condition as an independent disease. But you can protect yourself and your unborn baby as much as possible, minimize the risk of complications if you know about the disease before pregnancy and start treatment in a timely manner.

Tumors of the thyroid gland

Primary detection of thyroid tumors during pregnancy is a rarity. In terms of diagnosis, nothing changes, it is necessary to determine the level of thyroid hormones, perform an ultrasound scan.

Differential diagnosis between gland cysts and malignant neoplasms is performed using a puncture of the formation under ultrasound control. Based on the results of a cytological examination, a diagnosis will be established.

Cysts of the thyroid gland with a normal level of hormones and a negative result of the puncture (that is, no cancer cells were found) are subject to observation.

Tumors of the thyroid gland are subject to observation and treatment by an oncologist. The possibility of prolonging pregnancy against the background of a malignant neoplasm of the thyroid gland is decided at the council, but the final decision is always made by the patient herself.

Hypothyroidism and thyrotoxicosis do not deprive you of the opportunity to give life to the desired baby, but only require you to be much more disciplined in relation to your health. Thyroid diseases are not a categorical contraindication to independent childbirth. Plan your pregnancy ahead of time. Approach her with confidence in your health or a compensated state of chronic diseases, do not miss visits to your obstetrician-gynecologist, endocrinologist and other specialist doctors and follow their recommendations. Look after yourself and be healthy!

Obstetrician-gynecologist Petrova A.V.

The thyroid gland is called the main center of hormone synthesis. It affects the work of all body systems, including sexual.

The organ is prone to abnormalities and vulnerable to disease. Thyroid disorders often lead to problems with fertilization and childbearing, and also adversely affect the development of crumbs inside the mother's womb.

How does the thyroid gland affect conception and pregnancy?

Thyroid hormones affect the metabolic processes and the functioning of the organs of the gastrointestinal tract, nervous, cardiovascular and urogenital systems. When the endocrine background changes, the monthly cycle goes astray. This entails a disorder in the maturation of the eggs.

Without ovulation, pregnancy is impossible: infertility occurs. With pathologies of the thyroid gland, conception occurs in rare cases. If it does happen, gestation is interrupted in the early stages.

Excessive production of thyroid hormones leads to polycystic ovaries, fibrocystic mastopathy. This condition significantly reduces the ability to conceive a child.

When a woman becomes pregnant, the attending physician monitors the hormonal levels of the thyroid gland. With deviations in their content, the expectant mother develops consequences - early toxicosis, preeclampsia, chronic hypoxia of the child inside the womb, discoordination of labor.

Substances form the cardiovascular, nervous, central nervous and reproductive systems of the child. Pathology causes mental and physical abnormalities in the development of the crumbs.

Thyroid hormone levels:

Name	Values ​​during planning	Indications during pregnancy
TSH	0.4–4 µIU/ml	0.2–3.5 µIU/ml
T3 general	1.23-3.23 nmol/l	1.3–2.7 nmol/l
T3 free	2.6–5.7 nmol/l	2.3–6.3 nmol/l
T4 general	71–143 nmol/l	100-209 nmol / l - in the 1st trimester
		117-236 nmol / l - in 2-3 trimesters
T4 free	10–22 nmol/l	10.3-24.5 nmol / l - in the 1st trimester
		8.2-24.7 nmol / l - in the 2nd and 3rd trimesters

Features of the thyroid gland during pregnancy

From an early date, the endocrine organ begins to function intensively. Normally, the production of substances increases by 30–50% when all organs are laid and formed. Thyroid hormones of a woman provide embryogenesis.

Human chorionic gonadotropin is the most powerful stimulant of the gland. HCG is synthesized by the placenta and is similar in properties to TSH. The substance is intensively formed in the mother from the first weeks of pregnancy, so the concentration of thyroid-stimulating hormone decreases.

