The thyroid gland is a small organ (its mass is only about 20 g), located on the front surface of the neck and is a bit like a butterfly in shape. She works out thyroid hormones - thyroxine (T4) and triiodothyronine (T3), which have a variety of effects on metabolism, oxygenation of cells, normal growth and physical development. In addition, these hormones play a major role in the laying and formation of the cardiovascular, reproductive systems, musculoskeletal system, as well as the central nervous system of the fetus, actually providing the intellectual potential of a person in the future. A special type of cell in the thyroid gland produces and secretes another very important hormone, calcitonin, into the bloodstream. It is involved in the regulation of calcium levels in the body.

How does the thyroid gland affect pregnancy?

In our country, at present, the determination of the work of the thyroid gland in women has become a mandatory item in the examination of all pregnant women. After they began to conduct this examination, it turned out that about 45% of women have various disorders in the thyroid gland. Moreover, most of them do not even assume that they have such problems, because almost all thyroid diseases do not manifest themselves in the early stages.

The laying of the thyroid gland in the fetus occurs on, and it begins to synthesize hormones on its own only from the 15th week. Up to this point, the fetus grows and develops due to the thyroid hormones of its mother. If there is an imbalance of thyroid hormones, then problems appear. At the beginning of pregnancy, this condition negatively affects the process of implantation of the fetal egg, which leads to placental insufficiency (when the placenta, which supplies the baby with oxygen and nutrients, ceases to fully cope with its work). At the very beginning of pregnancy, this can lead to intrauterine death of the fetus and miscarriage, the formation of malformations of the nervous system and sensory organs, oxygen starvation of the fetus.

With a pronounced deficiency of thyroid hormones throughout pregnancy, children are born with symptoms of cretinism: irreparable loss of intelligence, deafness, and motor disorders. That is why the examination of the thyroid gland of a woman and the timely correction of violations of her work at the stage of preparation for pregnancy are so important.

Iodine deficiency and endemic goiter

In our country, it is the most common cause of thyroid dysfunction. This is due to the fact that iodine is part of the thyroid hormones. The main reservoir of iodine in nature is the ocean. A lot of iodine in sea fish, algae, seafood. From the ocean, iodine compounds dissolved in drops of sea water enter the air and are carried by winds over long distances. The further inland the areas are, the less iodine is contained in fruits and vegetables grown in this territory.

Iodine depleted areas fenced off from sea winds by mountain ranges. Therefore, the vast majority of Russians live in conditions of iodine deficiency. The real amount of iodine obtained from food by the inhabitants of Russia is 40-60 mcg per day, while the need for this microelement in an adult is 150 mcg, and for a pregnant and lactating woman - 200-250 mcg per day. The only source of this substance for the thyroid gland of the fetus is the iodine that circulates in the mother's blood.

According to experts from the World Health Organization, iodine deficiency is the most common cause of mental retardation in children. Studies conducted around the world have shown that the average indicator of mental development in regions with severe iodine deficiency is 15-20% lower than where there is no lack of this substance. Due to the lack of iodine in food and water in our country, salt iodization is used. However, potassium iodide, which salt is enriched with, is easily oxidized to iodine in humid warm air and then volatilizes. This explains the short shelf life of such salt - only 6 months.

The most optimal means of iodine prophylaxis during pregnancy planning is considered to be reception. It is better to start taking iodine preparations at least 3 months before the planned pregnancy, which will avoid iodine deficiency in the most important first months. It is first necessary to pass an analysis for thyroid hormones, since the only contraindication to taking such drugs, in addition to an allergy to iodine, is an increased level of thyroxine (T4) and triiodothyronine (T3) in the blood.

Pregnancy is a load that makes a woman's thyroid gland work with a vengeance. Normally, hormone production increases by 30-50%. Pregnancy against the background of iodine deficiency often leads to the occurrence of endemic goiter (endemic from endemos - “local”, that is, characteristic of the area). This is due to the fact that during the bearing of a baby, a special hormone appears in the woman's body, which is synthesized by the cells of the fetal egg - human chorionic gonadotropin (hCG). This hormone is very similar in structure to the pituitary thyroid-stimulating hormone. The thyroid gland “confuses” hCG with TSH, responding to it with an increased function of its cells (cells grow, but these efforts are in vain, there is no main component for synthesis - iodine).

If there is not enough iodine, then the full synthesis of T4 and T3 hormones does not occur, the “feedback” mechanism does not work, which leads to the growth of thyroid tissue. At the same time, it can reach significant sizes, deforming the shape of the neck and squeezing the surrounding organs and tissues. Some women even get the feeling of an oppressive collar when turtlenecks and scarves get in the way.

Endemic goiter is easy to prevent if iodine deficiency in the body is replenished in a timely manner.

Treatment of endemic goiter

Treatment of endemic goiter consists in replenishing iodine deficiency, only in rare cases surgical intervention is required.

Hypothyroidism in pregnancy

With chronic iodine deficiency and some other diseases (for example, autoimmune thyroiditis), the synthesis of thyroid hormones decreases, a condition called hypothyroidism or hypothyroidism develops (from thyroidea - “thyroid”). Hypothyroidism can be asymptomatic (when changes can only be detected in laboratory tests), or it can be obvious, manifesting itself as general weakness, fatigue, drowsiness, depression, muscle cramps, joint pain, memory impairment, weight gain, dry skin, brittle nails and hair, constipation and swelling. Lack of hormones leads to a decrease in heart rate and respiratory rate, a drop in body temperature - patients feel chilly even in hot weather. Deficiency also affects the reproductive health of women: they often suffer from menstrual irregularities, mastopathy and infertility.

Hypothyroidism in pregnant women leads to the threat of abortion, placental insufficiency, early and late pregnancy toxicosis, persistent increase in blood pressure, placental abruption, postpartum hemorrhage. A sharp lack of thyroid hormones in the mother, of course, can affect the unborn child. In severe cases, congenital hypothyroidism develops, the signs of which in a newborn are a large body weight at birth, immaturity during pregnancy, swelling of the face, hands and feet, a low rough voice when crying, poor healing of the umbilical wound, prolonged jaundice. If such a child does not receive proper treatment, he will have a delay in mental and physical development and violations in the genital area.

How to treat hypothyroidism in pregnant women?

In some cases, in preparation for pregnancy, in addition to potassium iodide preparations, the treatment of reduced thyroid function is carried out with a synthetic analogue of the human hormone - thyroxin. Many people are afraid of the very word "hormones" and do not want to take them for anything, attributing terrible side effects to them. There are indeed side effects from the use of hormonal drugs, but all the “horrors” are associated with the use of glucocorticoids - adrenal hormones, and have nothing to do with thyroid hormone preparations.

In the case of hypothyroidism, a dose of the drug is selected that will only make up for the deficiency of the hormone - exactly as much as your body needs. It takes time to select the dose of the drug and compensate for hypothyroidism, so pregnancy should be postponed for several months until the moment when the level of hormones is normal. During treatment, hormone levels are monitored every 4-6 weeks.

When the hormones return to normal, it will be possible to plan a pregnancy. However, the expectant mother will have to continue taking the drug while carrying the baby (perhaps even in an increased dose), since the need for it during this period increases.

Hyperthyroidism during pregnancy

There is also a reverse situation, when the thyroid gland works too actively and secretes more hormones than necessary. In this case, it develops (thyrotoxicosis, Graves' disease). With this disease, the pulse becomes frequent, interruptions in the work of the heart occur, pressure rises, fever, insomnia, trembling of the hands and the whole body, loss of appetite, frequent loose stools, stomach pain, sweating and irritability may disturb. Hyperthyroidism also affects the appearance of a woman - she has an unhealthy shine of her eyes, enlargement of her eyes (as they say, they become "bulging"), weight loss.

