Thyroid screening in pregnancy – guideline in practice

Česká verzia

Authors: Patrícia Páleníková ¹; Iveta Kalafutová ²; Zdenka Horníková ³; Juraj Payer ¹
Authors place of work: V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava, Slovenská republika ¹; Endokrinologická ambulancia, Bratislava, Slovenská republika ²; Endokrinologická ambulancia, Topoľčany, Slovenská republika ³
Published in the journal: Vnitř Lék 2017; 63(9): 555-560
Category: Original Contributions

Summary

Thyroid diseases may adversely affect the conception, maintain pregnancy. They increase the risk of complications in pregnancy and may have a negative effect on the fetus. Therefore it is necessary to capture thyroid diseases in the population of pregnant women, in the early stage of pregnancy. In Slovakia, since 2009, the Expert Guideline of the Ministry of Health of the Slovak Republic for the diagnosis and treatment of autoimmune thyroid diseases in women during pregnancy has been in force. In our patient cohort, we monitored 666 pregnant patients, the timeliness of screening, thyroid parameters, the number of pregnancies and their complications, the need for levothyroxine treatment. We found that screening was shifted to an earlier period of pregnancy (11.4 gestational week 2015/2016 vs 8.2 gestational week 2016/2017), the most sent patients were in the first trimester of pregnancy (72 %), 81 % of patients had positive thyreoperoxidase antibodies, 10 % had overt hypothyroidism, 90 % had subclinical hypothyroidism, pathology in the pregnancy had 13 % patients. The treatment was needed in 70 % of patients. Obviously, the number of screened patients in the 1^st trimester has increased (83 % 2016/2017) from the time since the introduction of screening. We can also see the high number of patients with positive autoantibodies. These are patients who need to be monitored and also treated if TSH increase more than upper limit for an actual trimester to minimize the risk of pregnancy complications.

Key words:
hypothyroidism – pregnancy – screening – thyroxin

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