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7/26/2019 Tiroides y reproduccion

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A qu grupos se les debe realizar tamizaje?Antecedentes de ciruga tiroidea, terapia con radioyodo oradioterapia cervicalDisfuncin tiroidea previa conocidaPresencia de anticuerpos antitiroideos (+)HipercolesterolemiaIMC > 30Infertilidad

EmbarazadasHallazgo de bocio al examen fsicoUso crnico de amiodarona o litio< de 65 aos con Depresin confirmada!de 65 aos con sospecha de depresin o trastornos cognitivosSndrome de DownSndrome de TurnerAntecedente personal de otras enfermedades autoinmunes:

!Diabetes Mellitus 1!Sindrome Sjgren!Esclerosis sistmica progresiva!

Artritis reumatoide!Enfermedad de Addison!Enfermedad celaca!Vitiligo

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PORCENTAJES

61: sanas29: HSC sin TPO5: HSC con TPO3: Solo TPO

1:Hipo con TPO1: Hipertiroidismo

Mosso et al, 2012


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EXIGENCIA TIROIDEA

HCG(sub. !"con TSH

Recep. HCG homologia recep. TSH)

Estrogenos

#TBG

$H.Libres Transitorio

#Leve TSH Transitorio

#Met. T4 porD3 Placentaria

Aporte de I (Clearance renal I aumentado)

#T4 y T3 totalT4 libre normal


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343 embarazadas en Hong Kong vs 63 controles.


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.+#+ L!J .#&X$# L#&X$!L#$REFERENCIA Poblacion Mediana

(p2,5-97.5)

HADDOW 1126

USA 0.94 (0.08-2.73)STRICKER 2272 SUIZA 1.04 (0.09-2.83)

PANESAR 343 CHINA 0.8 (0.03-2.3)

SOLDIN 312 USA 0.98 (0.24-2.99)

BOCOS-TERRAZ 1198 ESPAA 0.92 (0.03-2.65)MARWAHA 331 INDIA 2.1 (0.6-5)


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Thyroid 2005,15:44

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TSH ms sensible que T4Ldurante embarazo.

# Pocos estudioslongitudinales incluyenpacientes 1er trimestre.

# Medicin T4L no estaestandarizada paraembarazadas, aninfluenciada por TBG


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Best Pract & Res Clinic Endocrinol 2004,18:225

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Volume 15, Number 1, 2005


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2=]505b/ TSH primer trimestre

2.5-10Medir T4

TSH>10Iniciar levotiroxina

T4 normalMedir AcTPO

T4 bajaIniciar levotiroxina yajustar dosis a TSH

objetivo segn trimestrede embarazo

TPO positivosIniciar levotiroxina

TPO negativosEvaluar uso de

levotiroxinaControl cada 4 semanashasta las 20 semanasAjuste segn TSH


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T4 bajaIniciar levotiroxina yajustar dosis a TSH

objetivo segn trimestrede embarazo

TPO negativosEvaluar uso de

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$ Pacientes sin reserva tiroidea son ms lbiles$ Proposicin: educar a pacientes hipotiroideas aumentardosis de levotiroxina al confirmarse embarazo


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Consensos


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Niveles de Anticuerpos segn semana de embarazo


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Frecuencia de aborto en mujeres con Ab (+)vs mujeres con Ab (-). Odds ratio 95% CI

Stagnaro-Green et al. 17/100 (17 %) 33/392 (8 %) 2.23 1.194.20

Glinoer et al. 6/45 (13 %) 20/603 (3 %) 4.48 1.7011.81Lejeune et al. 5/23 (22 %) 16/340 (5 %) 5.63 1.8217.1Pratt et al. 8/13 (62 %) 12/42 (29 %) 10.0 2.2046.5Singh et al. 28/87 (32 %) 49/301 (16 %) 2.44 1.424.20Iijama et al. 13/125 (10 %) 52/951 (5 %) 2.01 1.063.80Kim et al. 4/10 (40 %) 4/35 (11 %) 5.17 2.7226.54Muller et al. 4/12 (33 %) 8/42 (19 %) 2.13 0.518.87

Rushworth et al. 10/24 (42 %) 30/77 (39 %) 1.12 0.442.84Poppe et al. 9/17 (53 %) 20/87 (23 %) 3.77 1.3410.63Total 104/456 336/2957 (11 %) 2.30 1.802.95

Prummel F et al. Eur J Endocrinol.2004;150(6):751

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