During pregnancy, an excess of thyroid hormones can lead to spontaneous miscarriages, premature birth, toxicosis of the second half of pregnancy, the baby can be born with low weight and malformations.

How to treat hyperthyroidism?

Hyperthyroidism is treated with drugs that suppress the thyroid gland. With the ineffectiveness of drug therapy, an operation is performed to remove part of the thyroid tissue or therapy with a radioactive isotope of iodine. Against the background of treatment, it is necessary to use reliable methods of contraception, since thyrotoxicosis does not reduce the ability to conceive to the same extent as hypothyroidism. It is worth waiting with pregnancy, planning a conception is possible only with normal levels of hormones in the blood that persist for a year. This will prevent the recurrence of the disease during pregnancy. You will have to wait with pregnancy for a year even after treatment with a radioactive isotope of iodine. With the surgical treatment of thyrotoxicosis, pregnancy is allowed immediately after the hormone levels return to normal.

nodular goiter

A nodule in the thyroid gland is a part of the tissue of the gland, limited by the capsule. Nodes can be detected against the background of normal hormone levels, and also be accompanied by both their decrease and increase. Approximately 30-50% of the world's population find such formations, and, unfortunately, the number of such cases is steadily increasing. Almost always, the conclusion of a specialist about the discovery of a node in the thyroid gland causes concern in patients. But it is important to understand that this is not a diagnosis, but only a reason for an additional examination.

Iodine deficiency is the most important factor in the formation of thyroid nodules, which most often do not manifest themselves in any way, but are an accidental finding on ultrasound. In the case of a large node, the only complaint is a cosmetic defect in the neck. Concerns associated with nodes in the thyroid gland are due to the fact that in 4-5% of cases, thyroid cancer can be hidden under the mask of a node. It should be said that the size of the node and the level of hormones are not defining indicators that may indicate the malignancy of the process.

To determine the nature of the process (benign or malignant), a biopsy (a piece of gland tissue) is taken under the control of an ultrasound machine (ultrasound). Only with the help of this study can you accurately diagnose and determine what to do next. If thyroid cancer is detected, the organ is completely removed (thyroidectomy) followed by radioactive iodine therapy. The removed tumor is examined. In 95% of cases, a highly differentiated form is detected (tumor cells look like cells of a healthy thyroid gland), with this form, a complete cure is almost always possible. After a thyroidectomy, the body no longer produces its own thyroid hormones, and hormonal preparations must be taken throughout life. But there is good news - even after an operation for such a serious disease, a woman has every chance to endure and give birth to a healthy baby. You can plan a pregnancy about a year after the cure, provided that the hormone levels are good and there are no signs of tumor recurrence.

In conclusion, we draw the following conclusions:
1. Pregnancy is possible in almost any disease of the thyroid gland.
2. When planning a pregnancy, a visit to an endocrinologist is mandatory for all women.
3. Any pathology of the thyroid gland must be fully compensated before pregnancy.

Who controls the thyroid gland?

The work of the thyroid gland itself is regulated by the pituitary gland, through thyroid-stimulating hormone (TSH). This hormone stimulates the thyroid gland. The concentration of TSH depends on the level of thyroid hormones. If there are a lot of them in the blood, then the pituitary gland inhibits the production of TSH, and if there are few, it increases its synthesis so that it, in turn, begins to stimulate the thyroid gland, thereby normalizing the level of hormones that it secretes. This connection between the pituitary gland and the thyroid gland is called "reverse".

Thyroid examination in preparation for pregnancy

• Anatomy examination: an examination by an endocrinologist and ultrasound of the thyroid gland can determine changes in its size and structure (in particular, the presence of tumors).
• Function research: through . For the initial examination, two indicators are sufficient: the level of thyroid-stimulating hormone (TSH) and antibodies to thyroperoxidase (AT/TPO).
• If these indicators are violated, there were previously problems with the thyroid gland or there are changes in its anatomy, then the levels of the hormones thyroxine (T4), triiodothyronine (T3) and some antibodies to the thyroid gland are additionally examined.

Failure of immunity

In addition to iodine deficiency, reduced thyroid function can be observed when the immune system fails, when the immune system mistakenly takes thyroid tissue as a foreign agent and begins to produce certain antibodies to it, preventing it from working normally. This disease is called autoimmune thyroiditis. These antibodies (thyroid peroxidase antibodies, abbreviated as AT/TPO) can be detected in a blood test. By itself, an elevated level of antibodies does not require treatment, but their presence increases the risk of developing hypothyroidism tenfold. Therefore, all women who have been found to have such antibodies need to regularly monitor the functioning of the thyroid gland, especially in preparation for pregnancy and while carrying a baby.

Thyroid during pregnancy: hypothyroidism, hyperthyroidism. How does the thyroid gland affect pregnancy?

During pregnancy, changes occur throughout the body, but one of the most important organs during pregnancy is the thyroid gland, of course, after the reproductive system. Although their functions are closely related to the proper development of the baby, his mental abilities depend on the proper functioning of the pregnant thyroid gland, normal hormonal levels.

The topic is important and you should familiarize yourself with it so as not to panic, for example, after receiving an ultrasound report or a blood test for thyroid hormones during pregnancy and at the planning stage.

• How does the thyroid gland work
• Regulation of the thyroid gland during pregnancy is normal and in diseases of the thyroid gland
• thyroid ultrasound during pregnancy
• Changes in thyroid hormones during pregnancy
• Why does TSH decrease and is this the norm
• Iodine deficiency during pregnancy: how it affects pregnancy and what to do
• Symptoms of hypothyroidism
• Symptoms of hyperthyroidism
• Who needs to take TSH at the stage of pregnancy planning
• Hypothyroidism and pregnancy
• Features of treatment

How does the thyroid gland work and how is the regulation of its work

If we consider the issue quite simply, then the main task of the thyroid gland is to produce the hormone thyroxine. This hormone acts on all cells of body tissues and acts as a regulator of metabolic processes. In case of violation of the thyroid gland, many pathological changes occur, which during pregnancy affect not only the woman, but also the fetus.

The thyroid gland is quite small, located superficially on the anterior surface of the neck. It is easy to palpate. Therefore, any changes: enlargement, nodes, areas of dense tissue can be determined by manual examination. Ultrasound is done to clarify the diagnosis. Glandula thyreoidea - has the shape of a butterfly: two wings and an isthmus.

The work of the thyroid gland is regulated by another gland - the pituitary gland through. The work of the pituitary gland, in turn, regulates the hypothalamus. And all these interactions and connections are still influenced by the central nervous system.

Regulation of the thyroid gland

1. Norm option:

If the thyroid gland secretes enough hormones T₃ and T₄, then the pituitary gland determines their concentration as normal and releases the amount of the stimulating hormone TSH, which will be enough to maintain a stable level of thyroid hormones. This balance is normal.

1. Hypothyroidism:

If pathological processes have occurred in the body, as a result of which the thyroid gland synthesized less hormones, then the pituitary gland releases more TSH into the blood, thereby stimulating the thyroid gland in terms of hormone synthesis. In some cases, an increased level of TSH is accompanied by an increased concentration of thyroxine (T₄). If this situation can be compensated at this stage, then subclinical hypothyroidism occurs - there are no clinics, complaints and manifestations of the disease, but TSH is elevated, and thyroid hormones are still normal. Normal levels of T₃ and T₄ are maintained only through active stimulation of the thyroid gland by the pituitary gland through TSH.

