Schilddrüsenerkrankungen in der Schwangerschaft bei Diabetes mellitus Typ 1

Zusammenfassung

Ein Typ-1-Diabetes mellitus ist mit einem erhöhten Risiko für weitere Autoimmunerkrankungen assoziiert, wobei die häufigste Kombination einer Zweiterkrankung die Autoimmunthyreopathie ist. Während der Schwangerschaft und post partum treten bei Typ-1-Diabetes mellitus im Vergleich zu stoffwechselgesunden Frauen häufiger pathologische AAK-Titer gegen Schilddrüsenperoxidase (TPO‐AK) und Schilddrüsenfunktionsstörungen auf. Bereits eine subklinische Hypothyreose kann einen schädigenden Einfluss auf die Entwicklung des Kindes nehmen. Eine Hypothyreose sollte bereits präkonzeptionell diagnostiziert und behandelt werden. Wird die Diagnose erst während der Schwangerschaft gestellt, ist unverzüglich eine Levothyroxinsubstitution einzuleiten. Bei erniedrigtem TSH-Spiegel in der Frühschwangerschaft kann eine immunogene Hyperthyreose von einer Schwangerschaftshyperthyreose durch den Nachweis morphologischer Schilddrüsenveränderungen und TSH-Rezeptor-Antikörper differenziert werden. Bei manifester Hyperthyreose infolge eines Morbus Basedow oder eines autonomen Schilddrüsenadenoms sollte eine thyreostatische Therapie eingeleitet bzw. angepasst werden, sodass die freien mütterlichen Schilddrüsenhormon-Spiegel im oberen Normbereich liegen. Für eine evidenzbasierte generelle Screeningempfehlung der Schilddrüsenfunktion aller Schwangeren ist die Studienlage nicht ausreichend. Jedoch zeigen Studien, dass Frauen mit einem DM1, die ein erhöhtes Risiko für eine Schilddrüsenerkrankung aufweisen, von einem Screening der Schilddrüsenfunktion profitieren.

Abstract

Diabetes mellitus type 1 is associated with other autoimmune disorders, in particular autoimmune thyroid disease. Pregnancy and the postpartum period increase the incidence of positive anti-thyroid peroxidase antibodies (TPO-ab) and thyroid dysfunction in women with diabetes mellitus type 1 to a greater extent than in a comparable population without metabolic disease. Both overt and subclinical hypothyroidism can have an adverse effect on the course of the pregnancy and the development of the fetus. Hypothyroidism should be diagnosed and corrected before the initiation of pregnancy. If hypothyroidism is diagnosed during pregnancy, the thyroid function should be normalized as rapidly as possible. A subnormal serum TSH concentration can be used to differentiate Graves' disease from gestational thyrotoxicosis on the evidence of autoimmunity (morphologic change of goiter and TSH-receptor antibodies). For overt hyperthyroidism due to Graves' disease or hyperfunctioning thyroid nodules anti-thyroid drug therapy should be either initiated or adjusted to maintain the maternal thyroid hormone levels for free T4 in the upper reference range for non-pregnant women. General screening of pregnant women for thyroid disease is not yet supported by adequate studies, but the screening of patients with DM1 who are at increased risk is strongly recommended.

Schlüsselwörter

TSH - TPO - Hypothyreose - Hyperthyreose

Key words

TSH - TPO - hypothyroidism - hyperthyroidism

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