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Лечение щитовидной железы во время беременности:
на поводу у гормонов


Заболевания щитовидной железы все чаще диагностируются у женщин детородного возраста. Они могут сопровождаться снижением продуктивности тиреоидных гормонов — гипотериозом — или повышением функции щитовидной железы — гипертериозом или тиреотоксикозом. Оба заболевания могут сказаться и на самочувствии матери, и на здоровье ребенка. Правильно подобранное лечение щитовидной железы минимизирует риск для обоих. Главное, не скрывать от гинеколога факт наличия соответствующих заболеваний и поставить эндокринолога в известность об ожидании малыша.

Снижение функции щитовидной железы во время беременности — гипотериоз

Для многих будущих мам со сниженной функцией щитовидной железы беременность становится долгожданным чудом — из-за нарушения работы щитовидки менструальный цикл был нерегулярным, и аист не маячил на горизонте. Если будущая мама проходит терапию тироксином, важно откорректировать его прием с наступлением беременности — на двоих тироксина потребуется примерно на 50 мкг в сутки больше. Если беременность планируется, увеличить дозу желательно еще до ее подтверждения, так как достаточное количество тироксина имеет особое значение уже с первых дней беременности. Недостаток тиреоидных гормонов может негативно сказаться на уровне умственного развития крохи.

Гиперфункция щитовидки во время беременности

Повышение функции щитовидной железы чаще всего вызывается болезнью Грейвса (также известной как болезнь Базедова). Аутоимунное заболевание стимулирует щитовидку к производству избыточного количества гормонов. Во время беременности иммунитет будущей мамы ослабевает, и тиреотоксикоз снижается. Однако лечение прекращать нельзя — избыточное количество тиреоидных гормонов, проникающее через плаценту, может вызывать у маленького человечка учащение сердцебиения и другие, более серьезные, отклонения.

Будущая мама принимает тиамазол или пропицил так же, как и до наступления беременности, эти препараты считаются безобидными для малыша, главное для врача — правильно подобрать дозировку. Посещать эндокринолога и контролировать уровень ТТГ в крови придется едва ли не чаще, чем наносить визиты в женскую консультацию.

В исключительных случаях, когда консервативное лечение невозможно или безрезультатно, а также при наличии злокачественных образований, проводят операцию на щитовидной железе. Как правило, доктора выбирают самый безопасный период — второй триместр. Радиойодотерпия для будущих мам запрещена, так как она разрушит и щитовидку ребенка.

После родов иммунитет восстанавливается, и тиреотоксикоз активизируется, иногда вызывая обострения — послеродовый тиреодит. Он свирепствует около двух месяцев, после чего сменяется гипотериозом, а через некоторое время возвращается в обычное состояние. Гормональные бури нередко провоцируют развитие послеродовой депрессии. Избежать осложнений помогает контроль уровня тиреоиных гормонов каждые 2-3 месяца в течение года после рождения ребенка.


  


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