At a certain point, the reserves of the thyroid gland are depleted, and an increase in TSH and a low level of thyroxine - T₄ are observed in the blood. This will be an insufficient function of the thyroid gland - hypothyroidism.

1. Hyperthyroidism:

In the reverse situation, a high concentration of thyroid hormones leads to a decrease in the production of the stimulant hormone TSH by the pituitary gland. This situation is called hypertoxicosis: TSH decreases and thyroxine rises.

Thyroid hormones during pregnancy

During pregnancy, it is primarily important, because when determining the concentration of only thyroxine (which will be within the normal range), one can falsely conclude that everything is normal with the pregnant woman's body. And at this time, TSH can be increased and the thyroid gland in a pregnant woman will work at the limit of her capabilities, only to maintain a normal level of T₃ and T₄.

At the same time, if the TSH level is normal, then the thyroid hormones will also be within the normal range. If TSH is increased or decreased, then T₄ and T₃ are examined.

If a pregnant woman is examined, she is given a referral for the study of TSH and thyroxine - T₄ free. This is done so that a woman is no longer sent to take tests, minimizing psychological stress before taking tests if the level of TSH is outside the normal range (increased or decreased).

There are two indicators of thyroxine: free and bound. The fact is that hormones are not just dissolved in plasma, but are associated with carrier proteins. A large proportion of thyroxin is associated with the carrier. Less than 1% of all thyroxine is in a free state. It is the free hormone that has its effect. Therefore, the free fraction of thyroxine is determined.

Triiodothyronine -T₃ is not routinely determined, only strictly according to indications.

There is another indicator that is prescribed quite often - antibodies to thyroperoxidase (AT-TPO). These are body proteins that are produced as a result of autoimmune processes, their action is directed against the thyroid gland and destroy its tissue. A high titer of antibodies should not be frightening, since the process of destruction is quite long and a decrease in thyroid function may not occur throughout life. An elevated level of AT-TPO is a reason to regularly monitor TSH (1 time in 3 months).

The superficial location of the thyroid gland allows you to examine the organ with your hands. An ultrasound of the thyroid gland during pregnancy can be done, but the study does not make sense without determining the TSH, and examining the endocrinologist. That is, the ultrasound method of research is assigned to clarify the diagnosis, if the endocrinologist sees an increase or determines the nodes during palpation.

The normal volume of the thyroid gland in women is up to 18 cm³. A node is considered to be a formation whose size exceeds 1 cm in diameter. If such a node is found on ultrasound, then it is advisable to puncture it and make sure that the process is not oncological.

Our country is in an endemic zone: almost everyone has mild and moderate iodine deficiency. Therefore, if thyroid hormones are normal, then nothing is usually done with such nodes.

Changes in thyroid hormones during pregnancy

During pregnancy, TSH levels decrease. The norm for a "non-pregnant" organism is 0.4-4 honey. In pregnant women, the TSH rate is lower:

• in the first trimester< 2,5 мЕд;
• in the second and third trimester< 3 мЕд.

Why does thyroid-stimulating hormone decrease during pregnancy?

The hormonal background during pregnancy changes, but it changes not quite the same. There are cases when human chorionic gonadotropin stimulates the thyroid gland very strongly and the TSH level can be less than 0.1 mU. In such a situation, if not, the pregnancy develops normally, there is no severe tachycardia (more than 140 beats per minute), this may be gestational hyperthyroidism, which does not require treatment. But one must always be on the alert for true thyrotoxicosis. If the level of TSH is very low and there are complaints, then you need to take a blood test for antibodies to TSH receptors, it is called AT-r-TSH. If these antibodies are not detected, then the transcendental decrease in TSH is associated with pregnancy, and not with diffuse toxic goiter.

Iodine deficiency during pregnancy

If there is enough iodine in food, then it is not necessary to prescribe drugs in the form of Iodomarin during pregnancy. But living in endemic areas provides for the appointment of iodine supplements at the planning stage and until the end of the third trimester. If a woman, being pregnant, goes to rest on the seashore, then the food that is grown on the coast is already rich in this element. Then the use of iodine tablets is not required. If you live in or go on vacation to a country where a universal salt iodization program has been adopted, then additional prescription of iodine preparations is also not necessary.

If a woman during pregnancy did not take additional iodine tablets and lived on lands with insufficient iodine content in the soil, then it is not necessary that the deficiency can affect the mental abilities of the baby. Most likely, the thyroid gland of a pregnant woman will try to compensate for iodine deficiency, it may increase in size in order to capture more iodine from the blood and provide the necessary amount of hormones for herself and the baby. In rare cases, hypothyroidism may occur.

Foods rich in iodine:

• seaweed;
• all types of marine fish and shellfish;
• squids;
• shrimps.

What you need to know about the thyroid gland during pregnancy

1. The starting point in diagnosing thyroid disease during pregnancy is the level of TSH.
2. Ultrasound of the thyroid gland is performed only according to indications.
3. When prescribing Iodomarin, the daily dose is 200 mcg per day, unless the doctor has prescribed otherwise. The drug should be taken throughout pregnancy and lactation. If you are relaxing at sea, in agreement with the doctor, the drug is temporarily canceled.
4. If L-thyroxine (Eutirox) has been prescribed, no experiments with the dose and frequency of administration can be carried out.

Features of the treatment of thyroid gland during pregnancy

L-thyroxine is taken on an empty stomach, at least 30 minutes before a meal. If you take the drug after breakfast or immediately before eating, the required dose will not fully enter the body. This is an identical hormone that the thyroid gland produces, it does not have a negative effect on the digestive organs.

During pregnancy, diseases of any organ of the expectant mother can be dangerous for the fetus. Therefore, it is necessary to engage in treatment immediately after the detection of any disease. The thyroid gland and pregnancy require special attention from the expectant mother, as it is one of the important human organs that produces the hormone thyroxine, which is responsible for the development of the nervous, cardiovascular and reproductive systems of the child.

Iodine is an essential element that every person needs. So, for example, its daily intake should be at least 150 mcg, during pregnancy this value is 200 mcg. If a woman is found to be deficient in iodine, she may develop hypothyroidism.

When planning a pregnancy, this organ is very important, since the quality of the hormones produced by the thyroid gland primarily affects the intelligence and mental abilities of the unborn child.

Being pregnant, in addition to tests, a woman should do an ultrasound to determine the condition of the fetus. This is a mandatory procedure that does not require special preparation. The only condition is access to the neck for research. Therefore, do not wear closed clothes and jewelry. This examination is carried out in the first trimester and with symptoms of diseases associated with the thyroid gland.

During the period of gestation, the thyroid gland of a woman begins to work with greater intensity than before pregnancy. So, for example, the hormone thyroxine is produced twice as much. Against the background of these factors, this organ increases in size. It was the enlargement of the thyroid gland in ancient times that was the first sign of pregnancy.

This organ begins to form in a child by the beginning of the second month of pregnancy, and already at week 12 it can accumulate iodine, and only by week 17 the organ is fully formed. There may also be temporary problems with the thyroid gland during pregnancy, which are called transient thyrotoxicosis. This condition usually does not require treatment and resolves on its own. It occurs in the first trimester.

