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Nuklearmedizin 2021; 60(04): 266-271
DOI: 10.1055/a-1400-3522
Review

Avoidance of iodine deficiency/excess during pregnancy in Hashimoto’s thyroiditis

Jodprophylaxe in der Schwangerschaft bei Hashimoto-Thyreoiditis
Lutz van Heek
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Christiane Staudacher
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Michael Faust
2   Center for Endocrinology, Diabetes and Preventive Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Costanza Chiapponi
3   Department of General, Visceral, Tumor and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Jasmin Mettler
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Matthias Schmidt
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Alexander Drzezga
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Markus Dietlein
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
,
Carsten Kobe
1   Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Abstract

Purpose Hashimoto’s thyroiditis is a common disease that also affects pregnant women. We analyzed to what extent the inflammatory process of Hashimoto’s thyroiditis changes with iodine prophylaxis in pregnant women. The target for immunologic activity was levels of thyroid antibodies (TPO).

Methods The data were collected retrospectively from 20 consecutive, pregnant patients who had been diagnosed with Hashimoto’s thyroiditis between 01.12.2012 and 01.12.2014 and had received iodine supplementation with 100 µg (n = 1) or 150 µg (n = 19). At least two measurements of TPO antibody levels taken during pregnancy and one after pregnancy were evaluated for each patient in the study group.

Results At the end of pregnancy, the average TPO antibody level for the 20 patients studied was 137 IU/ml (+/–214 IU/ml), the lowest being 16 IU/ml and the highest 1000 IU/ml. Despite iodine prophylaxis, levels of TPO antibodies decreased in 18 patients during pregnancy, falling below the reference value of 35 IU/ml in 5 cases. However, in one patient TPO antibodies increased from 60 IU/ml to 237 IU/ml during pregnancy while in another, levels remained constant at 1000 IU/ml.

Conclusion Iodine prophylaxis in pregnant women, taken at a dose of 100 or 150 μg daily was shown to have no negative systemic effects on Hashimoto’s thyroiditis in a group of pregnant women with increased TPO levels, and can therefore be recommended for expectant mothers, including those with this disease.

Zusammenfassung

Ziel Die Hashimoto-Thyreoiditis ist eine häufige Erkrankung, welche auch schwangere Frauen betrifft. Wir haben untersucht, in welchem Ausmaß sich der Entzündungsprozess einer Hashimoto-Thyreoiditis unter Jodprophylaxe bei schwangeren Frauen verändert. Zielgröße hierfür war der Verlauf der Thyreoperoxidase-Antikörper (TPO).

Patienten Methoden Die Daten wurden retrospektiv von 20 schwangeren Patienteninnen erhoben, bei denen im Zeitraum vom 01.12.2012 bis zum 01.12.2014 eine Hashimoto-Thyreoiditis diagnostiziert worden war und die eine Jodprophylaxe mit 100 µg (n = 1) oder 150 µg (n = 19) erhalten haben. Für die eingeschlossenen Patientinnen wurden mindestens 2 Werte der TPO-Antikörper in der Schwangerschaft sowie mindestens ein Wert der TPO-Antikörper nach der Schwangerschaft ausgewertet.

Ergebnisse Am Ende der Schwangerschaft lag der durchschnittliche TPO-Antikörper-Wert der 20 Patientinnen bei 137 IU/ml (+/–214 IU/ml), der niedrigste Wert lag bei 16 IU/ml und der höchste Wert bei 1000 IU/ml. Bei 18 Patientinnen waren die Werte der TPO-Antikörper trotz Jodprophylaxe in der Schwangerschaft gesunken, bei 5 Patientinnen unter den Referenzwert von 35 IU/ml. Bei einer Patientin waren die TPO-Antikörper während der Schwangerschaft von 60,3 IU/ml auf 237 IU/ml gestiegen und bei einer Patientin bei 1000 IU/ml konstant geblieben.

Schlussfolgerung Die übliche Jodprophylaxe bei schwangeren Frauen mit einer Dosierung zwischen 100 und 150 μg täglich zeigte keine systematisch negativen Auswirkungen auf die Hashimoto-Thyreoiditis in einer Gruppe von Schwangeren mit erhöhten TPO-Antikörpern und kann daher auch für werdende Mütter mit dieser Diagnose empfohlen werden.

