Thyroid Disease in Pregnancy and Neonatal Outcome

Öz

Thyroid disease is common in pregnancy and complicates up to 2-3% of all pregnancies. Euthyroid autoimmune disease has been reported in 10% of pregnant women. Better understanding the physiology of and the importance of the thyroid function in pregnancy within the last twenty years has helped to elucidate the relationship between untreated thyroid diseases with negative consequences of maternal and neonatal results. Raising awareness of thyroid disease is required to reduce the rate of complications in pregnancy. In this review neonatal outcomes and the etiology of thyroid disease in pregnancy will be discussed.

Anahtar Kelimeler

• Pregnancy,thyroid diseases

Gebelikte Tiroid Hastalıkları ve Neonatal Sonuçları

Öz

Tiroid hastalıkları gebelikte sık görülür. Tüm gebeliklerin en az %2-3’ü tiroid fonksiyon bozukluklarından etkilenir ve %10 kadarı ise ötiroid olmasına rağmen otoimmun tiroid hastalığına sahiptir. Son yirmi yıl içinde gebelikte tiroid fizyolojisinin daha iyi anlaşılması, gebeliğe tiroid fonksiyonlarının adaptasyonunun önemini ve tedavi edilmeyen tiroid hastalıklarının hipo ya da hipertiroidi maternal ve neonatal olumsuz sonuçlarla ilişkisinin ortaya koyulmasını sağlamıştır. Komplikasyon oranının azaltılması için gebelikte tiroid hastalıklarına farkındalığın artırılması gerekmektedir. Bu derlemede gebelikte görülen tiroid hastalıklarının etyolojileri ve neonatal sonuçları üzerinde durulacaktır.

Anahtar Kelimeler

• Gebelik,tiroid hastalıkları

Kaynakça

1. Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes.Obstet Gynecol 2006;107:337- 41.
2. Mestman JH. Hyperthyroidism in pregnancy. Best Pract Clin Endocrinol Metab 2004; 18:267–288.
3. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, BonselGJ.Higher maternal TSH levels in pregnancyare associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol 2009;160:985-91
4. Moleti M, Lo Presti VP, Campolo MC, Mattina F, Galletti M, Mandolfino M, Violi MA, Giorgianni G, De Domenico D, Trimarchi F, Vermiglio F. Iodine prophylaxis using iodized salt and risk of maternal thyroid failure in conditions of mild iodine deficiency. J Clin Endocrinol Metab 2008; 93:2616–262.
5. Qian M, Wang D, Watkins WE, Gebski V, Yan YQ, Li M, Chen ZP.The effects of iodine on intelligence in children: a meta-analysis of studies conducted in China. Asia Pac J Clin Nutr 2005;14:32-42.
6. Gyamfi C, Wapner RJ, D’Alton ME.Thyroid dysfunction in pregnancy.The basic science and clinical evidence surrounding the controversy in management. ObstetGynecol 2009;113:702–707.
7. Karras S, Tzotzas T, Kaltsas T, Krassas GE. Pharmacological treatment of hyperthyroidism during lactation: review of the literature and novel data. Pediatric Endocrinology Reviews 2010;8:25–33.
8. Krassas GE, Poppe K,Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010;31:702–755.

9. Van Dijke CP, Heydendael RJ, DeKleine MJ. Methimazole, carbimazole, and congenital skin defects.Ann Intern Med 1987;106:60-1.
10. Barbero P, Valdez R, Rodrguez H, TiscorniaC, Mansilla E, Allons A, Coll S, Liascovich R. Choanal atresia associated with maternal hyperthyroidism treated with methimazole: a case–control study. Am J Med Genet A 2008; 15:2390-5.
11. Mortimer RH, Cannell GR, Addison RS, Johnson LP, Roberts MS, Bernus I. Methimazole and propylthiouracil equally cross the perfused human term placental lobule. J Clin Endocrinol Metab 1997;82:3099-102.
12. Cheron RG, Kaplan MM, Larsen PR, Selenkow HA,Crigler JF Jr. Neonatal thyroid function after propylthiouracil therapy for maternal Graves’ disease. N Engl J Med 1981;26:304:525-8.
13. Azizi F, Khamseh ME, Bahreynian M,Hedayati M. Thyroid function and intellectual development of children of mothers taking methimazole during pregnancy. J Endocrinol Invest 2002;25:586-9.
14. Williams GR. Neurodevelopmental and neurophysiological actions of thyroid hormone. J Neuroendocrinol 2008;20:784-94.
15. Morreale de Escobar G, Obregon MJ, Escobar del Rey F. Role of thyroid hormone during early brain development. Eur J Endocrinol 2004 Nov;151Suppl 3:25-37.
16. Ausó E, Lavado-Autric R, Cuevas E, Del Rey FE, Morreale De Escobar G, Berbel P. A moderate and transient deficiency of maternal thyroid function at the beginning of fetal neocorticogenesis alters neuronal migration. Endocrinology 2004;145:4037-47.
17. Roman GC. Autism: transient in utero hypothyroxinemia related to maternal flavonoid ingestion during pregnancy and to other environmental antithyroid agents. J Neurol Sci 2007 15;262:15-26.
18. Wheeler SM,Willoughby KA, McAndrews MP et al. Hippocampal size and memory functioning in children and adolescents with congenital hypothyroidism. J Clin Endocrinol Metab 2011;96:E1427-34.
19. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 37, August 2002. (Replaces Practice Bulletin Number 32, November 2001). Thyroid disease in pregnancy.Obstet Gynecol 2002;100:387-96.
20. Rastogi MV, LaFranchiSH.Congenital hypothyroidism. Orphanet J Rare Dis 2010 10;5:17.