Gebelik ve Tiroid Hormonları

Tiroid hormonları gebelik oluşumu, devamı ve fetal gelişim için gereklidir. Maternal tirotropin plasentadan geçmez. Serbest tiroksin ve serbest trioiodotironin plasentadan geçer. Tüm fetüsler 12’inci gebelik haftasından önce ve konjenital hipotiroidisi olan fetüsler gebelik süresince maternal tiroid hormonuna gereksinim duyarlar. Tiroid hormone santral sinir sisteminin gelişmesinde önemlidir. Tiroid fonksiyon testleri içinde en hassas olanı TSH’dır. Önceden bilinen tiroid hastalığı olan veya riskli grupta bulunanlara gebelikte tiroid değerlendir-mesi yapılması önerilmektedir. Tüm gebelere tiroid değerlendirmesi yapılıp yapılmayacağı tartışılmaktadır. Bu konuda farklı komite ve konsensus kararları vardır. Bu konu kesin netlik kazanana kadar tüm gebelere tiroid fonksiyonu taraması yapılmasının yararlı olacağına inanıyorum

Anahtar Kelimeler:

Gebelik; tiroid hastalıkları; subklinik tiroid hastalıkları; tiroid fonksiyon testleri

Gebelik ve Tiroid Hormonları

Thyroid hormones necassary for fertility, pregnancy and fetal devalopment. Maternal thyrotropin can’t across plascenta, free thyroxine and treeiodothyronine across placenta. All fetus before 12th weeks of pregnancy and fetus with congenital hypothyroidia need maternal thyroid hormones during pregnancy. Thyroid hormones are crucial for central nervus system development. TSH is the most vulnerable test for determining thyroid function. Pregnant women with thyroid disease or are at risk of thyroid disease should undergo thyroid function test. All pregnant should be evaluated for thyroid function test is uncertain. There are different suggestions about this subject. Until this subject has certain end pregnant women should be screened for thyroid function test

Keywords:

Pregnancy; thyroid diseases; subclinical thyroid diseases; thyroid function tests,