If a woman is expecting twins or triplets, there is so much human chorionic gonadotropin that TSH production is suppressed. At 10-12 weeks, the hCG content drops, and the amount of thyroid-stimulating hormone increases. In the first trimester, TSH levels are lowered, and this is not a deviation.

Increased production of estrogen - additional stimulation of the thyroid gland. They provoke the formation of TSH in the liver. Globulin binds thyroid hormones, rendering them inactive.

In pregnant women, the total fractions of T3 and T4 are increased. Doctors prescribe studies specifically for free forms of substances.

With the onset of the gestational period, renal circulation increases. Iodine is excreted in the urine, which stimulates the production of substances by the thyroid gland.

If the organ functions normally, the concentrations of T3 and T4 increase. Hypothyroxinemia does not threaten the consequences for a non-pregnant woman. However, when carrying a child, the condition is fraught with danger to the fetus and the expectant mother.

Possible thyroid disorders

Deviations in the work of the body and pregnancy are closely related. Some pathologies of the thyroid gland are formed due to hormonal changes in the body and the harmful effects of external factors.

Consider the main diseases of the thyroid gland.

Hypothyroidism

Pretty common violation. It is characterized by an insufficient content of iodine in the body, followed by a deficiency of hormones.

The condition sometimes occurs even before pregnancy. Be sure to undergo a full examination during the planning of the child.

What are the complaints?

• increased fatigue;
• significant weight gain;
• loss of appetite;
• dry skin;
• fragility of nails and hair;
• swelling mainly in the face and legs;
• dyspnea;
• hoarseness of voice.

When symptoms are detected, the doctor conducts additional diagnostics. If the diagnosis is confirmed, a course of treatment will be required.

To replenish the level of T3 and T4, the doctor conducts replacement therapy. It is also performed during the period of bearing a child, since hypothyroidism increases the risk of miscarriage, premature delivery and intrauterine death of the crumbs. A significant drop in the content of thyroid hormones leads to mental retardation, deafness, and strabismus.

In the following video, an endocrinologist answers questions related to hypothyroidism in detail:

Hyperthyroidism

The level of T3 and T4 is too high. The condition is physiological in nature to meet the needs of the fetus. In a number of situations, doctors recognize excessive work of the body as a deviation.

Nodular goiter is the most common manifestation of hyperthyroidism. The disease is accompanied by the formation of large nodes. The main difference between hyperthyroidism and thyrotoxicosis is an increase in the volume of the organ.

Pregnancy with pathology is not excluded. To avoid a harmful effect on the baby, the doctor corrects T3 and T4 in the blood.

The entire period of bearing a child is strictly controlled by an endocrinologist. Don't worry: expectant mothers usually don't have surgery, even if the knot is larger than 4 cm. Surgery is indicated when the mass compresses the trachea, interfering with normal breathing.

What symptoms should alert you:

1. Increased fatigue.
2. Sudden weight loss.
3. Increase in body temperature.
4. Irritability and unreasonable fear.
5. Insomnia.
6. Increased heart rate and blood pressure.
7. Trembling of the hands and muscle weakness.
8. Expansion of the ocular fissures.
9. Hyperplasia of the gland.

The consequences of hyperthyroidism are dangerous with late preeclampsia, premature birth, anomalies in the development of the fetus, and low birth weight of the child. If the disease is detected in a timely manner, the likelihood of a healthy baby is high.

Euthyroidism

This is a borderline condition characterized by the growth of thyroid tissue in the form of diffuse enlargement or nodes with a normal content of thyroid hormones. The breach is considered temporary. Usually, against the background of euthyroidism, serious changes occur, accompanied by hypo- or hyperfunction of the endocrine organ.

The main manifestations of pathology:

• insomnia;
• pain in the neck of a pressing character;
• sensation of a coma in the throat with a violation of swallowing;
• emotional stress;
• visible increase in the size of the thyroid gland;
• fast fatiguability.

