When examining the thyroid gland during pregnancy. Doctors usually prescribe only the analysis of TSH and boldly prescribe a huge dose of iodine to almost everyone. How should the tactics of diagnosis and correction of thyroid hormone metabolism be formed correctly? What circumstances to pay attention to? What to do? (doses of iodine - at the end of the article).
1. Blood test
For a complete diagnosis of thyroid hormone metabolism can not be limited only to TSH. It is important to identify several indicators at the beginning: TSH, T3fr., T4fr., T4tot., T3tot., AT-TPO, AT-TG, as well as indicators of the "complete blood count".
In the future, the minimum set of indicators for blood analysis during pregnancy should be three criteria: TSH, T3cv. and T4sv.
If, during the initial “unfolded” blood test, changes in other indicators were identified, they should be added to the specified minimum.
2. Attention - on T3fr. and T4fr.!
When diagnosing, one should pay attention only to the value of TSH (this hormone causes the thyroid gland to produce energy-releasing hormones T4 and T3, but does not itself affect the reproduction process or other systems of the body). Always focus on T3fr.! This hormone is the main thyroid hormone consumed, which is formed from T4 (already outside the thyroid gland - in the liver, kidneys, intestines, muscles, etc.).
If T3fr. is in the middle of the norm (reference) interval, and T4fr. normally, the thyroid hormones are quite enough for the organism of the pregnant woman and her fetus (unborn child).
3. TTG value
The value of 2.5 mU / l empirically found by American experts should not be a key guideline. Moreover, the only one in the diagnosis of thyroid hormone metabolism of pregnant women.
TSH shows how intensively the body consumes thyroid hormones and how strongly the thyroid gland needs to be stimulated.
The optimum for TSH is a range of 0.4-1.3 mU / L. As well as outside of pregnancy. An increase in TSH to 2.2 mU / l is the first sign of an initial strain of the thyroid gland.
Every healthy woman during pregnancy has a thyroid gland even to a small extent, but it strains, trying to provide for increased needs for thyroid hormones. That is why TSH increases slightly.
4. Frequency of blood analysis
If the values of all the above indicators are in the zone of optimum norms, then the control can be carried out every trimester. Those. better to control.
If during the diagnosis at the beginning of pregnancy changes were identified, then it is important to monitor the blood test every month. In some cases, every three weeks. The frequency of research should be clarified with the competent endocrinologist (thyroidologist).
The optimum for T3 and T4 (Fr. and Tot.) is in the average 50% of the reference interval (norm).
5. Iodine and seafood
Only 20-30% of pregnant women have a real need for additional iodine injections. In other cases, it is a preventive measure. This measure should not be redundant! Iodine is not vitamin C. Excessive amounts of iodine can be irritating, not at all desirable during pregnancy.
From an excess of iodine, the temperature may rise, a feeling of excess heat may appear, a reduction in heart rate and heartbeat may appear ...
Check the adequacy of iodine in the body will help analysis of the concentration of iodine in the urine. This is a valid study for each person.
The optimal value is 140-200 µg / l of iodine in the urine. A smaller normal value of 100 µg / l is a sign of an initial iodine deficiency.
If 150 µg / l of iodine is detected in the urine, then it is not necessary to inject an iodine-containing drug. If 200 mcg / l is contraindicated. If 100 µg / l, 100 µg of iodine per day is enough (200 µg are not needed). If 50-80 mcg of iodine is detected in the urine, tablets with 200 mcg can be used, but approach this dose gradually over a period of 7-10 days.
Read more about the analysis of blood in pregnancy can be in the book for patients "Blood test for diseases of the thyroid gland".
Dr. A.V. Ushakov “Tthyroid clinic” conducts monthly monitoring of hormonal metabolism in patients with thyroid changes (hypothyroidism, autoimmune thyroiditis ...). Over the past 10 years, many healthy babies have been born under our control.
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