Diseases in pregnant women associated with the thyroid gland

One of the diseases of the thyroid gland can be called hypothyroidism. As a rule, with such a disease, the doctor can prescribe hormone replacement therapy during pregnancy planning and during gestation. With such a disease, the risks of abortion are very high, and the following consequences of pregnancy may also appear:

• the birth of a dead child;
• low birth weight;
• congenital hypothyroidism;
• premature birth;
• the development of pathologies in a child relating to different organs;
• death of a child in the womb.

In addition to these complications, the woman herself feels terrible during pregnancy. For treatment, the doctor may prescribe food enriched with iodine or preparations based on it.

With hyperthyroidism, treatment is prescribed based on the symptoms of the disease. The symptoms of this disease include the following:

• hand trembling, muscle weakness;
• liquid stool;
• loss of appetite;
• increased sweating;
• failure or absence of menstruation;
• pain in the stomach;
• hair loss;
• fatigue;
• glitter in the eyes;
• respiratory failure;
• fever;
• increased nervousness, mood changes;
• weakness;
• feeling of thirst;
• palpitations, rapid pulse.

Iodine deficiency can affect a significant decrease in hormones responsible for the development of the child. Therefore, before planning, you need to take tests for the thyroid gland.

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Hyperthyroidism is a disease that occurs in pregnant women, which can go away without treatment, as described above. As a rule, it passes after the body adapts to new conditions for itself. The symptoms of this thyroid disease are similar to the development of hyperthyroidism, but there are also distinctive signs:

• depression;
• dyspnea;
• dryness of the skin;
• puffiness;
• difficulty in speaking.

Another disease of the thyroid gland is diffuse toxic goiter, in which the thyroid gland greatly increases in size and bulging eyes appear. This disease, a complication of which can be called thyrotoxicosis, needs immediate and complex treatment. First of all, it is associated with hyperfunction and hypertrophy of the thyroid gland.

This disease develops due to a decrease in immunity, as antibodies begin to be produced against TSH receptors, which affect the thyroid gland. And, as you know, during pregnancy, a woman's immunity decreases, and therefore the bearing of a child is one of the predisposing factors for the development of the disease. If the disease is not treated, it progresses, the thyroid gland will increase in size, and in medical language it will be called a goiter, hence the name of the disease.

With symptoms such as vomiting and weight loss, you should be examined by an endocrinologist. Although these are signs of pregnancy, they can be symptoms of serious diseases that are dangerous for the baby.

Is pregnancy possible in the absence of a thyroid gland

A person can do without a thyroid gland, but can a pregnant woman carry a healthy child without this organ? The answer to this question is positive. In the event that the thyroid gland was removed due to cancer or other serious diseases, then pregnancy can be planned no earlier than a year later, provided there are no relapses. During this time, it is necessary to undergo a rehabilitation course and monitor your health.

But during pregnancy, you need to pay special attention to the development of your fetus. In this case, tests for the thyroid gland during pregnancy will have to be taken regularly. In the event that we are talking about an acute shortage of hormones, you need to worry about the unborn child, as this can negatively affect him.

Thyroid problems after childbirth

After the birth of a child, the immunity of a newly-made mother is not yet stable, and therefore, at this time, disturbances in the functioning of the thyroid gland may appear. The immune system, on the contrary, begins to produce antibodies that can destroy the thyroid gland.

Similar problems occur in about 5% of mothers after pregnancy, whose children are less than three months old. Postpartum thyroiditis is a disease that develops against the background of the fact that the thyroid gland reduces the functions of its work. But this disease is not so dangerous for mom, because after 8-9 months it goes away without treatment, and immunity becomes what it was before pregnancy.

Not all people understand how the thyroid gland affects the normal development of the fetus. However, much depends on the state of this organ, including the development of the child. In addition, with problems with the thyroid gland, the probability of becoming pregnant is lower than in the absence of diseases related to this organ. Even if you do not have this disease, it is important to prevent it, and in case of problems, treat it in a timely manner.

It still seems that it is not easy to cure the thyroid gland?

Given that you are now reading this article, we can conclude that this ailment still haunts you.

You probably also had thoughts about surgery. It is clear, because the thyroid gland is one of the most important organs on which your well-being and health depends. And shortness of breath, constant fatigue, irritability and other symptoms clearly interfere with your enjoyment of life...

But, you see, it is more correct to treat the cause, not the effect. We recommend reading the story of Irina Savenkova about how she managed to cure the thyroid gland...

Pregnancy is one of the most difficult stages in a woman's life. Despite the fact that motherhood is the greatest joy, this period does not always go as we would like. During the bearing of a child, the body is completely rebuilt: the blood flow changes, the center of innervation shifts, the hormonal background changes. The most serious restructuring during pregnancy occurs in the thyroid gland: the internal structure of the endocrine organ changes, as well as the ratio of hormones that it releases into the blood.

However, the pathology of the thyroid gland during pregnancy is not as dangerous as many may think. Modern medicine allows you to endure and give birth to a healthy baby, even with diseases of this organ.

The thyroid gland is one of the organs of the human endocrine system. The gland is normally localized on the front surface of the neck, and in shape it can resemble a butterfly for many, as it has two poles - “wings”, and an isthmus between them. The gland consists of parenchyma and stroma.

The chief cells are called thyrocytes. They carry out the main function of the gland - the production of the hormones thyroxine (T4) and triiodothyronine (T3). These are one of the most important hormones in the body, as they are able to regulate all types of metabolism, accelerating or slowing them down, as well as almost all the processes of growth and maturation of cells, tissues and organs that take place in the body.

Thyroid hormones contain iodine. This indicates another important function - the accumulation and storage of iodine in the body. It is included in a huge number of enzymes and chemicals that are synthesized in the human body.

In addition to thyrocytes, the gland contains C-cells that belong to the diffuse endocrine system and produce calcitonin, which regulates calcium metabolism in the body.

Thyroid hormones during pregnancy are of great importance for the normal development of the fetus. T3 and T4 are involved in all processes of growth and maturation of cells and tissues. The fetus is no exception.

The normal development of the nervous, cardiovascular, reproductive, urinary and all other systems of the child is possible only with a sufficient concentration of these hormones in the blood of the expectant mother.

In the first three years after the birth of a baby, hormones obtained from the mother's body become important for the normal development of the brain, the formation and maintenance of intelligence, since the own thyroid gland in newborns is not yet functioning.

The functioning of the thyroid gland during pregnancy

The thyroid gland undergoes some changes during pregnancy. There is its physiological increase and growth of the parenchyma. Thus, more hormones are produced by 30-50%.

Interestingly enough, the fact of an increase in the thyroid gland during pregnancy was noticed in ancient Egypt. A rather unusual test was used there. The Egyptians wore the thinnest silk thread around their necks. If the thread was torn, it was considered a confirmation of pregnancy.

The process of laying and differentiation of the thyroid gland in the fetus begins as early as the 12th week of pregnancy. The final formation occurs by the 17th week.

From this point on, the fetal thyroid gland is able to independently synthesize hormones. However, the source of iodine is maternal thyroid hormones. In addition, the mass of the thyroid gland in the fetus is only about 1.5-2 grams, that is, it is unable to fully provide for the baby's body.

