Schilddrüsenerkrankungen in der Schwangerschaft

Thyroid Diseases During Pregnancy. Pregnancy is associated with various changes in thyroid metabolism: increase in thyroxin binding globulin, decrease of TSH, increase of total thyroxin concentration as well as of iodine requirements. Here we provide an overview about pregnancyassociated thyroid diseases with focus on the risks for mother and child as well as current recommendations for diagnosis and treatment. Hypothyroidism during pregnancy is defined according to trimester-specific TSH cut-off values. Since it has been associated with adverse outcomes for both mother and offspring, a substitution is needed not only for manifest hypothyroidism but also for latent hypothyroidism. In the presence of anti-TPO-antibodies with normal thyroid status, a regular monitoring for TSH elevation is needed. The most frequent cause of hyperthyroidism during pregnancy is Graves’ disease, which has to be differentiated from gestational hyperthyroidism. Antithyroid drugs are recommended in the lowest effective dose for Graves’ disease with overt hyperthyroidism, so that fT4 is kept in the upper normal range and TSH remains suppressed. Trimester-specific contraindications for antithyroid drugs should be considered. TRAK is to be controlled monthly and a sonographic monitoring of the foetus is mandatory. The postpartum thyreoiditis (PPT) has a biphasic course, with a transient thyreotoxic phase in the first 6 months, followed by hypothyroidism and possible return to the euthyroid state after 1 year postpartum. If a differentiated thyroid cancer is diagnosed during pregnancy, surgery can mostly be safely postponed until after delivery. Furthermore, the importance of iodine deficiency and the recommendations for an optimal iodine intake during pregnancy are highlighted. J Gynäkol Endokrinol 2012; 22 (1): 6–12.