PDF

___

Kayaalp SO (Editör). Rasyonel Tedavi Yönünden Tıbbi Farmakoloji. In: Kayaalp OS. Gürlek A. Tiroid hormonları, antitiroid ilaçlar, tirotropin ve tirotropin salıverici hormon. 10uncu Baskı, Ankara: Hacettepe-TAŞ, 2002:1252-71.
Beardsall K, Ogilvy-Stuart AL. Congenital hypothyroidism. Current Paediatrics 2004;14(5):422-9.
Saranac L, Zivanovic S, Bjelakovic B, Stamenkovic H, Novak M, Kamenov B. Why is the thyroid so prone to autoimmune disease? Horm Res Paediatr 2011;75(3):157- 65.
Little JM. Thyroid disorders. Part I: hyperthyroidism. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(3):276-84.
LaFranchi S. Thyroid hormone in hypopituitarism, Graves’ disease, congenital hypothyroidism, and maternal thyroid disease during pregnancy. Growth Hormon IGF Res 2006;16(1):20-4.
Speroff L, Fritz MA (Editors). Clinical gynecologic endocrinology and infertility. In: Reproduction and the thyroid. 7th Edition, Philadelphia: Lippincott Williams & Wilkins, 2005:805-23.
Wier FA, Farley CL. Clinical controversies in screening women for thyroid disorders during pregnancy. J Midwifery Womens Health 2006;51(3):152-8.
Felice M, Lauro R. Thyroid development and ıts disorders: genetics and molecular mechanisms. Endocr Rev 2004;25(5):722-46.
İliçin G, Biberoğlu K, Süleymanlar G, Ünal S (Editörler). İç Hastalıkları. In: Sayınalp S. Tiroid hastalıklarına giriş. 2nci Baskı, Ankara: Güneş Kitabevi, 2003:2167-79.
Boelaert K, Franklyn JA. Thyroid hormone in health and disease. J Endocrinol 2005;187(1):1-15.
Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol 2006;108(5):1283-92.
Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993;81(3):349-53.
Glinoer D. Thyroid regulation and dysfunction in the pregnant patient. Thyroid 2004;14(3):234-45.
Anselmo J, Cao D, Karrison T, Weiss RE, Refetoff S. Fetal loss associated with excess thyroid hormone exposure. JAMA 2004;292(6):691-5.
Vulsma T, Gons MH, De Vijlder JMM. Maternal fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect of thyroid dysgenesis. N Engl J Med 1989;32(1):13-6.
Girling JC. Thyroid disorders in pregnancy. Curr Obstet Gynecol 2006;16(1):539-47.
Fisher DA. Fetal thyroid function: diagnosis and management of fetal thyroid disorders. Clin Obstet Gynecol 1997;40(1):16-31.
Pop VJ, E deVries AL, van Baar JJ, et al. Maternal thyroid peroxidase antibodies during pregnancy A marker of impaired 1995;80(12):3561-6. J Clin
Endocrinol 19. Reuss ML, Paneth N, Pinto-Martin JA, Lorenz JM, Susser MB. The relation of transient hypothyroxinemia in preterm infants to neurological development at two years of age. N Engl J Med 1996;334(13):821-7.
Weetman AP. The immunology of pregnancy. Thyroid 1999;9(7):643-6.
Lao TT, Thyroid disorder in pregnancy. Curr Opinion Obstet Gynecol 2005;17(2):123-7.
Mestman JH. Hyperthyroidism in pregnancy. Best Prac Res Clin Endocrin Metabol 2004;18(2):267-88.
166 Gebelik ve Tiroid Hormonları
Pregnancy and Thyroid Hormones
İliçin G, Biberoğlu K, Süleymanlar G, Ünal S (Editörler). İç Hastalıkları. In: Güllü S. Tirotoksikozlar. 2nci Baskı, Ankara: Güneş Kitabevi 2003:2193-210.
Horsley J, Ogilvy-Stuart AL. The infant of the mother with 2007;17(6):228-32. J thyroid disease. Paediatr Child
Health 25. Lin CH, Tapscott SJ, Olson JM. Congenital hypothyroidism (cretinism) in neuroD2-deficient mice. Mol Cell Biol 2006;26(11):4311-5.
Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol 2006;107(2 Pt 1):337-41.
Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2007;92(8):1-7.
Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Consessus statement: subclinical thyroid dysfunction: a joint statement on management from The American Association of Clinic Endocrinologists, The American Thyroid Association, and The Endocrine Sociaty. J Clin Endocrinol Metab 2005;90(1):581-5.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160(4):526-34.
Glinoer D. The systematic screening and management of hypothyroidism and hyperthyroidism during pregnancy. T Endocrinol Metab 1998;9(10):403-11.
LeBeau SO, Mandel SJ. Thyroid disorders during pregnancy. 2006;35(1):117-36.
Dashe JS, Casey BM, Wells CE, et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol 2005;106(4):753-7.
Galton VA, Martinez E, Hernandez A, St Germain EA, Bates JM, St Germain DL. Pregnant rat uterus expresses hihg levels of the type 3 iodothyronine deiodinase. J Clin Invest 1999;103(7):979-87.
Ross DS. Serum thyroid-stimulating hormone measurement for asessment of thyroid function and disease. Endocrinol Metab Clin North Am 2001;30(2):245- 64.
Casey BM. Subclinical hypothyroidism and pregnancy. Obstet Gynecol Surv 2006;61(6):415-20.
Sade CSM, Snodgrass GR, Hankins WR, Gary DV. Pharmacokinetics and pharmacotherapy of thionamides in pregnancy. Therapeutic Drug Monitoring 2006;28(4):477- 83.
Fisher DA, Nelson JC, Carlton EI, et al. Maturation of human hypothalamic-pituitary-thyroid function and control. Thyroid 2000;10(3):229-34.
Rose SR, Brown SR, Update of newborn screening and therapy 2006;117(6):2290-303. hypothyroidism.
Pediatrics 39. Surks MI, Ortiz E, Daniels GH. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004;291(2):228-38.
Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metabol 2007;92(1):203-7.
Brent GA. Diagnosing thyroid dysfunction in pregnant women: is case finding enough? J Clin Endocrinol Metab 2007;92(1):39-41.