From the above data, several conclusions can be drawn:

1. Adequate functioning and production of a sufficient amount of thyroid hormones is important for both the mother's body and the fetus. The development of all organs and systems without exception occurs only with the participation of T3 and T4 of the mother's organism. This situation persists until the end of the first trimester. After that, the fetus's own thyroid gland already differentiates, which nevertheless "takes" iodine from the mother's body, since the body has no other sources of this trace element. In the normal state, the daily requirement of iodine is 150 micrograms, but during pregnancy, this requirement increases to 200-250 micrograms. With the intake of a smaller amount of iodine, a disease develops, which is called hypothyroidism.
2. Excessive hormone production can cause a range of problems for the mother and fetus. Most often, such intoxication is observed in the first trimester of pregnancy, since the influence of the thyroid gland on pregnancy is maximum in this trimester. Thus, a disease develops - hyperthyroidism. In most cases, such a reaction during pregnancy is still considered a variant of the norm, does not require treatment and is able to pass on its own after a while. Therefore, this type of thyroid hyperfunction is called transient or temporary thyrotoxicosis of pregnancy. But thyrotoxicosis and hyperfunction are not always good, in some cases a disease develops, called Graves' or Basedow's disease, which requires immediate therapeutic intervention and treatment.

The shift of the thyroid gland in one direction or another is fraught with complications and dysfunction. But there are modern methods of compensation and stabilization for each individual condition.

Hypothyroidism

Hypothyroidism is a disease characterized by a lack of iodine in the body and, as a result, a lack of hormones. But in some cases, the intake of iodine in the body may not be reduced.

Complaints with hypothyroidism can be the following:

• weakness, increased fatigue, weight gain above the normative indicators, a feeling of chilliness;
• loss of appetite, lethargy, apathy, constant drowsiness, decreased concentration and attention;
• dry skin, its peeling, hair loss, brittle nails;
• the appearance of edema, especially in the face and lower leg;
• the appearance of shortness of breath, a decrease in blood pressure;
• hoarseness often occurs.

It should be understood that a lack of iodine in the body and a decrease in thyroid function can occur even before pregnancy. Therefore, it is extremely important to conduct a study of thyroid hormones when planning, and consultation with an endocrinologist is also mandatory.

The doctor, based on the results of the study, prescribes replacement therapy with thyroid hormone preparations - that is, T3 and T4 will enter the body from the outside.

Thus, there is a correction of the level of hormones and after that you can safely plan conception. In most cases of hypothyroidism, hormone replacement is continued during pregnancy.

With hypothyroidism, the risk of spontaneous miscarriages, premature births, and the death of a baby in utero increases significantly, especially in the early stages.

With a significant decrease in the concentration of thyroid hormones during pregnancy, it can lead to the birth of a baby with malformations: mental retardation, deafness, strabismus, etc.

To avoid all these problems, it is necessary to visit an endocrinologist when planning a pregnancy, or already directly in the early stages.

Do not neglect the vitamin complexes that are prescribed by your doctor.

For prevention, iodized salt or milk is also excellent, however, do not forget that eating too salty food is fraught with consequences for a pregnant woman. Many doctors recommend diversifying the diet with seafood.

Sea fish, squid, shrimp, mussels contain a huge amount of iodine, as in dairy products and meat. Under no circumstances should you get carried away. Another product containing a large amount of iodine is dried figs.

Among other things, it is important to note all the changes that occur in the body. Drowsiness, apathy, brittle hair, nails, dry skin are abnormal signs that accompany pregnancy.

Bearing a child is by no means a disease, therefore, having paid attention to such symptoms, it is recommended to contact specialists to conduct a detailed study and find out the reasons.

Hyperfunction of the thyroid gland

As well as a decrease in thyroid function, it is possible to increase it. As mentioned, hyperfunction is physiological in nature to meet the needs of the fetus. But, in some cases, it can be a pathology.

nodular goiter

Nodular goiter is a whole group of thyroid diseases that occur with the development of large nodular formations. The etiology of the disease is very diverse. In cases of large goiter formation, a cosmetic defect is also possible. Pregnancy and a thyroid nodule are not mutually exclusive.

Nodes are not dangerous if the concentration of hormones in the blood is corrected. Pregnancy, in the presence of nodes in the thyroid gland, should be carried out under the strict supervision of an endocrinologist. If the nodes are larger than 4 cm, then surgery is necessary, but not during pregnancy. Operations during gestation are carried out only in cases of compression of the trachea.

Symptoms of hyperthyroidism

Elevated levels of thyroid hormones in the blood can lead to:

• increased fatigue, weight loss, fever, up to fever;
• increased nervous excitability, irritability, causeless feeling of fear, insomnia;
• strengthening the work of the cardiovascular system, increasing the pulse, blood pressure;
• muscle weakness, hand tremor;
• possible disorders of the digestive system: loss of appetite, loose stools, pain;
• expansion of the palpebral fissures and the appearance of shine in the eyes.

The difficulty in diagnosing hyperthyroidism lies in the fact that it is quite difficult to distinguish the physiological norm of strengthening the work of an organ from pathological activity. Therefore, symptoms such as low-grade fever, feeling hot, weight loss and vomiting at the beginning of pregnancy should be regarded as possible manifestations of hyperthyroidism and carefully examined.

An increase in heart rate above 100 beats per minute, a large difference between the numerical values ​​​​of systolic and diastolic pressure in most cases indicate the presence of hyperthyroidism. Crucial in the diagnosis belongs to the determination of the level of hormones in the blood and ultrasound of the thyroid gland during pregnancy.

Hyperthyroidism can cause a number of complications:

• preeclampsia;
• fetal malformations;
• low birth weight of the baby.

Identification of the disease should be carried out in the early stages, then the chances of giving birth to a healthy and strong baby increase significantly.

Therapy for hyperthyroidism is aimed at suppressing the function of the gland. This is where the difficulty arises, since in no case should the thyroid gland of the fetus be affected. Therefore, in the treatment, only minimal concentrations of those agents that do not have permeability through the placental barrier are used.

Very rarely it becomes necessary to remove part of the thyroid gland. This operation can only be performed in the second trimester of pregnancy if the risk of complications outweighs the risk of surgery.

Autoimmune processes in the gland

Autoimmune diseases are called diseases that occur as a result of the production of antibodies to their own cells, that is, the immune system destroys the cells of its own body. Often these diseases are hereditary or caused by mutations.

This pathology is the most difficult in terms of pregnancy management, since the therapy of autoimmune processes is based on the use of large doses of steroid drugs and cytostatics, which are contraindicated during gestation.

The disease is also complicated by the fact that there is no hyperproduction of thyroid hormones, which are so necessary for the normal development of the fetus. Treatment can be conservative or surgical.

Conservative is to prevent the development of hypothyroidism by the introduction of hormones inside. Surgical - thyroid resection is prescribed only when the life of the mother is threatened.

Thyrotoxicosis

Thyrotoxicosis is a disease accompanied by an increase in the production of thyroid hormones. The main difference from hyperthyroidism is that there is no increase in the gland itself. Thyrotoxicosis during pregnancy is very rare. Symptoms and treatment are the same as for hyperthyroidism.

Thyroid tumors

Thyroid cancer is by no means an indication for abortion. With the right approach, it is possible to endure and give birth to a healthy baby in almost all rays.

Treatment is operative. Removal of thyroid cancer and pregnancy are also not contraindicated to each other. However, most often the operation is postponed until the postpartum period. If this cannot be done, then it is carried out in the second trimester, up to 24 weeks, since the risk of negative effects on the fetus is minimal.

Diagnosis of diseases

Thyroid diseases during pregnancy are complicated by the fact that many types of diagnostics can harm the fetus, so research must be done very carefully. The most common diagnostic method, which gives a 100% result and is absolutely safe for the fetus, is ultrasound. This study is desirable to conduct at the slightest suspicion of a violation of the body.

Ultrasound and a blood test for hormones are 2 irreplaceable studies that will help to make an unmistakable diagnosis in almost all cases.

