In a healthy body, pregnancy usually proceeds without complications. Unfortunately, not all women are completely disease-free. Some pathological processes begin in youth and remind of themselves at the most important moments of life. Negative consequences can occur if untreated autoimmune thyroiditis and pregnancy are combined.
How pathology arises and proceeds
Autoimmune thyroiditis (AIT) is a chronic inflammatory process in the thyroid gland, in which antibodies to the tissues of the organ are formed in the body. As a result, dystrophic changes develop in thyroid cells. This leads to a lack of their function – hypothyroidism is formed.
The causes of antibodies to the own tissues of the thyroid gland have not been precisely identified. The role of hereditary factors has been proven. If the closest relatives have a pathology of the thyroid organ, then genetic determination plays a direct role in the formation of the disease.
There are predisposing factors that, in combination, can lead to the disease. These include:
- any infectious processes in the body, accompanied by febrile fever for at least 3 days;
- neck injuries;
- excess iodine in the environment or in food;
- excessive insolation;
- selenium deficiency in the soil.
It is important to consider, since the causes of the disease are not precisely clarified, no woman can be completely protected from autoimmune thyroiditis.
If pregnancy is planned, it is necessary to conduct an examination before conception with the exception of this pathology.
How the disease manifests itself
There are no symptoms typical for thyroiditis. In the process of exposure of antibodies to the tissues of the organ, a hypothyroid state develops. The thyroid gland can significantly increase in size. The main clinical manifestations are associated either with the accompanying hypothyroidism, or compression of the surrounding tissues by the thyroid gland .
The most common manifestations are:
- decrease in working capacity;
- swelling of the face;
- difficulty swallowing;
- shortness of breath on exertion.
During pregnancy, anemia often develops due to the increased consumption of iron in the body. Autoimmune thyroiditis exacerbates anemic syndrome, leading to a significant decrease in hemoglobin numbers.
How the disease affects pregnancy
With autoimmune thyroiditis, there are two main problems for a pregnant woman. The first is the effect of immune complexes on the fetus and placenta. The second is the lack of thyroid hormones for the normal functioning of pregnancy. The negative impact is already in the first trimester.
The most dangerous negative effects of the disease are as follows:
- miscarriage in the early stages;
- bloody discharge from the genital tract;
- placental insufficiency, which leads to oxygen deficiency in the fetus;
- uterine hypertonicity ;
- underdevelopment of the thyroid gland during embryogenesis, which will lead to the formation of serious illnesses in the baby – myxedema and cretinism.
Most severe defects in the development of pregnancy are subject to artificial termination of pregnancy.
It is important to consider that all complications of autoimmune thyroiditis during pregnancy can be avoided if you properly prepare for conception.
What to do before pregnancy
Proper planning of conception implies mandatory screening of the level of gland hormones in the blood. If there was no illness, then this does not mean at all that the function of the organ is in perfect order. Determining the parameters of the functioning of the gland is also necessary because the lack of thyroid hormones has a sharp negative effect on fertility, that is, pregnancy may not occur at all. Therefore, all women should undergo the following examinations:
- blood test for thyroxine, triiodothyronine – thyroid hormones;
- determination in the blood of the level of thyroid-stimulating hormone, which is produced by the hypothalamic-pituitary system;
- a blood test for antibodies to thyroperoxidase , an enzyme in the cells of the thyroid organ;
- ultrasound of the neck area;
- lung radiography.
If no pathological abnormalities are detected, then autoimmune thyroiditis will not occur during pregnancy. The thyroid gland will not have any negative effect on the process of embryogenesis and the formation of the placenta.
If pathological changes are detected, this does not mean that autoimmune thyroiditis is incompatible with pregnancy. Comprehensive treatment is needed, which is aimed at eliminating the hormonal deficiency and normalizing the activity of the thyroid organ.
How to treat the disease
If autoimmune thyroiditis is detected before pregnancy, it is imperative to normalize the function of the organ before planning conception. This can be done with hormone replacement therapy. Preparations containing the thyroid hormone – thyroxine, or combined ones, which also include triiodothyronine, are used.
The most commonly used drug trade names are:
- euthyrox ;
- bagothyrox ;
- sodium levothyroxine ;
- L- tyrok ;
- thyrocomb .
The dose of the drug is selected individually, depending on the characteristics of the female body. Begin therapy with 50 mcg of the drug, gradually increasing to the maximum tolerated. Against the background of treatment, not only the hormonal background of the gland normalizes, that is, euthyroidism sets in, but the activity of antibodies also decreases. Upon reaching the euthyroid state, pregnancy can be planned. During all 9 months of the physiological process, thyroid function should be monitored at least three times. If the doctor prescribes a maintenance dose of thyroxine for the entire period of pregnancy, the therapy regimen must be strictly observed to avoid the consequences of the disease.
What to do if the disease is detected after conception
However, even identified autoimmune thyroiditis during pregnancy can result in the birth of a healthy child at term.
The main thing in such a situation is not to panic and not get upset. Any nervous stress will negatively affect the process of bearing a child. Not everyone is planning a pregnancy. It happens that the disease is detected when conception has occurred. The course of the physiological process will depend on the level of hormonal deficiency. In this case, the activity of antibodies is of secondary importance.
If the patient has euthyroidism , then only planned monitoring of the state of the gland and the course of pregnancy is necessary. In the presence of hypothyroidism, hormone replacement therapy is performed, but the dosage is selected at an accelerated pace. It is important to have time to normalize the function of the gland before the formation of the placenta. If the first three months were enough to develop euthyroidism , the chances that pathological changes in the fetus will not develop during pregnancy are high. In the case of a severe hypothyroid condition due to autoimmune thyroiditis that is not stabilized by 12 weeks of gestation, doctors will have to make the difficult decision to terminate for medical reasons.
Thus, the combination of autoimmune thyroiditis and pregnancy poses a serious threat to the woman and the unborn child. It is necessary to carry out preventive measures before conception in order to avoid the negative impact of the disease. Be sure to conduct a dynamic monitoring of the state of hormone activity during all 9 months.