[Thyroid malfunction in pregnancy]. / Poruchy stítné zlázy v tehotenství--souhrn výsledku nezávislých studií.

CONTEXT: Over the past 15 years there have been discussions about advisability of thyroid gland function screening in pregnant women, recommendations are being defined at least ten years. The reasoning is based on fact, that not only complications in pregnancy or after delivery were proved, but also problems in mental development of children, the mothers of which suffered impairement of thyroid gland function. OBJECTIVE: We are presenting thyroid parametres TSH, TPOAb, in part also FT4, in 1st trimestr of pregnancy. Examination were performed in three Czech centers and included 4500 pregnant women. RESULTS: The TSH suppression was proved in 3.6%, mostly without link to thyroid gland function, the increased TSH concentration in connection with (sub)clinical hypothyroidism was found in 5% of women, the low FT4 concentration under 9.8 pmol/I, which endangers fetal intellectual development, was found in 17 of 120 investigated woman with TSH higher than 4.00 mU/l. Thus exists a risk of minimum 1 to 170 in all group, that insufficient fetal brain development occurs. TPOAb were positive in 15% women. Increased risk of thyroid malfunction progress in women with positive TPOAb in pregnancy (and up to 50% after delivery) was repeatedly proved. CONCLUSION: Based on the results (5% hypothyroidism, 15% with TPOAb pregnant women) we would like to commence discussion concerning screening in pregnancy in CR, preferably before the planned conception, or at latest just before the actual pregnancy. Systematic cooperation among gynecologists, endocrinologists, general practitioners and laboratories should be established to solve the problems, as laboratory normal range, pregnancy timing for examination, unification of diagnostic procedures and correct interpretation of the results.

[Prevalence of thyroid gland disorders in pregnant women in the West Bohemia Region during their 2nd trimester of pregnancy in the year 2000--pilot study]. / Prevalence poruch stítné zlázy u tehotných zen v západoceském regionu ve 2. trimestru tehotenství v roce 2000--pilotní studie.

The diagnostics and the treatment of the disorders of the thyroid gland in pregnancy belong to the most important topics for most endocrinologists in the whole world. Untreated or mistreated thyroid gland disorders may influence the course of pregnancy and development of the foetus and child. Autoimmune thyroiditis, hyperthyroidism and hypothyroidism represent the most common thyreopaties in pregnancy and that is why the aim of the study was to establish their prevalence in population of pregnant women of the West Bohemia region. In our study we assessed serum levels of thyrotropin (TSH), free tyroxin (fT4) and antithyroid peroxidase antibodies (antiTPO) in 650 pregnant women. Sera were acquired during routine blood sampling for Down syndrome screening in the 2nd trimester of pregnancy. In our group we found the prevalence of 1.5% of hypothyroidism and 9.4% of autoimmune thyroiditis and we revealed no case of thyrotoxicosis, only subnormal TSH in 2.3%.

[Thyroid disease in pregnant women and its development after childbirth]. / Tyreopatie u tehotných zen a jejich vývoj po porodu.

OBJECTIVE: To assess the incidence of post-partum thyropathies in women with positive antibodies against thyroid peroxidase in the second trimester of pregnancy. MATERIAL AND METHODS: Based on a cross-sectional study of the prevalence of abnormal laboratory parameters of thyroid function in a group of 650 pregnant women in the second trimester of pregnancy the authors invited for subsequent clinical examination and repeated controls women with elevated antibodies against thyroid peroxidase (antiTPO) above 60 mU/l (1). The group comprised 75 pregnant women, incl. 44 (58.7%) who attended the examination. After delivery the authors examined the serum levels of TSH, fT4, antiTPO, if necessary fT3 and TRAK. RESULTS: 18, i.e. 58.1% women developed post-partum thyroiditis, incl. 10, i.e. 55.6% who developed hypothyroidism and 8, i.e. 44.4% who developed hyperthyroidism. CONCLUSION: Based on the presented study the authors recommend in pregnant women in the first trimester of pregnancy to introduce assessment of thyrotropin (TSH) and free thyroxin (fT$) and antibodies against thyroid peroxidase (antiTPO)[to detect neuropsychic sequelae on the infant after delivery. The investigation of serum levels of antiTPO antibodies will make it possible to select a group of women in risk of by the development of post-partum thyropathies which must be followed up.