Hypothyroidism and pregnancy: diagnosis and Management/Hipotireoidismo e gestacao: diagnostico e conduta/El hipotiroidismo y embarazo: diagnostico y tratamiento

The aim of this review is to highlight the importance of early identification of hypothyroidism in pregnant women with risk factors for the disease, shows its main causes and treatment, to avoid maternal and neonatal complications such as miscarriage, preterm delivery, placental abruption, intrauter...

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Published inRevista Hospital Universitário Pedro Ernesto Vol. 14; no. 2; p. 54
Main Authors de Almeida, Juliana P, Monteiro, Denise L.M, Trajano, Alexandre J.B
Format Journal Article
LanguageSpanish
Published Universidade do Estado do Rio de Janeiro- Uerj 01.04.2015
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Summary:The aim of this review is to highlight the importance of early identification of hypothyroidism in pregnant women with risk factors for the disease, shows its main causes and treatment, to avoid maternal and neonatal complications such as miscarriage, preterm delivery, placental abruption, intrauterine growth restriction and neurocognitive impairment. The main cause of primary hypothyroidism is Hashimoto's thyroiditis. Secondary hypothyroidism may result from hypothalamic or pituitary damage per tumor, surgery or radiation, Sheehan syndrome and lymphocytic hypophysitis. Pregnant women with risk factors should dose TSH, free thyroxine (FT4) fraction and, if necessary, the thyroid peroxidase (anti-TPO). Hypothyroidism is characterized by increased TSH levels and low FT4. When the TSH is high and FT4 is normal, configures subclinical hypothyroidism. In maternal hipotireoxinemia, FT4 is decreased (<0.86 ng / dL) and TSH remains normal, usually with low levels of anti-TPO. TSH levels vary with gestational age, being considered normal in the first trimester between 0.1-2.5 mIU / L, in the second trimester of 0.2-3.0 mIU / L and third trimester of 0 0.3 to 3 0 mIU / L. Subclinical hypothyroidism is associated with increased risk of pregnancy complications and neurocognitive deficits, especially in cases of positive anti-TPO. The aim of treatment is to maintain a normal serum TSH according to the specific trimester. The therapeutic option is oral levothyroxine (LT) and must be administered under fasting, single daily dose of 1.0 mcg / kg / day. In patients with TSH> 10mUI / L, the dose is 1.6 mg / kg / day. There isn't sufficient evidence to justify treatment in subclinical hypothyroidism with negative anti-TPO. It is not recommended routine screening in prenatal care and treatment in cases of hipotireoxinemia.
ISSN:1983-2567
1983-2567
DOI:10.12957/rhupe.2015.18420