Klinik pratikte kafa karıştıran bir durum: İzole maternal hipotiroksinemi

Abstract

İzole maternal hipotiroksinemi (İMH) klinik pratikte sık görülen bir sorundur. Düşük anne serbest tiroksin (FT4) düzeyi ile birlikte normal bir anne tiroid stimulan hormon (TSH) düzeyi mevcuttur. Bu derlemenin amacı İMH’nin güncel literatür eşliğinde gözden geçirilmesi ve İMH’nın yönetiminde klinisyenlere katkıda bulunmaktır. Etyolojide en önemli etken olarak iyot eksikliği bulunmaktadır. İMH’nın gebe ve fetüs üzerindeki etkileri net değildir. Ancak tiroid hormonlarının özellikle fetal beyin gelişimi üzerindeki etkisinin önemi düşünüldüğünde klinisyenler arasında ciddi bir endişe kaynağıdır. İMH tedavisinde ise yapılan çalışma sayısı yeterli olmayıp levotiroksin tedavisi konusunda fikir birliği ve kanıt yoktur. Ancak iyot takviyesi konusunda görüş birliği vardır ve günlük 250 mg iyot alınması önerilir. Sonuçta İMH gebelikte ciddiye alınması gereken, tanı ve tedavisi konusunda dikkatli olunması gereken bir problemdir. Ayrıca İMH’nın gebe ve fetüs sağlığı üzerine etkileri ve tedavisi konusunda daha fazla araştırmaya ihtiyaç vardır.

Keywords

• İzole maternal hipotiroksinemi
• Tiroid hormonu
• Gebe
• Fetüs
• İyot eksikliği

A confusing situation in the clinic practice: Isolated maternal hypothyroxinemia

Abstract

Isolated maternal hypothyroxinemia (IMH) is a common problem in the clinic practice. There is a normal maternal thyroid stimulating hormone (TSH) level with a low maternal free thyroxine (FT4) level. The aim of this review is to explain IMH in the light of current literature and to contribute to clinicians in the management of IMH. Iodine deficiency is the most important factor in etiology. The effects of IMH on the pregnant women and the fetus are not clear. However, it is a serious concern among clinicians, especially considering the importance of the effect of thyroid hormones on fetal brain development. As for the treatment of IMH, the number of studies conducted is not sufficient and there is no consensus and evidence on levothyroxine treatment. However, there is a consensus on iodine supplementation and it is recommended to take 250 mg of iodine daily. As a result, IMH is a problem that should be taken seriously during pregnancy and care should be taken regarding its diagnosis and treatment. Additionally, more research is needed on the effects and treatment of IMH on pregnant women and fetal health.

Keywords

• Isolated maternal hypothyroxinemia
• Thyroid hormone
• Pregnant
• Fetus
• Iodine deficiency

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