Features of gestation course in women with nodular goiter under conditions of iodine deficiency

Abstract

According to statistical data, hypothyroidism with an increase in the level of pituitary thyroid‑stimulating hormone (TSH) occurs during pregnancy in 2—2.5% of cases, thyrotoxicosis due to Graves’ disease — in 0.2%, transient hyperthyroidism due to uncontrollable vomiting of pregnant women — in 2—3%, and the frequency of development of autoimmune thyroiditis is 10%. In the postpartum period, the development of thyropathies is noted in 5—9% of women in labor. Graves’ disease is diagnosed in 70—80% of cases, and thyroid suppression in 20—30% of cases.
 Objective — to study the characteristics of the course of pregnancy, childbirth and the postpartum period in women with nodular formations in the thyroid gland under conditions of iodine deficiency.
 Materials and methods. Observations involved 159 pregnant women who constantly live under conditions of iodine deficiency. The patients were divided into two groups, the first group included 52 women with a history of thyroid surgery due to nodular formation, and women of the second group (n=57) were administered conservative treatment for nodular goiter during this pregnancy. The control group included 50 practically healthy women with a physiological pregnancy course. The term of pregnancy and the age of women in all groups did not differ significantly.
 Results. It has been demonstrated that insufficient intake of iodine by pregnant woman resulted in perinatal complications and requires monitoring of the iodine balance during pregnancy, in the postpartum and early neonatal periods. The threat of pregnancy termination in the group of surgical treatment of nodular goiter was 42.3%, in the group of conservative treatment 56.1%; the proportion of placental dysfunction was 76.9% and 57.9%, respectively; preeclampsia of the first degree of severity was registered in 11.5% and 12.3% of patients, respectively; mild and moderate anemia — in 78.9% and 64.9%, respectively, which significantly (p<0.05) exceeded similar indicators in the control group.
 Conclusions. Pregnant women with nodular formations of the thyroid gland have a greater number of complications during pregnancy, regardless of the method of treatment of nodular goiter, than women with a physiological pregnancy course.