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2012, Número 3

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Rev Cuba Endoc 2012; 23 (3)


Hipertiroidismo y embarazo

Martínez PHV, Hernández HMC

Idioma: Español
Referencias bibliográficas: 52
Paginas:
Archivo PDF: 181.22 Kb.


RESUMEN

El hipertiroidismo constituye la enfermedad tiroidea más frecuente de la gestación. Su diagnóstico puede ser algo difícil por los cambios fisiológicos que ocurren durante el embarazo, ambos se acompañan de bocio, hipermetabolismo y circulación hiperdinámica. La dificultad para ganar peso a pesar de mantener el apetito y la taquicardia en reposo (más de 90 latidos/minuto) son los signos más sugestivos. La causa más común (80-85 %) es la enfermedad de Graves, de etiología autoinmune, que aparece con mayor frecuencia en el primer trimestre y el posparto, y puede agravarse si existen niveles elevados de gonadotropina coriónica durante el primer trimestre. El hipertiroidismo manifiesto afecta al curso del embarazo con consecuencias adversas para la madre y el feto. La determinación de niveles elevados de tiroxina y triyodotironina libres es el estudio diagnóstico confirmatorio. El empleo de los antitiroideos de síntesis es la terapia de elección, y se sugiere emplear la dosis mínima necesaria para controlar el hipertiroidismo y mantener a la paciente eutiroidea, lo cual se logra mediante un seguimiento clínico y de la función tiroidea cada 4 o 6 semanas. La lactancia se permite en madres que ingieren dosis de 200 mg/día de propiltiuracilo o 20 mg/día de metimazol.


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