Нарушение функции щитовидной железы при беременности: когда и кого лечить?

Щитовидная железа является важным органом эндокринной системы. Ее гормоны оказывают свое влияние на все органы и системы человека. Среди нарушений функции щитовидной железы наиболее распространенным вариантом является первичный гипотиреоз. Так как во время беременности щитовидная железа матери претерпевает изменения и повышается потребность в тиреоидных гормонах, то риск гипотиреоза повышается. Особое внимание следует уделять женщинам, являющимся носителями антитиреоидных антител, т. к. вероятность нарушения функции щитовидной железы во время беременности у них выше. В связи с этим таким пациенткам в каждом триместре беременности должна исследоваться функция щитовидной железы. Известно, что гипотиреоз, как манифестный, так и субклинический, оказывает негативное влияние на исходы беременности и психофизическое развитие ребенка в последующем. При явном гипотиреозе повышается риск преждевременных родов, артериальной гипертензии, преэклампсии и других осложнений, поэтому лечение гипотиреоза во время беременности должно начинаться незамедлительно. Основой лечения данной патологии является назначение заместительной терапии L-тироксином сразу в полной заместительной дозе. Женщинам, которые уже принимали препарат до беременности, доза L-тироксина увеличивается на 20-30% с началом гестации. Также во время беременности может наблюдаться снижение тиреоидных гормонов, как правило, тироксина (Т4св) при нормальном ТТГ. Данное состояние называется изолированной гипотироксинемией. Ее причинами могут быть недостаточное потребление йода, а также повышенный уровень тироксин-связывающего глобулина. Его повышение приводит к увеличению концентрации общих фракций гормонов Т4 и Т3, но при этом занижается истинный уровень Т4св. Изолированная гипотироксинемия не требует лечения при нормальных уровнях ТТГ.

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