Efikasnost neinvazivnih metoda za procenu uticaja autoimunog obolenja štitaste žlezde majke na fetus
Efficacy of non invasive diagnostic procedures in evaluation of maternal autoimmune thyreoiditis effect on the fetus
Author
Gudović, Aleksandra M.Mentor
Spremović-Rađenović, Svetlana
Committee members
Lazović, GordanaPopović-Brkić, Vera
Cvetković, Miloš
Metadata
Show full item recordAbstract
Kod fetusa majki sa autoimunim obolenjem štitaste žlezde povećava se rizik za razvoj
hipo ili hipertireoze ploda, zbog prolaska antitiroidnih antitela i tireosupresivnih lekova
kroz posteljicu.
Cilj studije: Primarni ciljevi studije su: korelacija antitiroidnih antitela majke i fetusa
sa ultrazvučno procenjenom veličinom štitaste žlezde fetusa i sa slobodnim tiroksinom
fetusa (fT4); procena karakteristika ultrazvuka štitaste žlezde fetusa kao dijagnostičkog
testa za otkrivanje izmenjenih vrednosti fT4 fetusa kod majki sa autoimunom bolešću
štitatse žlezde. Sekundarni ciljevi su ispitivanje povezanosti fT4 fetusa majki sa
autoimunimobolenjem štitaste žlezde, sa ultrazvučnim biometrijskim parametrima,
terapijskom dozom leka koji uzima majka zbog obolenja štitaste žlezde i sa hormonima
štitaste žlezde majke.
Pacijenti i metod: Ispitivanje je sprovedeno prospektivnim praćenjem 51 trudnice sa
autoimunim obolenjem štitaste žlezde, 20 u grupi obolelih od hipertereoze i 31 u grupi
obolelih od ...hipotireoze. Kontrolnu grupu je činilo 20 zdravih trudnica. Hormoni štitaste
žlezde i antitiroidna antitela majke i ploda odreñivani su iz uzoraka krvi dobijenih
venepunkcijom kod majke i kordocentezom kod ploda, izmeñu 26-e i 30-e nedelje
gestacije: fT4, tireostimulišući hormon (TSH), koncentracija antitiroidnih antitela
(antitireoperoksidazna-anti TPO i antitela na receptor za tireostimulišući hormon-
TRAK). Istovremeno je urañena ultrazvučna procena veličine štitaste žlezde, rasta i
morfologije ploda. Podaci su obrañeni statistički, uz pomoć softverskog paketa SPSS
15.0.
Rezultati: U grupi žena obolelih od hipertireoze 40% fetusa imalo je povećane fT4 u
krvi. U grupi žena obolelih od hipotireoze, povećane vrednosti fT4 imalo je 48.4%, a
snižene vrednosti fT4 je imalo 3.2% fetusa. Antitiroidna antitela majke i antitiroidna
antitela ploda bila su u jasnoj, pozitivnoj korelaciji. Anti TPO majke i ploda korelirala
su statistički visoko značajno sa standardizovanim vrednostima fT4 ploda (Spearman-ov
koeficijent korelacije: majka: 0,396, p=0,004 i plod: 0,466, p=0,001). Prosečne
koncentracije anti TPO i majke i ploda značajno su se razlikovala kod fetusa sa
normalnim i izmenjenim obimom štitaste žlezde (kod normalnog obima štitaste žlezde
ploda/ kod povećanog obima/ kod smanjenog obima: anti TPO kod majke su: 119 ± 247 vs 377 ± 506 vs 376± 422; Kruskal- Wallis: 10,726, p= 0.005, a kod ploda su: anti
TPO 43,98 ± 63,99 vs 140,48 ± 136,99 vs 85,49 ± 88,42; ANOVA, F= 5,567, p<0,05).
Kada su anti TPO majke u opsegu referentnih vrednosti, 100% fetusa je imalo
normalan obim štitaste žlezde i svi su imali normalne vrednosti fT4...
Maternal autoimmune thyroid disease increases the incidence of foetal hypo and
hyperthyreosis due to antithyroid antibodies and thyroid suppressive drugs passage
through the placenta.
Aim of the study: Primary aims: Correlation between antithyroid antibodies level in
mothers and foetal serum with ultrasound estimation of foetal thyroid size and free
thyroxin (fT4) in foetal blood; ultrasound morphology of foetal thyroid as diagnostic
tool in estimation of foetal fT4 values. Secondary aims: to investigate correlation
between foetal fT4 with ultrasonographic foetal biometry, therapeutical drug dosage
used to treat maternal thyroid disease, and maternal thyroid status.
Patients and methods: The study was conducted as a prospective follow up of 51
pregnants with autoimmune thyroid disease, 20 patients hyperthyroid, and 31
hypothyroid. Control group was consisted of 20 healthy pregnancies. Thyroid
hormones and anti thyroid antibodies values were measured from blood sampled from
mothers and ...from umbilical cord in foetuses, between 26-30 weeks of gestation. These
included: fT4, TSH, antithyriod antibodies (anti thyreoperoxidase At-TPO, TSH
receptor antibody-TRAK). At the same ultrasound estimation of foetal thyroid volume,
foetal growth and morphology were assessed. The data were statistically analyzed using
SPSS 15.0.
Results: 40 % of foetuses in hyperthyreotic pregnancies were found with increased fT4
in cord blood. 48,4% foetuses from hypothireotic pregnancies were found to have
increased fT4, and 3,2% were found to have decreased fT4 in cord blood. Maternal and
foetal antithyroid antibodies were in obvious positive correlation. Maternal and foetal
anti TPO correlated highly significant with standardized values of foetal fT4 (Spearman
correlation coefficient: mother 0,396, p=0,004, foetus 0,466, p=0,001). Mean
concentration of anti TPO in mother and foetus significantly differed in foetuses with
normal and impaired foetal thyroid size (normal foetal thyroid size/increased foetal
thyroid size/decreased foetal thyroid size: maternal anti TPO: 119 ± 247 vs 377 ± 506
vs 376± 422; Kruskal- Wallis: 10,726, p=0.005, foetal anti TPO: anti TPO 43,98 ±
63,99 vs 140,48 ± 136,99 vs 85,49 ± 88,42; ANOVA, F= 5,567, p<0,05).
In maternal anti TPO within normal range, all foetuses were found with normal thyroid
size and normal fT4...