230 - Clinical management of hypothyroidism in pregnancy-the actions
Autor(s): A. Cassio (Bologna), L. Chiovato (Pavia), A. Cicognani (Bologna), R.M. Dorizzi (Forlì), P. Garofalo (Palermo), A.R. Genazzani (Pisa), D. Glinoer (Bruxelles), R. Negro (Lecce), E. Papini (Albano Laziale), F. Petraglia (Siena), A. Pinchera (Pisa), M. Tonacchera (Pisa), V. Toscano (Roma), H. Valensise (Roma), M. Zini (Reggio Emilia)
Issue: RIMeL - IJLaM, Vol. 3, N. 4, 2007 (MAF Servizi srl ed.)
Page(s): 230-231
Before pregnancy
Diagnosed hypothyodism
• Counseling
• Increase administration of FT4 or start treatment (goal for TSH: < 2.5 mU/L and FT4 within reference limits
No known hypothyroidism
• Counseling and estimation of risk
• Clinical and biochemical (TSH reflex) assessment and ultrasonography when goiter or nodules are present
• Start l-T4 treatment if hypothyroidism is detected
Pregnancy
• Measure FT4 e TSH and increase l-T4 dose
• Involve gynaecologist
I - II trimester
• Monitor TSH and FT4 bimonthly
• Fetal ultrasonography (each trimester)
• Thyroid ultrasonography when goiter or nodules are present
III trimester
• Measure TSH, FT4 and TRAb
• Involve paediatrician/neonatologist
Delivery
• Avoid antisepsis with iodine in newborn and mother
• Carry out neonatal screening indicating the mother’s disease
• Measure TRAb if positive in mother
Post-partum
Mother:
• Decrease l-T4 within one month
• Measure FT3, FT4, TSH after 3-9 months
Newborn:
• Use milk supplemented with iodine
• If screening positive involve the pediatrician
• Start treatment if TSH increased
• In hypothyroidism carry out ultrasonography and measure thyroglobulin and TRAb