Патогенетичне обґрунтування діагностики та лікування вагітних з дифузною еутиреоїдною гіперплазією щитоподібної залози

У беременных с тиреоидной патологией отмечено абсолютное снижение коэффициента небелковых фракций почти в 2,4-2,5 раза и белковой фракции в 1,4 - 1,8 раза по сравнению с контрольной группой, увеличение активности супероксиддисмутазы и каталазы.

Согласно полученным данным гемостазиограмм, для беременных І и ІІ групп характерна хронометрическая и структурная гиперкоагуляция, которая у беременных с субклиническим гипотиреозом проявляется в виде хронического синдрома ДВС крови, у беременных с эутиреозом - в виде субклинической формы синдрома ДВС крови. Для беременных с тиреотоксикозом характерна гиперкоагуляция и структурная гипокоагуляция.

В результате проведенных исследований разработан алгоритм диагностики и лечения беременных с диффузной эутиреоидной гиперплазией ЩЖ. Включение в комплексное лечение беременных с данной патологией препарата “Барба-йод” способствует улучшению показателей гормонального статуса, метаболических процессов, показателей системы гемостаза, что создает благоприятные условия для вынашивания беременности.

Ключевые слова: беременность, щитовидная железа, гипотиреоз, гипертиреоз, эутиреоз, гормоны, перикисное окисление липидов, антиоксидантная система, гемостаз, метаболические процессы.

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Olkhovyk V.L. Pathogenetic substantiation of diagnostics and treatment of pregnant women suffering from diffuse euthyroid hyperplasia. - Manuscript.

Thesis for obtaining Candidate of Medicine's academic degree with a specialisation in 14.01.01 - Obstetrics and Gynecology. - Kharkiv national medical university, Ministry of Health, Kharkiv, 2009.

The thesis is devoted to pathogenesis peculiarities of pregnancy complications of women suffering from diffuse euthyroid hyperplasia considering hormonal status indices, metabolic processes and hemostatic system and to the development of science-based approaches to early detection and timely correction of the identified abnormalities.

There were 147 pregnant women under surveillance, among them there were 117 women suffering from diffuse euthyroid hyperplasia (the main group) including 45 pregnant women having gestational subclinical hypothyroidism, 33 women with euthyroidism, 39 pregnant women having had transitory gestational thyrotoxicosis and 30 women with physiological pregnancy (control group).

It has been defined that the average levels of estradiol, progesterone, prolactine and chorionic gonadotropin of the women in the main group were within the range of one sigma departure from the norm. Besides, dislipemia with the growth of lipid peroxidation intensity and decrease of antioxidant protection system activity have been detected in the main group.

Among pregnant women with thyroid disease absolute nonprotein fractions rate reduction (2,4 - 2,5 times as much) and that of protein fractions (1,4 - 1,8 times) comparing to the control group have been observed. Activity increase of superoxide dismutase and catalase was noted.

According to the findings of hemostasis indices, for the pregnant of the I and II groups chronometric hypercoagulation and structural hypocoagulation are characteristic, which declare themselves with chronic DIC in pregnant women with subclinical hypothyroidism, for the pregnant with euthyroidism subclinical form of chronic DIC is characteristic. For pregnant women with thyrotoxicosis hypercoagulation and structural hypocoagulation are characteristic.

The algorithm of diagnostics and treatment of pregnant women suffering from diffuse euthyroid hyperplasia has been worked out. Use of “Barba-iodine” medicine in complex treatment of the pregnant from the main group promoted iodine balance renewal, improvement of metabolic processes and gemostatic system indices, which have made it possible to retain pregnancy for 93,3% of the women.

Key words: pregnancy, thyroid, lipid peroxidation, antioxidant protection system, hemostasis, metabolic processes, hypothyroidism, hyperthyroidism, euthyroidism, hormones.

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