Schilddrüse und Schwangerschaft

Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function. Both overt and subclinical hypothyroidism have adverse effects on the course of pregnancy and development of the fetus. Hypothyroidism should be diagnosed and corrected before initiation of pregnancy. If hypothyroidism is diagnosed during pregnancy, thyroid function should be normalized as rapidly as possible. Adequate iodine intake is important. By hyperthyroidism differentiation of Graves’ disease from gestational thyrotoxicosis is possible by evidence of autoimmunity (morphologic change of goiter and TSH-receptor antibodies). For overt hyperthyroidism due to Graves’ disease or hyperfunctioning thyroid nodules antithyroid drug therapy should be either initiated or adjusted to maintain the maternal thyroid hormone levels for free T4 in the upper reference range for nonpregnant women. TSH screening should be obtained of patients who are at increased risk (such as miscarriage, preterm deliver miscarriage or history of thyroid disease, Age >?30 years, goiter, autoimmune disease such as diabetes mellitus type 1).