Pregnancy after surgical removal of the gland

Pregnancy after surgery to remove the thyroid gland is possible, but not earlier than two years later. This period is needed for complete rehabilitation and restoration of the hormonal balance of the female body.

After the removal of the thyroid gland, a woman will be forced to be on hormone replacement therapy all her life, even during pregnancy. Therefore, when planning, it is necessary to consult with an endocrinologist-gynecologist who will manage the pregnancy until childbirth.

Pregnancy and thyroid disease are closely linked. A competent attending physician is the only thing that is needed in the situation of detecting thyroid pathology during gestation.

Pathology of the endocrine organ can seriously affect the health of both mother and baby. Perhaps even more than once during the entire pregnancy, the question of the need for interruption will arise.

But only thanks to the psychological attitude of the mother and competent treatment, incredible results can be achieved.

Useful video about the thyroid gland

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Lecture for doctors "Diseases of the thyroid gland and pregnancy". A course of lectures on pathological obstetrics for medical college students. The lecture for doctors is conducted by Dyakova S.M., an obstetrician-gynecologist, a teacher with a total work experience of 47 years.

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 within 28 weeks, due to hemocirculatory adaptation - an increase in BCC, cardiac output - cardiovascular decompensation may occur: tachycardia up to 120-140 beats per minute, 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 mercalil, 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 the 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.

Diagnosis of thyroid diseases

It is necessary to interview the patient to collect characteristic complaints, a general examination (color of the skin, moisture or, conversely, dry skin and mucous membranes, tremor of the hands, swelling, size of the palpebral fissure and the degree of its closure, visual enlargement of the thyroid gland and the anterior part of the neck), palpation of the 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.

Hyperthyroidism during pregnancy

Hyperthyroidism is a condition in which the production of thyroid hormones is increased and thyrotoxicosis develops. Hyperthyroidism that occurs during pregnancy significantly increases the risk of spontaneous miscarriage, fetal growth retardation, and other serious complications.

Causes

Hyperthyroidism is not a diagnosis, but only a syndrome caused by increased production of thyroid hormones. In this condition, the concentration of T3 (thyroxine) and T4 (triiodothyronine) increases in the blood. In response to an excess of thyroid hormones, thyrotoxicosis develops in the cells and tissues of the body - a special reaction accompanied by an acceleration of all metabolic processes. Hyperthyroidism is diagnosed mainly in women of childbearing age.

Diseases in which hyperthyroidism is detected:

• diffuse toxic goiter (Graves' disease);
• autoimmune thyroiditis;
• subacute thyroiditis;
• thyroid cancer;
• pituitary tumors;
• ovarian neoplasms.

Up to 90% of all cases of thyrotoxicosis during pregnancy are associated with Graves' disease. Other causes of hyperthyroidism in expectant mothers are extremely rare.

Symptoms

The development of thyrotoxicosis is based on the acceleration of all metabolic processes in the body. With an increase in the production of thyroid hormones, the following symptoms occur:

• low weight gain during pregnancy;
• increased sweating;
• rise in body temperature;
• warm and moist skin;
• muscle weakness;
• fast fatiguability;
• exophthalmos (bulging eyes);
• enlargement of the thyroid gland (goiter).

Symptoms of hyperthyroidism develop gradually over several months. Often the first manifestations of the disease are detected long before the conception of a child. Perhaps the development of hyperthyroidism directly during pregnancy.

Excessive production of thyroid hormones interferes with the normal functioning of the cardiovascular system. Symptoms of hyperthyroidism include:

• tachycardia (increase in heart rate over 120 beats per minute);
• increased blood pressure;
• palpitations (in the chest, neck, head, abdomen);
• cardiac arrhythmias.

In the long run, hyperthyroidism can lead to the development of heart failure. The likelihood of severe complications increases in the second half of pregnancy (28-30 weeks) during the period of maximum stress on the heart and blood vessels. In rare cases, a thyrotoxic crisis develops - a condition that threatens the life of a woman and a fetus.

Thyrotoxicosis also affects the state of the digestive tract. Against the background of excessive synthesis of thyroid hormones, the following symptoms occur:

• nausea and vomiting;
• increased appetite;
• pain in the umbilical region;
• diarrhea;
• liver enlargement;
• jaundice.

Hyperthyroidism also affects the activity of the nervous system. An excess of thyroid hormones makes a pregnant woman irritable, capricious, restless. There may be mild impairment of memory and attention. Hand tremor is typical. In severe hyperthyroidism, the symptoms of the disease resemble those of a typical anxiety disorder or manic state.

Endocrine ophthalmopathy develops in only 60% of all women. Changes in the eyeball include not only exophthalmos, but also other symptoms. Very characteristic is a decrease in the mobility of the eyeballs, hyperemia (redness) of the sclera and conjunctiva, and rare blinking.

All manifestations of hyperthyroidism are most noticeable in the first half of pregnancy. After 24-28 weeks, the severity of thyrotoxicosis decreases. Possible remission of the disease and the disappearance of all symptoms due to a physiological decrease in hormone levels.

Gestational transient thyrotoxicosis

Thyroid function changes with the onset of pregnancy. Shortly after the conception of a child, there is an increase in the production of thyroid hormones - T3 and T4. In the first half of pregnancy, the fetal thyroid gland does not function, and the maternal gland takes over its role. Only in this way can the baby receive the thyroid hormones necessary for its normal growth and development.

An increase in the synthesis of thyroid hormones occurs under the influence of hCG (human chorionic gonadotropin). This hormone is similar in structure to TSH (thyroid-stimulating hormone), so it can stimulate the activity of the thyroid gland. Under the influence of hCG in the first half of pregnancy, the concentration of T3 and T4 almost doubles. This condition is called transient hyperthyroidism and is completely normal during pregnancy.

In some women, the concentration of thyroid hormones (T3 and T4) exceeds the norm established for pregnancy. At the same time, there is a decrease in the level of TSH. Gestational transient thyrotoxicosis develops, accompanied by the appearance of all the unpleasant symptoms of this pathology (excitation of the central nervous system, changes in the heart and blood vessels). Manifestations of transient thyrotoxicosis are usually mild. Some women may have no symptoms of the disease.

A distinctive feature of transient thyrotoxicosis is indomitable vomiting. Vomiting in thyrotoxicosis leads to weight loss, vitamin deficiency and anemia. This condition persists up to 14-16 weeks and resolves on its own without any therapy.

Complications of pregnancy

Against the background of hyperthyroidism, the likelihood of developing such conditions increases:

• spontaneous miscarriage;
• placental insufficiency;
• delayed fetal development;
• preeclampsia;
• anemia;
• placental abruption;
• premature birth;
• intrauterine fetal death.

Excess production of thyroid hormones primarily affects the cardiovascular system of the mother. Blood pressure rises, heart rate increases, various rhythm disturbances occur. All this leads to impaired blood flow in large and small vessels, including the small pelvis and placenta. Placental insufficiency develops - a condition in which the placenta is not able to perform its functions (including providing the baby with the necessary nutrients and oxygen). Placental insufficiency leads to a delay in the growth and development of the fetus, which adversely affects the health of the child after birth.

Transient thyrotoxicosis, which occurs in the first half of pregnancy, is also dangerous for the woman and the fetus. Indomitable vomiting leads to rapid weight loss and a significant deterioration in the condition of the expectant mother. Incoming food is not digested, beriberi develops. Nutritional deficiencies can cause spontaneous miscarriage in up to 12 weeks.

