Schilddrüsenerkrankungen in der Schwangerschaft bei Diabetes mellitus Typ 1

Abstract

Diabetes mellitus type 1 is associated with other autoimmune disorders, in particular autoimmune thyroid disease. Pregnancy and the postpartum period increase the incidence of positive anti-thyroid peroxidase antibodies (TPO-ab) and thyroid dysfunction in women with diabetes mellitus type 1 to a greater extent than in a comparable population without metabolic disease. Both overt and subclinical hypothyroidism can have an adverse effect on the course of the pregnancy and the development of the fetus. Hypothyroidism should be diagnosed and corrected before the initiation of pregnancy. If hypothyroidism is diagnosed during pregnancy, the thyroid function should be normalized as rapidly as possible. A subnormal serum TSH concentration can be used to differentiate Graves' disease from gestational thyrotoxicosis on the evidence of autoimmunity (morphologic change of goiter and TSH-receptor antibodies). For overt hyperthyroidism due to Graves' disease or hyperfunctioning thyroid nodules anti-thyroid drug therapy should be either initiated or adjusted to maintain the maternal thyroid hormone levels for free T4 in the upper reference range for non-pregnant women. General screening of pregnant women for thyroid disease is not yet supported by adequate studies, but the screening of patients with DM1 who are at increased risk is strongly recommended.