Hormonal changes that occur during pregnancy, affect all systems and organs, including the thyroid gland. This is especially true of hyperthyroidism (Graves' disease), which was before pregnancy. Uncompensated thyrotoxicosis during pregnancy leads to various complications, while controlled thyrotoxicosis may disappear completely after birth.

Gestational thyrotoxicosis

Gestational hyperthyroidism occurs only during pregnancy and is a physiological condition that requires no treatment. The development of gestational hyperthyroidism is associated primarily with the formation of human chorionic gonadotropin, which is first synthesized tissue (chorion) of the fetus, and after sixteen weeks of pregnancy the placenta. Its structure is very similar to chorionic gonadotropin on the thyroid-stimulating hormone produced by the thyroid gland. Thyroid hormone stimulates the secretion of the thyroid gland, while human chorionic gonadotropin temporarily stimulates the thymus during pregnancy. In some pregnant chorionic hormone stimulation is so strong that it leads to increased levels of T4 in the blood, while the reduced thyroid hormone. Such a condition called gestational or transient (temporary) thyrotoxicosis.

The second factor that affects the development of gestational thyrotoxicosis, is a high level of estrogen, which stimulates protein synthesis in the liver. This protein binds the thyroid hormone that reduces the level of free thyroxine in turn causes the thyroid to produce more hormones.

Differences gestational thyrotoxicosis of diffuse toxic goiter

Gestational thyrotoxicosis is characterized by symptoms that resemble the symptoms of early toxicity Toxicosis: expectant mothers as interesting   (nausea, vomiting, palpitations, hot flashes), and is found only in the early stages of pregnancy. Also with transient thyrotoxicosis no history of thyroid disease Thyroid disease - when to start worrying?   and no increase in antibody titers to the thyroid gland. On US thymus is not changed, there was a slight increase in T4 and a moderate decrease in thyroid-stimulating hormone, while the level of the hormone human chorionic significantly increased (more than 100,000 IU / L). During multiple pregnancy Multiple Pregnancy - Are there any special recommendations?   gestational hyperthyroidism is more common. The main preventive measure which prevents the development of diffuse toxic goiter is iodine intake. Pregnant and lactating women should get 200 micrograms of iodine per day. For this purpose registers Iodide-200 one tablet per day.

Graves' disease and pregnancy

Diffuse toxic goiter (Graves 'disease and Graves' disease) is an organ autoimmune disease, which is accompanied by an increase in thyroid cancer, her hyperactivity and the response of tissues and organs in the excess of thyroid hormones. It is found in only one or two women per 1000 pregnancies. According to the classification are three degree increase in thyroid cancer:

• zero degree - no goiter;
• first degree - the goitre is not visible, not palpable;
• second degree - goiter palpable and visible to the eye.

The clinical picture of diffuse toxic goiter consists of a triad of symptoms: hyperthyroidism, eye symptoms and enlargement of the thyroid gland. Hyperthyroidism manifests increased appetite, and weight reduced, weakness, fatigue, shortness of breath, sweating and irritability. Symptoms of hyperthyroidism exophthalmos joins, tremor, and goiter. In addition, when diffuse toxic goiter observed fluctuations in blood pressure and a slight fever. Graves' disease during pregnancy results in the development of various complications.

On the part of the mother:

• arterial hypertension;
• preeclampsia;
• premature birth;
• miscarriage;
• spontaneous abortion;
• heart failure;
• thyrotoxic crisis.

On the part of the fetus:

• intrauterine growth retardation;
• small baby at birth;
• fetal death;
• malformations;
• Neonatal hyperthyroidism.

Treatment of hyperthyroidism during pregnancy is carried drugs that are the least cross the placenta (propiltiuratsil) in moderation. Also appointed sedatives (motherwort, valerian) and propranolol and reserpine to alleviate symptoms of hyperthyroidism (tremor, palpitation), and lower blood pressure.

Anna Sozinova

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