Consequences for the fetus

Maternal hormones (TSH, T3 and T4) practically do not cross the placenta and do not affect the condition of the fetus. At the same time, TSI (antibodies to TSH receptors) easily pass through the blood-brain barrier and enter the fetal circulation. This phenomenon occurs with Graves' disease - an autoimmune lesion of the thyroid gland. Diffuse toxic goiter in the mother can cause the development of intrauterine hyperthyroidism. It is not excluded the occurrence of a similar pathology and immediately after the birth of a child.

Symptoms of fetal hyperthyroidism:

• goiter (enlargement of the thyroid gland);
• swelling;
• heart failure;
• growth retardation.

The higher the TSI level, the higher the likelihood of complications. With congenital hyperthyroidism, the likelihood of intrauterine fetal death and stillbirth increases. For children born at term, the prognosis is quite favorable. In most newborns, hyperthyroidism resolves on its own within 12 weeks.

Diagnostics

To determine hyperthyroidism, it is necessary to donate blood to determine the level of thyroid hormones. Blood is taken from a vein. The time of day doesn't matter.

Signs of hyperthyroidism:

• increase in T3 and T4;
• decrease in TSH;
• the appearance of TSI (with autoimmune damage to the thyroid gland).

To clarify the diagnosis, an ultrasound of the thyroid gland is performed. The condition of the fetus is assessed during ultrasound with Doppler, as well as using CTG.

Treatment

Outside of pregnancy, priority is given to medical treatment with the use of radioactive iodine preparations. In obstetric practice, such drugs are not used. The use of radioisotopes of iodine can disrupt the course of pregnancy and interfere with the normal development of the fetus.

For the treatment of pregnant women, antithyroid drugs (not radioisotopes) are used. These drugs inhibit the production of thyroid hormones and eliminate the symptoms of thyrotoxicosis. Antithyroid drugs are prescribed in the first trimester immediately after diagnosis. In the II trimester, the dosage of the drug is reviewed. With the normalization of hormone levels, a complete abolition of the drug is possible.

Surgical treatment for hyperthyroidism is indicated in the following situations:

• severe course of thyrotoxicosis;
• lack of effect from conservative therapy;
• large goiter with compression of adjacent organs;
• suspected thyroid cancer;
• intolerance to antithyroid drugs.

The operation is performed in the second trimester, when the risk of spontaneous miscarriage is minimized. The volume of surgical intervention depends on the severity of the disease. In most cases, bilateral subtotal strumectomy (excision of most of the thyroid gland) is performed.

Untreated hyperthyroidism is an indication for abortion. Abortion is possible up to 22 weeks. The optimal time for an induced abortion is the period up to 12 weeks of pregnancy.

Pregnancy planning

Pregnancy against the background of hyperthyroidism should be planned. Before conceiving a child, a woman should be examined by an endocrinologist. According to the indications, the dose of the drugs taken is corrected, symptomatic therapy is prescribed. You can plan the conception of a child in a state of euthyroidism (normal levels of thyroid hormones). It is recommended to wait 3 months after drug withdrawal.

Pregnancy due to hypothyroidism

Hypothyroidism is a condition in which the production of thyroid hormones is reduced.

Causes:

1. Autoimmune thyroiditis (the most common cause of hypothyroidism, the essence of the disease is damage to the thyroid gland by its own protective antibodies)
2. Lack of iodine
3. Damage by various types of exposure (drugs, radiation exposure, surgical removal, and others)
4. Congenital hypothyroidism

A separate cause is the relative hypothyroidism that develops during pregnancy. For normal life, thyroid hormones are enough, but in conditions of increased consumption during pregnancy, they are no longer there. This may indicate that there are violations in the gland, but they appeared only against the background of an increased load.

Classification:

1. Subclinical hypothyroidism. Hypothyroidism, which is detected according to laboratory tests, but does not show obvious clinical signs. This stage of hypothyroidism may be detected during examination of an infertile couple or when presenting for weight gain, as well as in other cases of diagnostic search. Despite the fact that there is no bright clinic, metabolic changes have already begun, and they will develop if treatment is not started.

2. Manifest hypothyroidism. This stage of hypothyroidism is accompanied by characteristic symptoms.

Depending on the presence and effect of treatment, there are:

Compensated (there is a clinical effect of the treatment, the TSH level returned to normal)
- decompensated

3. Complicated. Complicated (or severe) hypothyroidism is a condition that is accompanied by severe dysfunction of organs and systems, and can be life threatening.

Symptoms:

1. Changes in the skin and its appendages (dry skin, darkening and roughening of the skin of the elbows, brittle nails, loss of eyebrows, which starts from the outside).

2. Arterial hypotension, less often an increase in blood pressure, which is difficult to treat with conventional antihypertensive drugs.

3. Fatigue, up to severe, weakness, drowsiness, memory loss, depression (often there is a complaint that “I wake up already tired”).

5. Weight gain with reduced appetite.

6. Myxedema, myxedematous lesion of the heart (swelling of all

tissues), accumulation of fluid in the pleural cavity (around the lungs) and in

pericardial region (around the heart), myxedema coma (extremely

severe manifestation of hypothyroidism with damage to the central nervous system

Diagnostics:

On palpation, the thyroid gland may be diffusely enlarged or only the isthmus, painless, mobile, the consistency may vary from soft (testy) to moderately dense.

1. Study of thyroid hormones. The level of TSH is above 5 μIU / ml, T4 is normal or reduced.

2. Research of antibodies. AT to TG above 100 IU/ml. AT to TPO above 30 IU/ml. An elevated level of autoantibodies (antibodies to one's own tissues) indicates an autoimmune disease, most likely in this case the cause of hypothyroidism is autoimmune thyroiditis.

3. Ultrasound of the thyroid gland. Ultrasound can detect changes in the structure and homogeneity of the thyroid tissue, which is an indirect sign of thyroid disease. Small nodules or cysts may also be found.

Hypothyroidism and its effect on the fetus.

Hypothyroidism occurs in about one in 10 pregnant women, but only one has overt symptoms. But the effect of a lack of thyroid hormones on the fetus is manifested in both.

1. Influence on the development of the central nervous system of the fetus (CNS). In the first trimester, the fetal thyroid gland is not yet functioning, and the development of the nervous system occurs under the influence of maternal hormones. With their lack, the consequences will be very sad: malformations of the nervous system and other defects, cretinism.

2. Risk of intrauterine fetal death. The first trimester is especially important, while the thyroid gland of the fetus is not yet functioning. Without thyroid hormones, the entire spectrum of metabolism is disrupted, and the development of the embryo becomes impossible.

3. Chronic intrauterine fetal hypoxia. The lack of oxygen adversely affects all processes of fetal development and increases the risk of intrauterine death, the birth of small children, premature and discoordinated births.

4. Violation of the immune defense. Children with a lack of thyroid hormones in the mother are born with a reduced immune function and poorly resist infections.

5.Congenital hypothyroidism in the fetus. In the presence of a disease in the mother and incomplete compensation, the fetus has a high risk of congenital hypothyroidism. The consequences of hypothyroidism in newborns are very diverse, and you need to know that if left untreated, they become irreversible. Characteristic: slow physical and psycho-motor development, up to the development of cretinism. With early diagnosis and timely initiation of treatment, the prognosis for the baby is favorable.

The consequences of hypothyroidism for the mother

Manifest hypothyroidism compared with subclinical hypothyroidism has the same complications, but much more frequently.

