Ultrazvučna analiza štitnjače u trudnoći

The aim of the study was to determine whether pregnancy induced ultrasonographically detectable changes of the thyroid gland. It is a very interesting clinical feature, because some parts of inland Croatia were an endemic goiter area before the implementation of the 1996 act on salt iodination. Sixty-six pregnant women with no history of thyroid disease were repeatedly examined by ultrasound during the course of pregnancy. The size and echostructure of the thyroid were estimated. The thyroid volume increased slightly during pregnancy, but mostly remained within the normal range for particular age. A significant thyroid volume enlargement was observed in third trimester as compared with either first trimester (p=0.02) or control group (p=0.01). Mild goiter of 16% was found in pregnant women in comparison to control group. Morning urine sample, thyroid hormone, TSH and thyroid antibodies were also analyzed in 89 women. Median urine iodine was 8.8 µg/dL. Sixty percent of pregnant women had an iodine concentration below 10 µg/dL. In four out of nine subjects with goiter, urinary iodine excretion was below 5 µg/dL. Elevated serum TSH concentration was recorded in three (3%) women; however, they were euthyroid at the time of the study. Results of the study supported the hypothesis that thyroid volume and thyroid function adapt to the physiologically increased iodine and energy demands. The possible goitrogenic effect of pregnancy could be prevented by an increased iodine intake by diet rich in iodine.U kontinentalnim dijelovima Hrvatske prije uvođenja novoga pravilnika o jodiranju soli 1996. godine zabilježena je endemska gušavost. Stoga je svrha ovoga istraživanja bila utvrditi postoji li i u kojoj mjeri gušavost, odnosno povećanje volumena štitnjaču trudnica sa zagrebačkog područja. Šezdeset šest zdravih trudnica u kojih prethodno nije postojala bolest štitnjače u više je navrata pregledano ultrazvukom, pri čem je određen volumen i ehostruktura štitnjače. Utvrđen je porast volumena štitnjače u sva tri trimestra trudnoće koji je, međutim, prelazio gornju granicu normalne veličine štitnjače (18 mL) i to uglavnom u trećem trimestru. Značajan porast veličine štitnjače ustanovljen je u trećem trimestru u odnosu na prvi trimestar (p=0,02) te na kontrolnu skupinu (p=0,01). Umjerena guša nađena je u 16% trudnica u odnosu na kontrolnu skupinu. U skupini od 89 trudnica određena je koncentracija joda u mokraći, koncentracija hormona štitnjače, TSH te tiroidna protutijela. Utvrđen je medijan koncentracije joda u mokraći od 8,8 µg/dL, a 60% trudnica imalo je koncentraciju nižu od 10 µg/dL. U četiri od devet trudnica s ustanovljenom gušom razina joda bila je ispod 5 µg/dL. Povišena razina TSH u serumu nađena je u 3% trudnica, ali uz normalne razine hormona štitnjače. Ovim smo ispitivanjem potvrdili očekivani porast volumena štitnjače u trudnoći kao posljedicu povećane potrebe za energijom i jodom. Stoga zaključujemo da se očekivani goitrogeni učinak trudnoće može spriječiti prehranom obogaćenom jodom