Features of achieving compensation of hypothyroisis in pregnant women

E. G. Yakubova
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Abstract

BACKGROUND: Hypofunction of the thyroid gland in women at the pre-pregnancy stage and during pregnancy is associated with a high risk of congenital hypothyroidism in children, as a result of which irreversible changes in the nervous system are formed. Despite the mandatory intake of potassium iodide preparations, pregnant women often develop gestational hypothyroidism, which requires the appointment of levothyroxine. Many women have episodic hypofunction of the thyroid gland before pregnancy, associated with various factors. Diagnosed hypothyroidism requires hormonal correction. The recommended dose of levothyroxine calculated by the patient’s weight is not always adequate to achieve TSH targets. In addition, there are pharmacological factors. Levothyroxine sodium preparations differ in bioavailability. The stability of drugs is affected by external factors and the composition of fillers from different manufacturers of drugs. AIM: To assess the dependence of TSH reduction on the method of taking levothyroxine in a population of pregnant women. MATERIALS AND METHODS: Statistical analysis and prospective study was carried out from 2019 to 2021. On the basis of the «Perinatal Center», Tyumen, women’s consultative and diagnostic department. Pregnant women with diagnosed primary subclinical and manifest hypothyroidism in the first trimester of pregnancy (n=76) were selected for cohort observation. All pregnant women were prescribed L-thyroxine Berlin-hemi. Other levothyroxine preparations were not used in order to exclude distortion of the results of the study. RESULTS: Pregnant women with hypothyroidism were divided into two groups according to the method of taking L-thyroxine: oral (n=54) and sublingual (n=22). A month later, TSH normalization was observed in 41 pregnant women in the oral group (76%) and in 22 pregnant women in the sublingual group (100%). Women who did not achieve hypothyroidism compensation were recommended sublingual administration without increasing the dose of L-thyroxine, provided that TSH was no higher than 4.0 mcME / ml. A TSH study a month later showed that all pregnant women achieved compensation. CONCLUSION: Based on the conducted research, it is shown that the more rational administration of levothyroxine sodium preparations is sublingual, since there is a slightly alkaline reaction in the oral cavity, which does not have a destructive effect, like gastric juice.
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孕妇甲状腺功能减退实现代偿的特点
背景:孕前和孕期妇女甲状腺功能减退与儿童先天性甲状腺功能减退的高风险相关,其结果是神经系统形成不可逆转的变化。尽管强制摄入碘化钾制剂,孕妇经常出现妊娠甲状腺功能减退,这需要预约左甲状腺素。许多妇女在怀孕前有偶发性甲状腺功能减退,与各种因素有关。诊断为甲状腺功能减退需要激素矫正。根据患者体重计算的左旋甲状腺素的推荐剂量并不总是足以达到TSH目标。此外,还有药理因素。左甲状腺素钠制剂的生物利用度不同。药物的稳定性受到外部因素和不同药品生产厂家的填料组成的影响。目的:评价孕妇TSH降低对左旋甲状腺素服用方法的依赖性。材料与方法:2019 - 2021年进行统计分析和前瞻性研究。在秋明“围产期中心”的基础上,妇女咨询和诊断部门。选择妊娠早期诊断为原发性亚临床和明显甲状腺功能减退的孕妇(76例)进行队列观察。所有孕妇均给予l -甲状腺素柏林半。没有使用其他左甲状腺素制剂,以排除研究结果的失真。结果:根据l -甲状腺素给药方法将甲状腺功能减退孕妇分为口服(54例)和舌下(22例)两组。1个月后,口服组41例(76%)和舌下组22例(100%)孕妇TSH恢复正常。在TSH不高于4.0 mcME / ml的情况下,没有达到甲状腺功能减退补偿的妇女建议舌下给药,而不增加l -甲状腺素的剂量。一个月后的TSH研究表明所有孕妇都达到了补偿。结论:根据所进行的研究,左甲状腺素钠制剂舌下给药更为合理,因为口腔内有微碱性反应,不像胃液那样具有破坏性作用。
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