"Thyroiditis
Hashimoto's thyroiditis and pregnancy
Women of childbearing age affected by Hashimoto's thyroiditis run a greater risk of giving birth to children with intellectual disabilities and liver and kidney problems; fortunately it is possible to prevent this complication through an "adequate therapy. Hashimoto's thyroiditis, therefore, does not represent a contraindication to the search for pregnancy. It is simply necessary to undergo periodic and constant medical monitoring, to ensure that thyroid hormone levels are compatible with conception; these tests must be carried out especially when planning a pregnancy having one or more relatives affected by thyroid disease. In pregnant women with Hashimoto's thyroiditis, transient remissions of hypothyroidism may occur which should not in any case lead to discontinue levothyroxine therapy. Conversely, the disease tends to worsen after childbirth. In addition, some pregnant women may have hypo- or hyperthyroidism and it may be necessary to institute treatment to maintain the state of euthyroidism.
Diagnosis
Thanks to advances in medical science, it is now possible to diagnose thyroid disorders at a particularly early stage, even before they produce relevant symptoms. In the case of Hashimoto's thyroiditis and other forms of hypothyroidism, it is important to evaluate the blood levels of the aforementioned thyroid stimulating hormone (TSH) and those produced by this gland. As stated above, the diagnosis of hypothyroidism will be positive in the presence of high TSH values and low levels of thyroid hormones. To obtain confirmation that it is Hashimoto's thyroiditis, it is possible to perform special antibody tests, looking for the presence of immunoglobulins against thyroid peroxidase (an enzyme normally present in the gland that participates in the synthesis of thyroid hormones) in the blood. This variation can be found when the patient is still euthyroid, that is when his thyroid retains the ability to produce sufficient quantities of hormones despite the immune attack (in this case periodic monitoring is generally indicated and not treatment). Other detectable antibodies in the blood are those anti-thyroglobulin.
The plasma TSH dosage is also particularly important for monitoring the patient's response to the therapy undertaken.
Care and treatment
Treatment of Hashimoto's thyroiditis can be based on simple observation (in the presence of euthyroidism), or on hormone replacement therapy (in the presence of hypothyroidism). This is based on the use of levothyroxine (eutirox), a synthetic analogue of the thyroxine (T4) hormone produced by the thyroid. Daily oral administration restores the normal plasma level of thyroid hormones, positively resolves any symptoms of hypothyroidism and prevents its complications. The dosage used is related to the hormonal deficit, needs time to be optimized and may vary according to periodic blood checks On the other hand, therapy aimed at resolving the autoimmune disorder, for example through cortisone and immunosuppressive drugs, is not effective, but potentially harmful.
In the presence of Hashimoto's thyroiditis, hormone replacement therapy must be continued throughout life. To maintain hormone levels constant, it is necessary to follow therapy regularly and take into account any interference resulting from the simultaneous use of other medicines, supplements or particular foods. For this it is necessary to communicate to your doctor the possible intake of soy derivatives in large quantities, foods rich in fiber and iron or calcium supplements (which can also be found in common multivitamins - multiminerals). Some medicines taken for the treatment of ulcer (sucralfate), heartburn and gastroesophageal reflux (aluminum hydroxide), hypercholesterolemia (cholestyramine) and kidney problems accompanied by hyperkalaemia (sodium polystyrene sulphonate) can also modify the " therapeutic action of levothyroxine used in the treatment of thyroiditis.
