EVALUATION OF ULTRASOUND SCREENING FOR THYROID DISEASES IN WOMEN OF FERTILE AGE IN THE PRECONFIDENTIAL STAGE AND IN THE FIRST TRIMESTER OF PREGNANCY
Main Article Content
Abstract
Objective – to evaluate the effectiveness of ultrasound screening of thyroid diseases in women of fertile age at the pre-pregnancy stage and in the first trimester of pregnancy.
Materials. 1670 ultrasound examinations of the thyroid gland were performed, including 1532 in non-pregnant women (at the pre-pregnancy stage) and 138 studies in pregnant women in the 1st trimester. The women were divided into groups: A1 (n = 182) – women with revealed structural changes in the thyroid gland at the pre–pregnancy stage, B1 (n = 32) – comparison group (without changes in the thyroid gland), A2 (n = 124) – women with revealed structural changes in the thyroid gland during gestation, B2 (n = 14) – a comparison group of pregnant women (without changes in the thyroid gland).
Results. Diffuse changes in the thyroid gland at the pregravidar stage were detected in 11.9 % of women. The revealed changes in the structure of the gland are characterized by the accentuation of contours and increased blood flow in the parenchyma, which statistically significantly correlated with an increased content of TSH in the blood. Diffuse changes were noted in 30.4 % pregnant women. A reliable sign of subclinical hypothyroidism (with an increase in TSH) is only an increased emphasis on the contours of the thyroid lobes during echographic scanning.
Conclusion. The most effective and accurate in the diagnosis of thyroid pathology is a combination of ultrasound and determination of TSH in blood plasma. Echographic examination of the thyroid gland with the determination of TSH in blood plasma should be included in the examination program of patients at the pre-gravidar stage.
Downloads
Article Details
Issue
Section
References
Abramova CV, Blohina EN, Murashova EM, Paramonova TK. The effect of diffuse changes in the thyroid gland on the incidence of complications of pregnancy and childbirth in women of the Republic of Mordovia. Medicus. 2018; 4(22): 8-10. Russian (Абрамова С.В., Блохина Е.Н., Мурашова Е.М., Парамонова Т.К. Влияние диффузных изменений щитовидной железы на частоту возникновения осложнений беременности и родов у женщин республики Мордовия //Medicus. 2018. № 4(22). С. 8-10)
Avramenko TV. Thyroid diseases and pregnancy. Zdorov'e zhenshhiny. 2016; 4(110): 10. Russian (Авраменко Т.В. Заболевания щитовидной железы и беременность //Здоровье женщины. 2016. № 4(110). С. 10)
Blumenthal NJ, Eastman CJ. Beneficial. Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism. J Thyroid Res. 2017; 2017: 4601365. doi: 10.1155/2017/4601365
Kravchenko EN, Kovalenko MA, Beznoshhenko GB. Outcomes of pregnancy and childbirth in thyroid diseases in women living in the Arctic. Russian Bulletin of Obstetrician-Gynecologist. 2018; 18(4): 44-48. Russian (Кравченко Е.Н., Коваленко М.А., Безнощенко Г.Б. Исходы беременности и родов при заболеваниях щитовидной железы у женщин, проживающих в условиях Заполярья //Российский вестник акушера-гинеколога. 2018. Т. 18, № 4. С. 44-48)
Zhang Y, Wang H, Pan X, Teng W, Shan Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: A systematic review and meta-analysis. PLoS One. 2017; 12(4): e0175708. doi: 10.1371/journal.pone.0175708
Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ. et al. Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2016; 26(4): 580-590. doi: 10.1089/thy.2015.0418
Fadeev VV. Based on the materials of the clinical recommendations of the American Thyroid Association for the diagnosis and treatment of thyroid diseases during pregnancy in 2017. Clinical and experimental thyroidology. 2018; 14(3): 128-139. Russian (Фадеев В.В. По материалам клинических рекомендаций американской тиреоидной ассоциации по диагностике и лечению заболеваний щитовидной железы во время беременности 2017 года //Клиническая и экспериментальная тиреоидология. 2018. Т. 14, № 3. С. 128-139)
Ortega Carpio A, Vázquez Rico I, Castaño López MA, Duarte González L, Montilla Álvaro M, Ruiz Reina A. Thyrotropin reference ranges during pregnancy in the province of Huelva, Spain. Semergen. 2018; 44(6): 372-379. doi: 10.1016/j.semerg.2017.08.008
La'ulu SL, Roberts WL. Ethnic differences in first-trimester thyroid reference intervals. Clin Chem. 2011; 57(6): 913-915. doi: 10.1373/clinchem.2010.161240
Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C. et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27(3): 315-389. doi: 10.1089/thy.2016.0457
Pavlova TV, Petruhin VA, Maljutina ES, Kaplin AN, Zemljanskaja LO. New in the study of clinical and morphological aspects in endocrinopathies in pregnant women. Russian Bulletin of Obstetrician-Gynecologist. 2020; 20(5): 13-20. Russian (Павлова Т.В., Петрухин В.А., Малютина Е.С., Каплин А.Н., Землянская Л.О. Новое в изучении клинико-морфологических аспектов при эндокринопатиях у беременных //Российский вестник акушера-гинеколога. 2020. Т. 20. № 5. С. 13-20)
Joosen AM, van der Linden IJ, de Jong-Aarts N, Hermus MA, Ermens AA, de Groot MJ. TSH and fT4 during pregnancy: an observational study and a review of the literature. Clin Chem Lab Med. 2016; 54(7): 1239-1246. doi: 10.1515/cclm-2015-0629
López-Tinoco C, Rodríguez-Mengual A, Lara-Barea A, Barcala J, Larrán L, Saez-Benito A, Aguilar-Diosdado M. Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism. Endocrinol Diabetes Nutr. 2018; 65(3): 150-155. doi: 10.1016/j.endinu.2017.11.013
Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. N Engl J Med. 2017; 376(9): 815-825. doi: 10.1056/NEJMoa1606205
Shestakova TP. Features of examination and treatment of thyroid diseases during pregnancy. Current state of the problem. RMZh. 2017; (1): 37-40. Russian (Шестакова Т.П. Особенности обследования и лечения заболеваний щитовидной железы во время беременности. Современное состояние проблемы //РМЖ. 2017. № 1. С. 37-40)
Kravchenko EN, Kovalenko MA. Prevalence of thyroid pathology in pregnant women in the Arctic. Doktor.Ru. 2018; 10(154): 59-61. Russian (Кравченко Е.Н., Коваленко М.А. Распространенность патологии щитовидной железы у беременных в условиях заполярья //Доктор.Ру. 2018. № 10(154). С. 59-61)
Tuhbatullin MG. Echography in the diagnosis of diseases of internal and superficially located organs. Kazan': Medicinskaja kniga, 2016. 208 p. Russian (Тухбатуллин М.Г. Эхография в диагностике заболеваний внутренних и поверхностно расположенных органов. Казань: Медицинская книга, 2016. 208 с.)
