Tireoide e Gravidez

DOI: 10.1590/S0004-27302008000700004 In book: Rotinas em Obstetricia, Edition: 6a, Chapter: Tireóide e Gravidez, Publisher: Artmed, Editors: Fernando Freitas, Sérgio H Martins-Costa, José Geraldo Lopes Ramos, José Antônio Magalhães, pp.679-694
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Available from: Marcello Casaccia Bertoluci, Sep 30, 2015
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    ABSTRACT: The frequent occurrence of post-partum hypothyroidism associated with endemic goiter was described by Roberton in 1948. In general, however, post-partum hypothyroidism is thought to result from hypopituitarism. We have found that in Japan transient thyrotoxicosis or hypothyroidism or transient thyrotoxicosis followed by hypothyroidism often occurs after delivery in patients with autoimmune thyroid diseases. Similar post-partum syndromes have been observed in Canada, England, and the United States. We suggested that the physiologic and immunologic changes associated with gestation might induce post-partum aggravation of autoimmune thyroid diseases, and speculated that a subclinical form of the disease might develop into overt disease after delivery. Subclinical autoimmune thyroiditis has been found in 8.5 per cent of women in the general population of Japan. Therefore, we made a population survey of post-partum thyroid dysfunction and found that 5.5 per cent of post-partum women had transient thyrotoxicosis or hypothyroidism. The prevalence of thyroid dysfunction was higher in women giving birth to a girl. Interestingly, the condition of some of these patients mimicked so-called post-partum psychosis.
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    ABSTRACT: Hypothyroidism during pregnancy has been associated with impaired cognitive development and increased fetal mortality. During pregnancy, maternal thyroid hormone requirements increase. Although it is known that women with hypothyroidism should increase their levothyroxine dose during pregnancy, biochemical hypothyroidism occurs in many. In this prospective study we attempted to identify precisely the timing and amount of levothyroxine adjustment required during pregnancy. Women with hypothyroidism who were planning pregnancy were observed prospectively before and throughout their pregnancies. Thyroid function, human chorionic gonadotropin, and estradiol were measured before conception, approximately every two weeks during the first trimester, and monthly thereafter. The dose of levothyroxine was increased to maintain the thyrotropin concentration at preconception values throughout pregnancy. Twenty pregnancies occurred in 19 women and resulted in 17 full-term births. An increase in the levothyroxine dose was necessary during 17 pregnancies. The mean levothyroxine requirement increased 47 percent during the first half of pregnancy (median onset of increase, eight weeks of gestation) and plateaued by week 16. This increased dose was required until delivery. Levothyroxine requirements increase as early as the fifth week of gestation. Given the importance of maternal euthyroidism for normal fetal cognitive development, we propose that women with hypothyroidism increase their levothyroxine dose by approximately 30 percent as soon as pregnancy is confirmed. Thereafter, serum thyrotropin levels should be monitored and the levothyroxine dose adjusted accordingly.
    New England Journal of Medicine 08/2004; 351(3):241-9. DOI:10.1056/NEJMoa040079 · 55.87 Impact Factor
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    New England Journal of Medicine 11/1994; 331(16):1072-8. DOI:10.1056/NEJM199410203311608 · 55.87 Impact Factor
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