Key Words

iodine - hashimoto thyroiditis - pregnancy

Schlüsselwörter

Iod - Hashimoto-Thyreoditis - Schwangerschaft


Publication History

Received: 07 September 2020

Accepted: 25 February 2021

Article published online:
23 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Renz-Polster H, Krautzig S, Braun J. Basislehrbuch Innere Medizin. München: Urban & Fischer; 2004
    Google Scholar
  • 2 Budenhofer BK, Ditsch N, Jeschke U. et al. Thyroid (dys)function in normal and disturbed pregnancy. Berlin Heidelberg: Springer-Verlag; 2012: 4
    Google Scholar
  • 3 Meng W. Schilddrüsenerkrankungen. 4. Auflage. München: Urban & Fischer Verlag; 2002: 6
    Google Scholar
  • 4 WHO/UNICEF/ICCIDD. Assessment of the iodine deficiency disorders and monitoring their elimination. World Health Organization; 2007: 6
    Google Scholar
  • 5 Lou Y, Kawashima A, Ishido Y. et al. Iodine Excess as an Environmental Risk Factor for Autoimmune Thyroid Disease. Int J Mol Sci 2014; 15 (07) 12895-12912
    CrossrefPubMedGoogle Scholar
  • 6 Wuchter T. Einfluss der renalen Elimination auf die Serumspiegel des nicht hormongebundenen Jods bei Patienten mit Morbus Hashimoto. Medizinische Fakultät Charité – Universitätsmedizin Berlin; 2007: 2 ff.
    Google Scholar
  • 7 Institut für Klinische Chemie des Universitätsklinikums Köln (2008) Testprinzip. http://klinische-chemie.uk-koeln.de/ : und Referenzwerte: http://klinische-chemie.uk-koeln.de/diagnostik/formulare/referenzbereiche.pdf
  • 8 Stagnaro-Green A, Abalovich M, Alexander E. et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Thyroid 2011; 21 (10) 1081-1125
    CrossrefPubMedGoogle Scholar
  • 9 Arbeitskreis Jodmangel. 2014 http://jodmangel.de/wissenschaft/erster-berliner-joddialog-jodversorgung-nicht-optimal/
  • 10 Morreale de Escobar G, Obregon MJ, Escobar del Rey F. Role of thyroid hormone during early brain development. Eur J Endocrinol 2004; 151 (Suppl. 03) U25-U37
    CrossrefPubMedGoogle Scholar
  • 11 Moleti M, Presti VPL, Cristina M. et al. Iodine Prophylaxis using iodized Salt and Risk of Maternal Thyroid Failure in Conditions of Mild Iodine Deficiency. J Clin Endocrinol Metab 2008; 93 (07) 2616-2621
    CrossrefPubMedGoogle Scholar
  • 12 Moleti M, Trimarchi F, Vermiglio F. Thyroid physiology in pregnancy. Endocr Pract 2014; 20 (06) 589-596
    CrossrefPubMedGoogle Scholar
  • 13 Stagnaro-Green A, Abalovich M, Alexander E. et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Thyroid 2011; 21 (10) 1081-1125
    CrossrefPubMedGoogle Scholar
  • 14 Lazarus J, Brown RS, Daumerie C. et al. 2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children. Eur Thyroid J 2014; 3: 76-94
    CrossrefPubMedGoogle Scholar
  • 15 Leung AM, Braverman L-E. Consequences of excess iodine. Nature Reviews Endocrinology 2014; 10: 136-142
    CrossrefPubMedGoogle Scholar
  • 16 WHO/UNICEF/ICCIDD. Assessment of the iodine deficiency disorders and monitoring their elimination. World Health Organization; 2007: 12
    Google Scholar
  • 17 Latrofa F, Fiore E, Rago T. et al. Iodine Contributes to Thyroid Autoimmunity in Humans by Unmasking a Cryptic Epitope on Thyroglobulin. J Clin Endocrinol Metab 2013; 98 (11) 1768-1774
    CrossrefPubMedGoogle Scholar
  • 18 Lou Y, Kawashima A, Ishido Y. et al. Excess as an Environmental Risk Factor for Autoimmune Thyroid Disease. Int J Mol Sci 2014; 15 (07) 12895-12912
    CrossrefPubMedGoogle Scholar
  • 19 Delange F. Iodine requirements during pregnancy, lactation and the neaonatal period and indicators of optimal iodine nutrition. Public Health Nutr 2007; 10 (12) 1571-1580 , discussion 1581-1583
    CrossrefPubMedGoogle Scholar
  • 20 Zimmermann M, Delange F. Iodine supplementation of pregnant women in Europe: a review and recommendations. Eur J Clin Nutr 2004; 58 (07) 979-984
    CrossrefPubMedGoogle Scholar
  • 21 Sakaihara M, Yamada H, Kato EH. et al. Postpartum thyroid dysfunction in women with normal thyroid function during pregnancy. Clin Endocrinol (Oxf) 2000; 53 (04) 487-492
    CrossrefPubMedGoogle Scholar