Autoimmunthyreopathien in der Schwangerschaft

Zusammenfassung

Im letzten Jahrzehnt sind viele Aspekte der Interaktion von Schilddrüsenfunktion und Schwangerschaft klarer geworden. Zwei wesentliche neue Aspekte sind zum einen der negative Einfluss einer mütterlichen Hypothyreose auf die kindliche Intelligenz und damit die Relevanz der frühzeitigen Anpassung der Schilddrüsenhormondosis sobald die Schwangerschaft feststeht und zum anderen die viel diskutierte Änderung zu der Aussage, dass Propylthiouracil das Thyreostatikum der 1. Wahl in der Schwangerschaft ist - nur unter Methimazol wird vereinzelt eine Aplasia cutis beschrieben. Eine präkonzeptionelle Beratung bei Kinderwunsch und bekannter Autoimmunthyreopathie der Mutter ist unter den folgenden Gesichtspunkten sinnvoll: optimale Behandlung einer mütterlichen Hypothyreose in der Schwangerschaft, Jodversorgung, definitive Behandlung einer Basedow-Hyperthyreose vor einer geplanten Schwangerschaft und das Risiko der Exazerbation einer bekannten Autoimmunhyperthyreose bzw. Entwicklung einer postpartalen Thyreoiditis in der Postpartalzeit.

Abstract

In the past decade a lot of new information have clarified the interaction of the gestational process and the regulation of the normal thyroid gland. Two main new aspects are: 1) Hypothyroidism in pregnant women may adversely affect neuropsychological development of their fetuses; therefore women with known hypothyroidism should increase their levothyroxine dose as soon as pregnancy is confirmed. 2) A discussion about side effects of antithyroid drugs - aplasia cutis is only described with methimazole in single cases - has led to the recommendation that during pregnancy propylthiouracil should be preferred to methimazole. Preconceptional counselling in women with autoimmune thyroid disease is recommended concerning optimal treatment of maternal hypothyroidism, iodine supply, definitive treatment of Graves' disease prior to pregnancy and exacerbation of autoimmune hyperthyroidism or postpartal thyroiditis in the postpartal period.

Schlüsselwörter

Autoimmunerkrankungen der Schilddrüse - Schwangerschaft - Hypothyreose - Hyperthyreose

Key words

Autoimmune thyroid disease - pregnancy - hypothyroidism - hyperthyroidism

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