Muñoz CFJM, Vorhauer RS, Rodríguez LR, Palacios MCA, Villagomez AMI, Ayala YR

Idioma: Español
Referencias bibliográficas: 52
Paginas: 111-117
Archivo PDF: 272.99 Kb.

RESUMEN

El hipotiroidismo en el embarazo repercute de manera directa en las complicaciones maternas y fetales. Esta guía incluye recomendaciones recientes de tamizaje, diagnóstico y tratamiento del hipotiroidismo en el embarazo, así como información adicional sobre eventos obstétricos adversos y pronóstico fetal a largo plazo. Un enfoque clínico apropiado es importante, ya que el tratamiento oportuno puede mejorar el neurodesarrollo y los resultados neonatales. Existe controversia sobre el tamizaje universal o selectivo para hipotiroidismo en pacientes embarazadas. Los estudios favorecen el cribado universal en la primera visita prenatal. El diagnóstico de hipotiroidismo en el embarazo se realiza midiendo los niveles de hormona estimulante de la tiroides y de hormona tiroidea, de acuerdo a los valores normales en cada uno de los trimestres; las hormonas tiroideas son de vital importancia para el neurodesarrollo y el crecimiento cerebral. Las complicaciones maternas más importantes del hipotiroidismo durante la gestación son la pérdida del embarazo, el parto pretérmino y el desprendimiento prematuro de la placenta. Los recién nacidos que cursaron con niveles bajos de hormona tiroidea durante el embarazo tienen una función cognitiva menor. Un tratamiento adecuado puede mejorar la capacidad intelectual y los resultados neonatales a largo plazo.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Patton P, Samuels M, Trinidad R, Caughey A. Controversies in the management of hypothyroidism during pregnancy. Obstet Gynecol Surv. 2014; 69 69 (9): 346-358.

2. Serrano BM. Alteraciones de tiroides y embarazo: resultados perinatales. Rev Esp Med Quir. 2013; 18 (3): 200-205.

3. Gómez G, Ruiz R, Sánchez V, Segovia A, Mendoza C, Arellano S. Hipotiroidismo. Med Int Mex. 2010; 26 (5): 462-471.

4. Chen L, Du W, Dai J, Zhang Q, Si G, Yang H et al. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PLoS One. 2014; 9 (10): e109364.

5. Medeiros M, Cerqueira T, Silva Junior J, Amaral M, Vaidya B, Poppe K et al. An international survey of screening and management of hypothyroidism during pregnancy in Latin America. Arq Bras Endocrinol Metabol. 2014; 58 (9): 906-911.

6. Campos-Hinojosa SE, García-de la-Torre JI, Garza Marínez LE. Asociación entre hipotiroidismo subclínico y enfermedad hipertensiva del embarazo. Ginecol Obstet Mex. 2016; 84 (7): 413-419.

7. Blumenthal N, Eastman C. Beneficial effects on pregnancy outcomes of thyroid hormone replacement for subclinical hypothyroidism. J Thyroid Res. 2017; 2017: 4601365.

8. Ayala-Yáñez R, Velasco-Sordo R, Alfaro-Alfaro J. Repercusiones del hipotiroidismo al principio del embarazo: consideraciones para mejorar el diagnóstico y la intervención. Ginecol Obstet Mex. 2016; 84 (10): 652-667.

9. Resnik R, Creasy R, Lams J, Lockwood C, Moore T, Greene M. Creasy and Resnik’s maternal-fetal medicine: principles and practice. Philadelphia, PA: Saunders/Elsevier, 2013. Print.

10. Laurberg P, Andersen S, Pedersen I, Andersen S, Carle A. Screening for overt thyroid disease in early pregnancy may be preferable to searching for small aberrations in thyroid function tests. Clin Endocrinol (Oxf). 2013; 79 (3): 297-304.

11. Hammond K, Cataldo N, Hubbard J, Malizia B, Steinkampf M. Gestational hypothyroidism: development of mild hypothyroidism in early pregnancy in previously euthyroid women. Fertil Steril. 2015; 103 (6): 1532-6.e1.

12. American College of Obstetricians and Gynecologists. Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol. 2015; 125 (4): 996-1005.