To overcome the disease, the doctor prescribes iodine preparations. With the ineffectiveness of conservative therapy and the appearance of large nodes or cysts, surgical intervention is performed with a biopsy.

thyroid cancer

A malignant neoplasm is not considered an indication for abortion. Expectant mothers most often found papillary adenocarcinoma.

Women undergo a study of the function of the tumor and its biopsy. The puncture is especially important when the size is over 2 cm.

Clinical guidelines state that the operation to remove the neoplasm is carried out in the 2nd trimester. If the tumor is detected in the 3rd trimester, treatment is delayed until delivery. Fast-growing cancers are removed regardless of gestational age. After resection, suppressive doses of thyroid hormone will have to be taken.

Chronic autoimmune thyroiditis

This is a disease that occurs due to the formation of antibodies to one's own cells. The immune system destroys the thyroid gland. Pathology is inherited from parents or caused by mutations.

Autoimmune thyroiditis negatively affects the body of the expectant mother. If a woman does not receive treatment, a miscarriage or premature birth occurs.

The main manifestations of AIT:

1. Hypoplasia of the thyroid gland.
2. Detection during palpation of painless seals.
3. Slight weight loss.
4. Tachycardia.
5. Increased irritability.
6. Euthyroidism.

To diagnose the disease, you need to take an analysis for antibodies to thyroglobulin and thyroperoxidase. When immunoglobulins to both substances are detected, doctors consider this a bad sign. Autoimmune thyroiditis has already developed in the body, or it will appear soon.

Replacement therapy is prescribed to suppress chronic inflammation of the organ. It compensates for the deficiency of thyroid hormones and prevents hypothyroidism.

Pregnancy after surgical removal of the gland

In the absence of an organ, changes will affect metabolic processes and affect the central nervous and reproductive systems of a woman.

Is it possible to get pregnant after a complete organ resection? Yes it is possible. However, you will have to strictly follow all doctor's prescriptions.

Possible violations during the removal of the gland:

1. hypocalcemia. The condition is accompanied by an acute lack of calcium in the blood. A low concentration of a chemical element threatens with impaired heart function, reduced bone mineralization, and muscle atony. Due to the deficiency of the substance, the intrauterine development of the fetus will also be disturbed.
2. miscarriage. In women with a removed gland, the hormonal background changes greatly, which increases the risk of spontaneous abortion. To cope with the pathology, courses of substitution therapy are needed.
3. The development of chromosomal abnormalities in a baby. When radioactive iodine is used during resection of the gland, the original DNA code is violated. This is fraught with the birth of a child with genetic abnormalities.

Is it possible to do an ultrasound of the thyroid gland during pregnancy

Any research during the "interesting position" must be justified. Usually those procedures are prescribed that cannot be dispensed with.

Ultrasound diagnosis of the thyroid gland is done only when indicated. The procedure is simple and does not require special training.

What are the symptoms of an ultrasound?

• constant sleepiness;
• increased irritability and unreasonable aggressiveness;
• significant weight fluctuations;
• the appearance of asthma attacks;
• determination of seals or neoplasms in the thyroid gland during palpation examination.

The earlier violations are detected, the less the manifestations of the disease affect the course of pregnancy and the fetus. If your doctor recommends a test, don't be afraid to take it. Ultrasound diagnostics will not harm the baby.

How to avoid thyroid disease - preventive measures

To prevent possible pathologies, the expectant mother needs to restore the endocrine system. It is advisable to normalize the function of the gland even before pregnancy - at the planning stage. Undergo a complete medical examination to exclude pathology.

The complex of prevention includes taking iodine-containing drugs. You will have to drink them from the first weeks of gestation until childbirth. Additional intake of iodine reduces the threat of goiter and restores hormonal production.

Add iodized salt and bread to your diet.

Replace tap water with special mineral water, which will contain the necessary trace elements.

Also on the menu should be sea fish, kelp, squid, mussels, shrimp, lean meat, milk. Eliminate fatty, fried and spicy foods, alcoholic beverages, coffee and fast food.

