Features of achieving compensation of hypothyroisis in pregnant women

Abstract

BACKGROUND: Hypofunction of the thyroid gland in women at the pre-pregnancy stage and during pregnancy is associated with a high risk of congenital hypothyroidism in children, as a result of which irreversible changes in the nervous system are formed. Despite the mandatory intake of potassium iodide preparations, pregnant women often develop gestational hypothyroidism, which requires the appointment of levothyroxine. Many women have episodic hypofunction of the thyroid gland before pregnancy, associated with various factors. Diagnosed hypothyroidism requires hormonal correction. The recommended dose of levothyroxine calculated by the patient’s weight is not always adequate to achieve TSH targets. In addition, there are pharmacological factors. Levothyroxine sodium preparations differ in bioavailability. The stability of drugs is affected by external factors and the composition of fillers from different manufacturers of drugs. AIM: To assess the dependence of TSH reduction on the method of taking levothyroxine in a population of pregnant women. MATERIALS AND METHODS: Statistical analysis and prospective study was carried out from 2019 to 2021. On the basis of the «Perinatal Center», Tyumen, women’s consultative and diagnostic department. Pregnant women with diagnosed primary subclinical and manifest hypothyroidism in the first trimester of pregnancy (n=76) were selected for cohort observation. All pregnant women were prescribed L-thyroxine Berlin-hemi. Other levothyroxine preparations were not used in order to exclude distortion of the results of the study. RESULTS: Pregnant women with hypothyroidism were divided into two groups according to the method of taking L-thyroxine: oral (n=54) and sublingual (n=22). A month later, TSH normalization was observed in 41 pregnant women in the oral group (76%) and in 22 pregnant women in the sublingual group (100%). Women who did not achieve hypothyroidism compensation were recommended sublingual administration without increasing the dose of L-thyroxine, provided that TSH was no higher than 4.0 mcME / ml. A TSH study a month later showed that all pregnant women achieved compensation. CONCLUSION: Based on the conducted research, it is shown that the more rational administration of levothyroxine sodium preparations is sublingual, since there is a slightly alkaline reaction in the oral cavity, which does not have a destructive effect, like gastric juice.