Effect on the course of pregnancy of thyroid hormones. Ultrasound and other methods of diagnosis of pathologies. An increase in thyroid gland during pregnancy. Pregnancy after removal of the gland
Pathologies of the endocrine system are among theThe most common. Most often, thyroid disorders are diagnosed, and many cases are diagnosed in women during childbearing.
Thyroid and pregnancy
As is known, this period is characterized by a number of metamorphoses in the body. All systems and organs begin to work in the mode of increased loads.
This also applies to the endocrine system, which begins to work differently in the first few weeks. Stimulation of its functioning is due to the period of the formation of organs and systems in the fetus.
For this process to proceed normally, the bodyWomen are provided with a large number of thyroid hormones, which are later needed by the child. Normally, the production of these substances is increased by 50%. This allows the body to reorganize to a new mode of operation, and also ensures the normal development of the baby.
The effect of the thyroid gland on pregnancy
The work of this body during the carrying out of the childIs stimulated by thyroid-stimulating hormone of the pituitary (TTG), and also by chorionic gonadotropin (HG) produced by the placenta. When the level of CG is significantly increased, the amount of TSH decreases. This process begins in the first weeks after conception, then at 4 months the concentration of HG decreases, which, accordingly, leads to an increase in TSH. This phenomenon is considered the norm.
During pregnancy, a woman may suffer fromTransient hyperthyroidism. This pathology is characterized by a high level of CG for a long time (more than it is supposed to), which leads to a complete suppression of the production of TSH. Very often, this complication occurs with multiple pregnancies. In this case, differentiation is necessary with a diffuse toxic form of goiter.
Thyroid hormones during pregnancyDepend on the synthesis of estrogens, the amount of which rises during gestation. Thanks to this, a thyroxine-binding protein is produced. It is produced by the liver for binding thyroid hormones and deactivating them.
For this reason, the level of free hormones T3 andT4 remains within the normal range, while the common T3 and T4 increase. As can be judged from the above, in the period of gestation, only the amount of free fractions of hormones is of value.
Often, women develop thyroid pathologies associated with an increase or decrease in the secretory activity of the organ, that is, thyrotoxicosis and hypothyroidism.
Such pathology of the thyroid gland asThyrotoxicosis, and pregnancy in the complex can lead to a number of complications: cardiovascular insufficiency, the violation of the course of the birth process, the pronounced pathologies of the endocrine system in the newborn. The patient has weakness, a sensation of heat, the temperature may rise.
Women become irritable, experience problems with sleep, there is a trembling of hands, muscle weakness, excessive sweating, stool (diarrhea), palpitations.
When the pregnant woman stops producingThe required amount of hormones, hypothyroidism occurs. In this case, the following symptoms occur: dry skin, bradycardia, joint pain, depression, constipation, seizures, memory problems, nausea, fast weight gain, intense hair loss.
Thyroid Disease and Pregnancy
This body plays an important role in this period asFor the child, and for the mother, the process of birth and the condition of both organisms in the postpartum period largely depends on him. In pathologies, severe complications can occur.
The most common of these are the following deviations:
- Arterial hypertension, transient increase in pressure;
- Heart failure;
- Placental abruption;
- Postpartum uterine bleeding;
- Miscarriage or premature birth.
Disorders in the endocrine system canLead to the birth of a child with malformations, low weight, dwarfism, mental retardation and deaf-mute. Still with hypothyroidism stillbirth occurs. Given this, you need to consult the doctor-endocrinologist at the planning stage of the child, examine the thyroid gland and determine its condition.
Thyroid ultrasound and other methods of diagnosis during pregnancy
Identification of pathologies of the endocrine system during this period has some aspects:
- It is necessary to determine the level of free T4, TSH,Antibodies to TPO. The norm is considered an increase in the concentration of T4 and a decrease in TSH in the first trimester. That is why their level needs to be determined for a period of up to 10 weeks. In addition, an isolated increase in the amount of antibodies to SRW is not considered a pathology at a normal level of hormones, this condition occurs in 10% of pregnant women and does not require specific treatment. Closer to childbirth TTG comes back to normal, the percentage of free T4 decreases. This is a variant of the norm and is not considered as hypothyroidism;
- Ultrasound is used to assess the condition of nodal formations. During gestation, an aspiration biopsy can be performed when the size of the formation exceeds a centimeter;
- Radioisotope methods and scintigraphy during this period are contraindicated. Ionizing radiation and X-rays affect the fetus irrespective of the gestational age.
If any pathologies are found, appropriate measures are taken, appropriate therapy is prescribed. Treatment for diseases of the thyroid also has some features.
For example, if hypothyroidism is revealed whenPlanning and used to treat L-thyroxine, then the dose of this drug is increased. At the same time, women create a hormonal profile in the body, similar to that of a pregnancy that develops against the background of an euthyroid condition.
If a decreased functional ability is detected after the conception, the same drug is prescribed, but the dose should be complete replacement, in the subsequent it is not necessary to increase it.
Treatment of thyrotoxicosis is to maintainFree T4 at the proper level. For this purpose, appropriate drugs are prescribed in minimal doses. They are canceled, as a rule, in the third trimester, because then there is a physiological drop in the level of hormones. Often there is a relapse of the disease in the postpartum period, so the course of taking thyreostatics resumes.
Thyroid enlargement (goiter) in pregnancy
Basically, during the diagnosis, colloid proliferative nodular goiter is detected. This pathology does not apply to tumoral and does not require the use of surgical methods of treatment.
In addition, goiter is not a contraindication toConception, if the formation is less than 4 cm in diameter and there is no squeezing syndrome. When the goiter is detected already during the period of gestation, and it is more than the established rate, but does not compress the trachea, the operation is postponed to the postpartum period.
If necessary, a biopsyUltrasound monitoring. It is worth noting that the increase in formations against the background of gestation is quite low. In addition, the pathology does not affect the function of the gland, respectively, the hormonal background remains stable. The doctor can prescribe iodine prophylaxis. The control of functions of a gland, concentration of free T4 and a thyroid-stimulating hormone in each trimester is shown.
The plan of conducting a woman with pathology of the endocrineSystem requires consistent and careful observation of the patient. It is necessary to regularly determine the hormonal profile, functional indicators. However, potentially dangerous methods and medications are not used.
Pregnancy after removal of the thyroid gland
It is possible to plan the child only after 2 years fromThe moment of the operation, not before. This is the time it will take to complete a comprehensive rehabilitation course and restore normal hormonal background.
After removing the gland, the woman isLife should take replacement hormones, this applies to periods of gestation. Therefore, such patients should be observed not only in the women's consultation, but also in the endocrinologist throughout the 9 months.
The course of pregnancy is usually normal, butProvided that the future mother adheres to the instructions of the doctor and supports the hormonal background. As already mentioned, thyroid hormones are extremely important for the normal development of the child and the course of pregnancy.