An important rule of prevention is maintaining a normal weight. Avoid becoming overweight. This negatively affects the gland: during the gestational period, it works hard.

Try not to stay in the open sun for a long time and in no case visit the solarium. It is advisable to walk in the morning and evening.

Conclusion

The thyroid gland and pregnancy are closely related. During the period of bearing a child, the endocrine organ ensures both the full development of the fetus and the health of the expectant mother. Thyroid hormones contribute to the normal functioning of the central nervous, cardiovascular, musculoskeletal system of the baby.

Throughout pregnancy, the attending physician monitors the functioning of the thyroid gland. For any deviations, he conducts blood tests for hormones and ultrasound diagnostics. During treatment, iodine-containing drugs, replacement therapy, or even surgery may be prescribed.

Thyroid gland: what is it for?

The thyroid gland is located on the anterior surface of the neck, anterior to the trachea. It has the shape of a butterfly. The thyroid gland is the only organ that synthesizes organic substances containing iodine. It is an endocrine gland that produces the hormones thyroxine (T4) and triiodothyronine (T3). They are involved in the metabolism and energy, growth processes, maturation of tissues and organs. Synthesis of these hormones occurs in special cells of the thyroid gland, called thyrocytes. The thyroid gland also produces the hormone calcitonin. It is involved in the formation of new bone tissue.

The activity of the thyroid gland in the production of hormones is regulated by higher centers: the pituitary gland, the hypothalamus and the central nervous system (CNS). Understanding these relationships is necessary to explain the mechanism of disorders occurring in the reproductive system of a woman in diseases of the thyroid gland.

Hypothyroidism: who is at risk?

Hypothyroidism is a disease characterized by a decrease in the function of the thyroid gland and a decrease in the content of the hormones that it produces in the blood serum. Hypothyroidism is one of the most common endocrine pathologies. It is more common in women than in men. Every tenth representative of the fair sex suffers from this disease.

Hashimoto's autoimmune thyroiditis (AIT) is the most common. This is a disease caused by autoimmune attacks of one's own antibodies, which are necessary to protect against invading foreign agents: viruses, bacteria, etc. In autoimmune conditions, for unknown reasons, antibodies begin to be produced uncontrollably and kill their "native" cells. As a result of such attacks, cells can die, as a result of which the function of the organ that is targeted by the immune attack suffers. In AIT, it is the thyroid gland.

Why does hypothyroidism occur?

Whatever the reason for the decrease in thyroid function, in any case, with hypothyroidism, there is a decrease in the synthesis of the hormones T3, T4 and calcitonin. Since all these hormones are very important for the life of the body, a signal about their lack comes to the regulatory centers: the pituitary gland and the hypothalamus.

In response to the "request from below", the "leadership from above" (pituitary and hypothalamus) gives the "command" to activate the thyroid gland. To implement this command, special substances are released that enter the thyroid gland through the blood. Due to this, the production of its hormones increases: the pituitary gland secretes thyroid-stimulating hormone (TSH), the hypothalamus secretes thyroliberin, and the concentration of these substances in the blood increases sharply.

But the problem is that the "factory" for the production of hormones, that is, the thyroid gland, "broke": the commands cannot be executed! "Commanders" (pituitary and hypothalamus) continue to give "orders" that it is necessary to restore the production of hormones important for life, that is, they secrete TSH and thyroliberin. And the "factory" does not respond to commands: T3 and T4 remain at a low level.

How is it manifested?

The most common manifestations of hypothyroidism are:

Metabolic disorders: obesity, lowering body temperature, chilliness, cold intolerance, yellowness of the skin.

Edema: puffiness of the face, teeth marks on the tongue, swelling of the legs and arms, difficulty in nasal breathing (associated with swelling of the nasal mucosa), hearing impairment (swelling of the auditory tube and middle ear organs), hoarse voice (swelling and thickening of the vocal cords).

