Thyrotoxicosis is a pathological condition that can be caused by several pathologies, the common clinical and diagnostic sign of which is an excessive concentration of thyroid hormones in the blood serum. Thyrotoxicosis during pregnancy can lead to complications of gestation, and therefore this pathology needs timely correction.

The pathogenesis of thyrotoxicosis

Diseases that are characterized by the clinic of thyrotoxicosis are divided into two groups: pathologies that are combined with hyperthyroidism , and pathologies that occur without hyperthyroidism . The first group should include:

• thyrotoxic adenoma;
• thyrotropin ;
• multinodular toxic goiter;
• trophoblastic tumor pathologies;
• ovarian adenomas in combination with its atrophic and sclerotic changes;
• thyroid cancer;
• autoimmune thyroiditis in the hyperthyroid phase;
• diffuse toxic goiter.

The second group of diseases include:

• radiation thyroiditis;
• postpartum thyroiditis;
• thyroiditis provoked by the use of interferon and amiodarone preparations;
• subacute thyroiditis.

The pathological nature of thyrotoxicosis during pregnancy is quite rare – the probability is 0.1-0.2%. Most often, thyrotoxicosis in pregnant women is provoked by Graves’ disease , that is, diffuse toxic goiter. This pathology is autoimmune in nature and develops as a result of the formation of antibodies to thyroid-stimulating hormone receptors. Clinically, the pathology is manifested by hypertrophy of the thyroid tissue and the formation of thyrotoxicosis syndrome, which provokes extrathyroid symptoms.

If a patient is diagnosed with diffuse toxic goiter, this is not considered an indication for termination of pregnancy. Just in this case, pregnancy planning should begin with determining the functional state of the thyroid gland and its correction, if necessary.

Thyrotoxicosis can somewhat reduce fertility, that is, the ability to conceive a child. At the same time, this property of the pathology is less pronounced than in hypothyroidism. But the moderate and severe course of thyrotoxicosis in 90% of clinical cases provokes the development of infertility.

Symptoms of pathology

Pregnancy with thyrotoxicosis of the thyroid gland is complicated by the development of characteristic clinical symptoms. Often the first symptom is vomiting, which makes diagnosis difficult, since toxicosis in the early stages provokes the same symptom. Also, the thyrotoxic state is characterized by a feeling of heat, sweating, rapid pulse, nervousness, and an increase in the size of the thyroid gland. But these signs can also appear in the case of a normal pregnancy.

The exophthalmos characteristic of Graves’ disease can help in the diagnosis . The determining indicator in the detection of thyrotoxicosis is a blood test for hormones. The patient must donate blood to determine the level of thyroid hormones and thyroid-stimulating hormone. At the same time, subclinical thyrotoxicosis can also be detected, which does not give pronounced manifestations.

A thyrotoxic state can provoke miscarriage , the appearance of congenital pathologies in a child. Therefore, it is extremely important to identify and correct the pathology in a timely manner, and pregnancy in this case will proceed with the same probability of complications as in healthy women.

Diagnosis of pathology

Identification of pathology during pregnancy is possible by analyzing clinical manifestations and laboratory data. In addition, it is important to conduct an ultrasound examination of the thyroid tissue.

At the same time, Graves’ disease should be distinguished from transient gestational hyperthyroidism, which does not require therapeutic correction and resolves spontaneously as the period increases.

Therapy for thyrotoxicosis

When thyrotoxicosis is detected, provoked by Graves’ disease , thyrotoxic drugs are prescribed to pregnant women, which form the basis of conservative treatment. Surgical treatment is possible only in case of intolerance to antithyroid drugs. After the intervention, the appointment of L-thyroxine is mandatory.

In the absence of treatment or control of the effectiveness of therapy, the risk of spontaneous interruption increases. Therefore, the treatment is selected in such a way that the euthyroid state is maintained throughout the entire period of bearing the child. In this case, the doses of thyreostatics should be minimal and selected individually, taking into account the possible risk of their use for the fetus.

Principles of therapy for pathology in pregnant women

When treating thyrotoxicosis during pregnancy, the following principles should be followed:

1. It is necessary to determine the concentration of free thyroxine every month.
2. The main drug, the use of which is possible in pregnant women, is propylthiouracil .
3. In the case of moderate thyrotoxicosis, the dose of the drug is 200 mg per day, divided into 4 doses.
4. When the concentration of thyroxin reaches the upper limit of normal values, the dose of the drug is reduced to a maintenance dose, that is, up to 25-60 mg per day.
5. Thyreostatics can be completely canceled at normal values of thyroxin, and if necessary, appoint again.
6. It is important to monitor the patient’s condition after childbirth, since the likelihood of relapse is high.