13. Ghassabian A, Henrichs J, Tiemeier H. Impact of mild thyroid hormone deficiency in pregnancy on cognitive function in children: lessons from the Generation R Study. Best Pract Res Clin Endocrinol Metab. 2014; 28 (2): 221-232.

14. Roti E, Minelli R, Salvi M. Clinical review 80: management of hyperthyroidism and hypothyroidism in the pregnant woman. J Clin Endocrinol Metab. 1996; 81 (5): 1679-1682.

15. Kumar A, Singh R, Prasad S. Hypothyroidism during pregnancy. Indian J Endocrinol Metab. 2012; 16 (3): 364-370.

16. Nazarpour S, Tehrani F, Simbar M, Tohidi M, AlaviMajd H, Azizi F. Comparison of universal screening with targeted high-risk case finding for diagnosis of thyroid disorders. Eur J Endocrinol. 2016; 174 (1): 77-83.

17. Maraka S, Singh N, O’Keefe D, Rodriguez-Gutierrez R,
 Espinosa De Ycaza A et al. Effects of increasing levothyroxine on pregnancy outcomes in women with uncontrolled hypothyroidism. Clinical Endocrinology (Oxf). 2017; 86: 150-155.

18. Abalovich M, Vázquez A, Alcaraz G, Kitaigrodsky A, Szuman G, Calabrese C et al. Adequate levothyroxine doses for the treatment of hypothyroidism newly discovered during pregnancy. Thyroid. 2013; 23 (11): 1479-1483.

19. Korevaar TI, Muetzel R, Medici M, Chaker L, Jaddoe VW, de Rijke YB et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol. 2016; 4 (1): 35-43.

20. Lazarus J, Bestwick J, Channon S, Paradice R, Maina A, Rees R et al. Antenatal Thyroid Screening and Childhood Cognitive Function. N Engl J Med. 2012; 366 (6): 493-501.

21. De Groot L, Abalovich M, Alexander E, Amino N, Barbour L, Cobin R et al. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97 (8): 2543-2565.

22. Teng W, Shan Z, Patil-Sisodia K, Cooper D. Hypothyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013; 1 (3): 228-237.

23. Negro R, Stagnaro-Green A. Diagnosis and management of subclinical hypothyroidism in pregnancy. BMJ. 2014; 349: g4929.

24. Reid S, Middleton P, Cossich M, Crowther C, Bain E. Interventions for clinical and subcinical hypothyroidism pre-pregnancy and during pregnancy. Cochrane Database of Systematic Reviews. 2013; 5: CD007752.

25. Villagelin D, Comarella A, Tiago D, Ward L. Management of gestational hypothyroidism: results of
a Brazilian survey. Arch Endocrinol Metab. 2016; 60 (1): 16-20.

26. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007; 92 (1): 203-207.

27. Vila L, Velasco I, González S, Morales F, Sánchez E, Lailla J et al. Detection of thyroid dysfunction in pregnant women: Universal screening is justified. Endocrinol Nutr. 2012; 59 (9): 547-560.

28. Milanesi A, Brent G. Management of hypothyroidism in pregnancy. Curr Opin Endocrinol Diabetes Obes. 2011; 18 (5): 304-309.

29. Alexander E, Pearce E, Brent G, Brown R, Chen H, Dosiou et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017; 27 (3): 315-389.

30. Chen S, Zhou X, Zhu H, Yang H, Gong F, Wang L et al. Preconception TSH and pregnancy outcomes: a population-based cohort study in 184 611 women. Clin Endocrinol (Oxf). 2017; 86 (6): 816-824.

31. Idris I, Srinivasan R, Simm A, Page R. Maternal hypothyroidism in early and late gestation: effects on neonatal and obstetric outcome. Clin Endocrinol (Oxf). 2005; 63 (5): 560-565.

32. Fitzpatrick D, Russell M. Diagnosis and management of thyroid disease in pregnancy. Obstet Gynecol Clin North Am. 2010; 37 (2): 173-193.

33. Yim C. Update on the management of thyroid disease during pregnancy. Endocrinol Metab (Seoul). 2016; 31 (3): 386-391.

