Функція щитоподібної залози у вагітних з антитілами до тиреоїдної пероксидази

Abstract

Purpose - to study the function of the thyroid gland (TG) in pregnant women with antibodies to thyroid peroxidase (AB-TPO) during pregnancy. Materials and methods. The clinical group included 158 patients. The Group I - 69 pregnant women with a level of AB-TPO<350 IU/ml, the Group II - 59 pregnant women with a level of AB-TPO>350 IU/ml, the Control group - 30 conditionally healthy women without an elevated level of AB-TPO and with a physiological course of pregnancy. To determine the volume of TG the J. Brunn formula was used during ultrasound examination. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. It was established that the level of thyroid-stimulating hormone (TSH) in the I trimester has a physiologically low value - 1.2 (0.9; 1.4) mIU/l; during pregnancy its level increased to 1.6 (1.3; 1.8) mIU/l; p<0.001. The median indicator of free thyroxine (FT4) at 7-8 weeks was at the level of 18.2 (16.2; 20.7) pmol/l; by the II trimester, it increased by 12.00% from the baseline, was 20.1 (16.2; 22.8) pmol/l; p<0.001; by the end of pregnancy - 19.6 (17.6; 20.1) pmol/l; p=0.17. The median indicator of free triiodothyronine (FT3) in the II trimester was higher by 13.6% than in the early stages of pregnancy, p=0.01. It was established that 27.5% of patients of the Group I and 30.5% of pregnant women of the Group II had laboratory signs of subclinical hypothyroidism (TSH>3.5 mIU/l) before the III trimester; p<0.05. A decrease in the production of FT3 and FT4 reflects the exhaustion of the compensatory capabilities of TG in pregnant women carriers of AB-TPO at a concentration above 350 IU/ml. Before the end of pregnancy, 17.4% of patients of the Group I and 20.3% of pregnant women of the Group II were diagnosed with manifest hypothyroidism. Conclusions. In pregnant women with a normal level of AB-TPO in the early stages of pregnancy, a physiological decrease in the level of TSH with subsequent normalization in the II and III trimesters is determined; FT4 and FT3 levels increase with increasing gestational age; the volume of TG physiologically increased by 15.2% from the indicators of the early periods, which requires regular monitoring of the thyroid status in the dynamics of pregnancy and timely correction. Тhe research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. A informed sonsennt was collected in order to carry out the research. No conflict of interests was declared by the authors.