Graviditet i samband med underfunktion i sköldkörteln

Sammanfattning: Backgrond: The thyroid is a hormone-producing endocrine gland which is located in the front of the throat. The thyroid gland tissue contains several microscopic and spherical cavities called follicles. Thyroid hormones thyroxine (T4) and triiodothyronine (T3) are produced from the follicle cells and regulated by a so-called three-hormone sequence. Thyroid stimulating hormone (TSH) is the second hormone in the sequence and is produced from the pituitary gland. During pregnancy, the thyroid gland produces a greater amount of hormone to cater the needs of the mother and her offspring. When the gland produces too little hormone, it is called hypothyroidism. The disease causes symptoms such as chills, dryness, depression, and hair loss. The disease is divided into different types depending on the underlying cause of the disease. It is called primary hypothyroidism when disorders are in the thyroid gland itself and secondary when the problem is elsewhere in the body, usually in the hypothalamus. Hypothyroidism during pregnancy increases the risk of obstetric complications and can also lead to reduced IQ development in the fetus. Levothyroxine is a synthetic T4 and is used as a first-line drug in the treatment of hypothyroidism. Aim: The aim of this study was to investigate whether treatment with levothyroxine in subclinical hypothyroidism in pregnancy reduces the risk of pregnancy complications and also to analyze how thyroid autoimmunity and subclinical hypothyroidism affect the pregnant woman. Method: The work is a literature study conducted using six relevant published articles retrieved from the medical database and the search engine PubMed. Results: The studies 2,4,5 concluded that subclinical hypothyroidism and thyroid autoimmunity increase the risk of pregnancy complications. Studies 1 and 6 could not show any connection between these groups. Levothyroxine treatment in pregnancy with TSH value greater than 4 mIU/L is effective and leads to reduced risk of miscarriage, admission to neonatal wards and premature birth. In addition, the studies showed that the levothyroxine treatment in patients with TSH value less than 4mIU/L is without any significant effect.   Conclusion: The evidence at present, is unclear and there is insufficient data to determine the efficacy of treatment in patients with TSH levels below 2.5 mIU / L. More and larger clinical randomized controlled trials in pregnant women with subclinical hypothyroidism and positive for thyroperoxidase antibodies are needed to increase the validity of the treatment. In contrast, levothyroxine treatment in mothers with a TSH level in serum greater than 4 mIU / L is effective and of significant importance for both the woman and her offspring.