Керівні настанови Європейської тиреоїдної асоціації щодо субклінічного гіпотиреозу у вагітних та дітей, 2014. Частина 1
DOI:
https://doi.org/10.30978/UJPE2021-1-40Ключові слова:
вагітність; субклінічний гіпотиреоз; діти; скринінг; моніторингАнотація
Настанови розроблено як офіційну заяву керівного комітету Європейської тиреоїдної асоціації. Субклінічний гіпотиреоз (СГ) вагітних визначають, якщо рівень тиреотропного гормону (ТТГ) у сироватці крові перевищує референтні значення для вагітних за нормальної концентрації тироксину в сироватці крові. Під час вагітності також можлива ізольована гіпотироксинемія (рівень тироксину < 2,5-го перцентиля референтних значень для вагітних при нормальному рівні ТТГ). У більшості випадків причиною СГ є автоімунний тиреоїдит, також його може спричинити дефіцит йоду. Причина ізольованої гіпотироксинемії зазвичай неочевидна, але дефіцит йоду може бути етіологічним чинником. Ізольована гіпотироксинемія та СГ асоціюються з несприятливими результатами пологів. Терапія левотироксином може полегшити деякі з них при СГ, але не при ізольованій гіпотироксинемії. Ізольована гіпотироксинемія та СГ пов’язані з нервово-інтелектуальними порушеннями у дитини, але немає доказів того, що терапія матері левотироксином поліпшує ці порушення. Прицільний антенатальний скринінг функції щитоподібної залози не виявить значної частки жінок з дисфункцією щитоподібної залози. У дітей із СГ (концентрація ТТГ у сироватці крові > 5,5—10,0 мОД/л) в 70% стан нормалізується і зберігається у більшості з решти пацієнтів протягом наступних 5 років, але погіршується рідко. Недостатньо проведено досліджень впливу СГ на нейропсихологічний розвиток дітей віком до 3 років. У дітей старшого віку дані щодо зв’язку між СГ та порушеннями нейропсихологічного розвитку суперечливі. Не вистачає якісних досліджень ефекту від лікування дітей із СГ.
Посилання
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