34. Kalra B, Gupta Y, Kalra S. Preconception management of thyroid disorders. J Pak Med Assoc. 2017; 67 (4): 645-647.

35. Uchida S, Maruyama T, Kagami M, Miki F, Hihara H, Katakura S et al. Impact of borderline–subclinical hypothyroidism on subsequent pregnancy outcome in women with unexplained recurrent pregnancy loss. J Obstet Gynaecol Res. 2017; 43 (6): 1014-1020.

36. Cooper D, Pearce E. Subclinical hypothyroidism and hypothyroxinemia in pregnancy-still no answers. N Engl J Med. 2017; 376 (9): 876-877.

37. Grattan M, Thomas D, Hornberger L, Hamilton R, Midodzi W, Vohra S. Maternal hypothyroidism may be associated with CHD in offspring. Cardiol Young. 2015; 25 (7): 1247-1253.

38. Vissenberg R, Vrijkotte T, Van der Post J, Fliers E, Goddijn M, Bisschop PH. Abnormal thyroid function parameters in the second trimester of pregnancy are associated with breech presentation at term: a nested cohort study. Eur J Obstet Gynecol Reprod Biol. 2016; 199: 169-174.

39. Maraka S, Singh N, O’Keefe D, Espinosa De Ycaza A, Gionfriddo M, Erwin PJ et al. Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis. Thyroid. 2016; 26 (4): 580-590.

40. Vaidya B, Hubalewska-Dydejczyk A, Laurberg P, Negro R, Vermiglio F, Poppe K. Treatment and screening of hypothyroidism in pregnancy: results of a European survey. Eur J Endocrinol. 2012; 166 (1): 49-54.

41. Liu H, Shan Z, Li C, Mao J, Xie X, Wang W et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid. 2014; 24 (11): 1642-1649.

42. Ma L, Qi H, Chai X, Jiang F, Mao S, Liu J et al. The effects of screening and intervention of subclinical hypothyroidism on pregnancy outcomes: a prospective multicenter single-blind, randomized, controlled study of thyroid function screening test during pregnancy. J Matern Fetal Neonatal Med. 2016; 29 (9): 1391-1394.

43. Tan T, Cheng Y, Caughey A. Are women who are treated for hypothyroidism at risk for pregnancy complications? Am J Obstet Gynecol. 2006; 194: e1-e3.

44. Negro R, Schwarts A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010; 95 (4): 1699-1707.

45. Arbib N, Hadar E, Sneh-Arbib O, Chen R, Wiznitzer A, Gabbay-Benziv R. First trimester thyroid stimulating hormone as independent risk factor for adverse pregnancy outcome. J Matern Fetal Neonatal Med. 2017; 30 (18): 2174-2178.

46. Wang S, Teng WP, Li J, Wang W, Shan Z. Effects of maternal subclinical hypothyroidism on obstetrics outcomes during early pregnancy. J Endocrinol Invest. 2012; 35 (3): 322-325.

47. Zhang Y, Wang H, Pan X, Teng W, Shan Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy hace a higher risk of miscarriage: A systematic review and meta-analysis. PLoS One. 2017; 12 (4): e0175708.

48. Casey B, Thom E, Peaceman A, Varner M, Sorokin Y, Hirtz D et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017; 376 (9): 815-825.

49. Haddow J, Palomaki G, Allan W, Williams J, Knight G, Gagnon J et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999; 341 (8): 549-555.

50. Finken M, Eijsden M, Loomans E, Vrijkotte T, Rotteveel J. Maternal hypothyroxinemia in early pregnancy predicts reduced performance in reaction time tests in 5- to 6-year-old offspring. J Clin Endocrinol Metab. 2013; 98 (4): 1417-1426.

51. Lain S, Bentley J, Wiley V, Roberts C, Jack M, Wilcken B et al. Association between borderline neonatal thyroid-stimulating hormone concentrations and educational and developmental outcomes: a population-based record-linkage study. Lancet Diabetes Endocrinol. 2016; 4: 756-765.

52. Diagnóstico y tratamiento de hipotiroidismo primario y subclínico en el adulto. México: Secretaría de Salud; 03/11/2016.