1. Preeclampsia. Preeclampsia is a pathological condition that is characteristic only for pregnant women, manifested by a triad of symptoms of edema - arterial hypertension - the presence of protein in the urine (read more in our article "Preeclampsia").

2. Detachment of the placenta. Premature detachment of a normally located placenta occurs due to chronic fetoplacental insufficiency. This is a very formidable complication of pregnancy with high maternal and perinatal mortality.

3. Anemia of pregnant women. Anemia in pregnant women is already extremely common in the population, but in women with hypothyroidism, the anemia clinic (drowsiness, fatigue, lethargy, skin manifestations and hypoxic state of the fetus) is superimposed on the same manifestations of hypothyroidism, which enhances the negative effect.

4. Prolongation of pregnancy. Against the background of hypothyroidism, various types of metabolism are disturbed, including energy metabolism, which can lead to a tendency to prolong pregnancy. Postterm pregnancy is considered to be more than 41 weeks and 3 days.

5. Complicated course of childbirth. For the same reason, childbirth can be complicated by the weakness of the tribal forces and discoordination.

6. Bleeding in the postpartum period. The risk of hypotonic and atonic bleeding in the afterbirth and early postpartum period is increased, as the overall metabolism is slowed down and vascular reactivity is reduced. Bleeding significantly complicates the course of the postpartum period and is in 1st place among the causes of maternal death.

7. The risk of purulent - septic complications in the postpartum period is increased due to reduced immunity.

8. Hypogalactia. Decreased production of breast milk in the postpartum period can also be a cause of thyroid hormone deficiency.

Treatment:

The only scientifically based treatment is hormone replacement therapy. Patients with hypothyroidism are shown lifelong treatment with L-thyroxine (levothyroxine) in an individual dosage. The dose of the drug is calculated based on the clinical picture, the weight of the patient, the duration of pregnancy (in the early stages, the dosage of the hormone is higher, and then reduced). The drug (trade names "L-thyroxine", "L-thyroxine Berlin Chemi", "Eutiroks", "Tireotom"), regardless of the dosage, is taken in the morning on an empty stomach, at least 30 minutes before meals.

Prevention:

In endemic areas, iodine prophylaxis is indicated for life in various regimens (with interruptions).

During pregnancy, iodine preparations are indicated for all pregnant women at a dose of at least 150 mcg, for example, as part of complex vitamins for pregnant women (femibion ​​natalkea I, vitrum prenatal).

Please note that the popular drug Elevit pronatal does not contain iodine in its composition, therefore potassium iodide preparations (iodomarin, iodine active, 9 months of potassium iodide, iodine balance) are additionally prescribed.

The dosage of iodine preparations begins with 200 mcg, as a rule, this is enough for prevention.

Taking iodine preparations begins 3 months before the expected pregnancy (if you are sure that the thyroid gland is healthy and only prevention is needed) and continue for the entire period of gestation and lactation.

Pregnancy due to hyperthyroidism

Hyperthyroidism (thyrotoxicosis) is a disease of the thyroid gland, accompanied by increased production of thyroid hormones.

Thyroid hormones are catabolic, that is, they speed up the metabolism. With their excess, the metabolism accelerates at times, calories obtained from carbohydrates and fats are burned at a high speed, and then protein breakdown occurs, the body works at its limit and “wears out” much faster. The breakdown of muscle proteins leads to dystrophy of the heart muscle and skeletal muscles, the conductivity of nerve fibers and the absorption of nutrients in the intestine are disturbed. Almost all complications of thyrotoxicosis for the mother and fetus are associated with an enhanced catabolic effect.

Causes:

1. Diffuse toxic goiter (or Graves-Basedow's disease, which consists in the fact that autoantibodies to TSH receptors are produced in the body, so the receptors become insensitive to the regulatory effects of the pituitary gland and hormone production becomes uncontrolled).

2. Nodular goiter (nodules are formed in the thyroid gland that provide hyperproduction of thyroid hormones).

3. Tumors (thyroid adenoma, TSH-secreting pituitary tumors, ovarian struma is a tumor in the ovary that consists of thyroid-like cells and produces hormones).

4. Overdose of thyroid hormones.

Specific causes of thyrotoxicosis in a pregnant woman are:

A transient increase in the level of thyroid hormones, which is physiologically determined (depends on the level of hCG). As a rule, this condition is temporary, is not accompanied by a clinic and does not require treatment. But sometimes pregnancy can become the starting point of a thyroid disease, which was formed gradually, but manifested itself only under conditions of increased stress.

Excessive vomiting of pregnant women (early severe toxicosis) can provoke hyperfunction of the thyroid gland.

Cystic drift (tumor-like growth of chorionic villi, while pregnancy has occurred, but does not develop). The condition is detected in the earliest stages of pregnancy.

Classification

1. Subclinical hyperthyroidism (T4 level is normal, TSH is lowered, there are no characteristic symptoms).

2. Manifest hyperthyroidism or explicit (T4 level is increased, TSH is significantly reduced, a characteristic clinical picture is observed).

3. Complicated hyperthyroidism (arrhythmia by the type of fibrillation and / or atrial flutter, cardiac or adrenal insufficiency, obvious psychoneurotic symptoms, organ dystrophy, severe underweight and some other conditions).

Symptoms

1. Emotional lability, groundless anxiety, anxiety, fears, irritability and conflict (appeared in a short period of time).

2. Sleep disturbance (insomnia, frequent waking up at night).

3. Tremor (hand trembling, and sometimes general tremor).

4. Dryness and thinning of the skin.

5. An increase in the pulse, which is observed steadily, the rhythm does not slow down at rest and during sleep; arrhythmias of the type of fibrillation and atrial flutter (uncoupled contraction of the atria and ventricles of the heart, the rhythm frequency sometimes exceeds 200 beats per minute).

6. Shortness of breath, decreased exercise tolerance, fatigue (is a consequence of heart failure).

7. Rare blinking of the eyes, dryness of the cornea, tearing, in clinically advanced cases, protrusion of the eyeball, decreased vision due to optic nerve degeneration.

8. Increased ("wolf") appetite, colicky abdominal pain for no apparent reason, occasional causeless loose stools.

9. Weight loss against the background of increased appetite.

10. Frequent and profuse urination.

Diagnostics

On palpation, the gland is diffusely enlarged, nodules can be palpated, palpation is painless, the consistency is usually soft.

1) A blood test for the quantitative content of hormones: TSH is reduced or normal, T4 and T3 are increased, AT in TPO and TG are usually normal.

2) Ultrasound of the thyroid gland to determine its size, tissue homogeneity and the presence of nodules of various sizes.

3) ECG to determine the correctness and frequency of the heart rhythm, the presence of indirect signs of dystrophy of the heart muscle and repolarization disorders (conduction of an electrical impulse).

Consequences of hyperthyroidism for the fetus

spontaneous abortion,
- premature birth,
- delayed growth and development of the fetus,
- the birth of small children,
- congenital pathologies of fetal development,
- antenatal fetal death,
- the development of thyrotoxicosis in utero or immediately after the birth of the baby.

Consequences for the mother

Thyrotoxic crisis (a sharp rise in thyroid hormones, accompanied by severe excitement, up to psychosis, increased heart rate, rise in body temperature to 40-41 ° C, nausea, vomiting, jaundice, in severe cases, coma develops).
- Anemia in pregnancy.
- Premature detachment of a normally located placenta.
- The development and progression of heart failure, which becomes irreversible when running.
- Arterial hypertension.
- Preeclampsia.

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 thyroid function of the fetus and the formation of goiter in 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.