Often, with hypothyroidism, there are lesions of the nervous system: drowsiness, lethargy, memory loss, muscle pain, paresthesia, decreased tendon reflexes.

Lesions of the digestive system: liver enlargement, biliary duct dyskinesia, colon dyskinesia, a tendency to constipation, decreased appetite, atrophy of the gastric mucosa, nausea, sometimes vomiting.

Manifestations of anemia: brittle nails and hair, dry skin.

Cardiovascular disorders: cardiac arrhythmias, bradycardia, angina pectoris, circulatory failure, hypotension.

The consequence of a deficiency of thyroid hormones can be violations of the genital area: bleeding (menorrhagia) or, conversely, rare scanty menstruation (oligomenorrhea) or their absence (amenorrhea); infertility.

With hypothyroidism, an increase in the level of prolactin is very often determined, which contributes to the release of milk or colostrum from the nipples (galactorrhea).

Thyroid examination

If complaints characteristic of hypothyroidism are detected, it is necessary to do an ultrasound of the thyroid gland, as well as a laboratory examination, including determining the levels of:

1. TSH,
2. free T4,
3. antithyroid antibodies.

Hypothyroidism and infertility: how are they related?

The cause of infertility in hypothyroidism is a violation of the ovulation process due to a deficiency of thyroid hormones, leading to a change in the processes of synthesis, transport and metabolism of female sex hormones.

Patients with antithyroid antibodies also have a higher number of failed IVFs than women without them. Therefore, carriers of antithyroid antibodies are at risk of early reproductive losses, which requires special monitoring of this category of women even at the stage of pregnancy planning.

Therefore, thyroid examination is mandatory in women with infertility.

Hypothyroidism during pregnancy

Recently, there has been evidence of an increase in the incidence of miscarriage in women with high levels of antithyroid antibodies. The risk of spontaneous termination of pregnancy in them exceeds that in women without antibodies by 24 times. It rises in the first trimester of pregnancy. In the future, in women with a history of recurrent miscarriage (3 or more spontaneous miscarriages), this risk increases with increasing gestational age.

Pregnancy and childbirth in women with thyroid pathology are characterized by a high incidence of a number of complications: early toxicosis, preeclampsia, chronic intrauterine fetal hypoxia, discoordination of labor.

Hormonal changes that occur during pregnancy lead to an increase in the load on the thyroid gland of the expectant mother. For almost the entire first half of pregnancy, the fetal thyroid gland is not yet functioning, and its development is fully dependent on the woman's thyroid hormones.

An adequate level of thyroid hormones in a pregnant woman is essential for normal embryogenesis. Thyroid hormones regulate the processes of development, maturation, specialization and renewal of almost all fetal tissues and are of exceptional importance for the laying and development of the brain, the formation of the child's intelligence, the growth and maturation of the bone skeleton, the reproductive system, affect sexual development, menstrual function and fertility an unborn baby.

Therefore, the need for thyroid hormones during pregnancy increases by 40-50%. If the future mother initially had reduced thyroid function, then during pregnancy, the deficiency of her hormones will be aggravated, the fetus will not receive the substances necessary for its development and growth, which will inevitably lead to irreversible pathology in the baby. First of all, this will affect the development of his central nervous system, cretinism may occur.

Treatment of hypothyroidism

In hypothyroidism of any etiology, replacement therapy with synthetic thyroid hormones in an individually selected dose is indicated. The most commonly used drugs are L-thyroxine. The goal of replacement therapy for primary hypothyroidism is to maintain TSH levels within 0.5–1.5 mIU/L.

In expectant mothers with compensated hypothyroidism, the dose of L-thyroxine should be increased immediately (usually by 50 mcg / day) as soon as pregnancy is declared. In case of hypothyroidism, first detected during pregnancy, a full replacement dose of L-thyroxine is immediately prescribed.

Happy pregnancy!