Peculiarities of the clinical course of hypothyroidism during pregnancy

Abstract

The article presents an analysis of resources about the course of thyroid pathology, specifically hypothyroidism, during pregnancy. This problem is of current interest, because hypothyroidism can cause infertility or miscarriage. This applies not only to overt but also to the subclinical one. The physiological changes that occur in the thyroid gland during pregnancy are described. Attention is drawn to the signs that can be mistaken for pathological. In addition, the reference values of hormonal thyroid parameters during pregnancy differ significantly from those in non-pregnant women. This should also be taken into account in the diagnosis of appropriate disorders. The presented resources data are illustrated by two clinical cases. The first case history demonstrates the deterioration of the autoimmune process on the background of the pregnancy. Interesting is the fact that this effect was delayed, ie during pregnancy, compensatory mechanisms created a proper supply of the body of a woman and two fetuses with thyroid hormones. At the same time, during lactation period there was a pronounced decompensation of the patient's condition, which was manifested by activation of autoimmune aggression against thyroid tissue with increasing titer of antithyroid antibodies, the development of overt hypothyroidism and deepening structural changes in the thyroid gland. The need for further follow-up of postpartum women with autoimmune thyroiditis is emphasized, even if no thyroid dysfunction has been reported throughout pregnancy. The second clinical case illustrates the importance of following the recommendations of the European and American thyroid associations regarding the level of thyroid-stimulating hormone (TSH) during pregnancy. When planning the first pregnancy of this patient, the doctor did not pay attention to the fact that TSH level, being within normal values for non-pregnant women, did not meet international guidelines for planning a pregnancy and its first trimester. This had extremely adverse consequences in the form of two miscarriages. The prescription of an appropriate hormone replacement therapy and careful monitoring of the patient both at the planning stage and throughout the pregnancy, led to the birth of a healthy baby. Thus, compliance with the principles of management and use of the proposed treatment regimens for pregnant women with thyroid pathology will ensure the normal course of pregnancy and the birth of a healthy child.