jueves, 1 de septiembre de 2011

Más sobre hipotiroidismo y embarazo


Tratamiento del hipotiroidismo durante el embarazo
María Carolina Barranco, Alejandro Alberto López, Franco Darío Gallard
Revista de Posgrado de la Cátedra de Medicina 2007;171:24-28.
RESUMEN
Las enfermedades de tiroides y particularmente el hipotiroidismo son muy comunes en mujeres. El hipotiroidismo primario es una enfermedad que se da del 3 al 10% de las mujeres y se asocia con frecuencia el inicio de ésta afección a la maternidad. La prevalencia es del 2 al 3% en la embarazada y varía entre los distintos países. La prevención del hipotiroidismo y sus efectos nocivos posibles sobre el feto y embarazo en esta población requiere de un esfuerzo de los médicos de atención primaria, de endocrinólogos, de obstetras y de la paciente. La droga de elección en la actualidad para el tratamiento de ésta enfermedad es la levotiroxina, a pesar que ha vuelto a surgir el interés por el uso combinado de levotiroxina y triyodotironina. La levotiroxina tiene que ser administrada lo antes posible, sobre todo en el primer trimestre. La dosis en un hipotiroidismo preexistente será aumentada a un 50% más durante el embarazo. Generalmente el aumento requerido por día es entre 25-50 μg durante la gestación. La administración de yodo previene el cretinismo y déficit neuromotor sobre todo si comienza antes del embarazo. El producto diario recomendado por la Organización Mundial de la Salud en la mujer embarazada es de 200 μg por día. Con un diagnóstico precoz y la instauración adecuada del tratamiento del hipotiroidismo estará garantizado un curso normal del embarazo y sin daños en el niño.
Palabras claves: hipotiroidismo, embarazo, tratamiento.

http://med.unne.edu.ar/revista/revista171/5_171.pdf  
Dos modelos logísticos para la predicción de hipotiroidismo en el embarazo
Two logistic models for the prediction of hypothyroidism in pregnancy.
Mbah AU, Ejim EC, Onodugo OD, Ezugwu FO, Eze MI, Nkwo PO, Ugbajah WC.
BMC Res Notes. 2011 Jun 18;4(1):205. [Epub ahead of print]
Abstract
BACKGROUND: The mounting evidence linking hypothyroidism during pregnancy with poor pregnancy outcome underscores the need for screening and, therefore, a search for more reliable and cheaper screening techniques. METHODS: The current study was conducted in two phases. The first phase comprised of healthy women in different stages of pregnancy who attended routine antenatal clinic at St Theresa's Maternity Hospital, Enugu, Nigeria from September 6 to October 18 1994. In this study the variables compared between hypothyroid and non-hypothyroid pregnant women were maternal age, the number of the pregnancy or gravidity, gestational age, social class, body weight, height and the clinically assessed size of thyroid glands. Hypothyroidism was, for the purpose of this study, defined as serum thyrotrophin (TSH) above and/or serum free thyroxin (FT4) below their respective laboratory reference ranges. Based on the parameter differences found between the hypothyroid pregnant women and their non-hypothyroid counterparts logistic discriminant analyses were carried out to produce two logistic models, Model I and Model 11, for the prediction of hypothyroidism during pregnancy. In the second phase the two models were tested in an independent, prospective validation study involving 197 apparently healthy pregnant women. FINDINGS: The findings were that 82 (50.3%) of the 163 pregnant women had thyroid gland enlargement while 60 (36.8%) had hypothyroidism as defined by FT4 values below and/or TSH above their laboratory reference ranges. The pregnant subjects with hypothyroidism, compared with their non-hypothyroid counterparts, were characterized by a higher gravidity (p <0.01), a higher body weight (p <0.01), a higher goiter prevalence rate (p<0.01) and a more advanced gestational age (p < 0.0001). A significant, positive correlation was also found between body weight and gestational age (r = 0.5; p <0.01) At the cut-off point for Model l (fitted with gravidity, thyroid size and gestational age) it had a sensitivity of 100%, a specificity of 72.8% and an overall predictive accuracy of 82.9%; whereas for Model II (fitted with gravidity, thyroid size and body weight) the sensitivity was 100%, the specificity was 59.2% and the overall accuracy of discrimination was 74.8%. In the prospective validation study both models showed a sensitivity of 100% each with specificities of 85.5% for Model I and 76.2% for Model II. CONCLUSION: It is concluded that logistic models fitting gravidity, thyroid gland size and gestational age or body weight are useful alternatives in screening for hypothyroidism during pregnancy. Key words: Pregnancy, Thyroid hypo function, Prediction, Screening, Logistic models.

http://www.biomedcentral.com/content/pdf/1756-0500-4-205.pdf 
Atentamente
Dr. Benito Cortes-Blanco
Anestesiología y Medicina del Dolor
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