Gestasyonel Geçici Tirotoksikoz
Özet
Gebelikte tiroid fonksiyon bozuklukları anne ve fetüs sağlığı açısından kritik bir öneme sahiptir. Gebeliğin ilk trimesterinde %2-11 oranında görülen gestasyonel geçici tirotoksikoz (GGT), otoimmün olmayan bir hipertiroidi formudur ve en sık hiperemezis gravidarum ile ilişkilidir. GGT'nin temel etiyolojisi, ilk trimesterde zirve yapan human koryonik gonadotropin (hCG) hormonunun TSH reseptörlerini uyarması ve TSH baskılanması ile serbest T4 düzeylerini artırmasıdır. Graves hastalığının aksine, GGT'de TSH-reseptör antikoru negatiftir, guatr veya oftalmopati gözlenmez. Semptomlar genellikle hafif olup bulantı, kusma ve kilo kaybı eşlik edebilir. GGT çoğunlukla medikal tedavi gerektirmez ve ilk trimesterden sonra hCG düzeylerinin düşmesiyle kendiliğinden düzelir. Ancak belirgin ve uzamış semptomları olan olgularda ya da çoklu gebeliklerde kısa süreli antitiroid tedavisi (ilk trimesterde propiltiourasil) düşünülebilir. Ayırıcı tanı, Graves hastalığı ile karışabilen bu durumun doğru yönetilmesi ve fetusta hipotiroidi riskinin önlenmesi açısından hayati önem taşır.
Thyroid dysfunction during pregnancy is crucial for both maternal and fetal health. Gestational transient thyrotoxicosis (GTT) is a non-autoimmune form of hyperthyroidism observed in 2-11% of pregnancies during the first trimester, most frequently associated with hyperemesis gravidarum. The primary etiology of GTT involves human chorionic gonadotropin (hCG), which peaks in the first trimester, stimulates TSH receptors, suppresses TSH levels, and increases free T4. Unlike Graves' disease, GTT is characterized by negative TSH-receptor antibodies, and patients do not present with goiter or ophthalmopathy. Symptoms are generally mild, often accompanied by nausea, vomiting, and weight loss. GTT typically does not require medical intervention, resolving spontaneously after the first trimester as hCG levels decline. However, short-term antithyroid treatment (propylthiouracil in the first trimester) may be considered in cases with severe, prolonged symptoms or multiple pregnancies. Differential diagnosis is vital to ensure correct management, distinguish it from Graves' disease, and prevent potential fetal hypothyroidism.
Referanslar
Aggarawal N, Suri V, Singla R, Chopra S, Sikka P, Shah VN, et al. Pregnancy outcome in hyperthyroidism: a case control study. Gynecologic and obstetric investigation. 2014;77(2):94-9.
Lazarus JH. Thyroid function in pregnancy. British medical bulletin. 2011;97(1):137-48.
Cignini P, Cafà EV, Giorlandino C, Capriglione S, Spata A, Dugo N. Thyroid physiology and common diseases in pregnancy: review of literature. Journal of prenatal medicine. 2012;6(4):64.
Bostancı MS, Taşkesen F. Gebelikte tiroid fonksiyon bozuklukları ve sonuçlarının değerlendirilmesi. J Clin Exp Invest www clinexpinvest org Vol. 2011;2(2).
Krassas G, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocrine reviews. 2010;31(5):702-55.
Şahin OT. Gestasyonel geçici tirotoksikozlu hastaların incelenmesi. 2018.
Malek NZH, Kalok A, Hanafiah ZA, Shah SA, Ismail NAM. Association of transient hyperthyroidism and severity of hyperemesis gravidarum. Hormone molecular biology and clinical investigation. 2017;30(3).
Yim CH. Update on the management of thyroid disease during pregnancy. Endocrinology and Metabolism. 2016;31(3):386-91.
Metin K. Gebelik ve tiroid hormonları. Kocatepe Tıp Dergisi. 2013;14(3):160-6.
Fister P, Gaberscek S, Zaletel K, Krhin B, Hojker S, Gersak K. Thyroid function in the third trimester of pregnancy and after delivery in an area of adequate iodine intake. International Journal of Gynecology & Obstetrics. 2011;112(1):52-5.
Nguyen CT, Sasso EB, Barton L, Mestman JH. Graves’ hyperthyroidism in pregnancy: a clinical review. Clinical diabetes and endocrinology. 2018;4(1):1-9.
Iijima S. Pitfalls in the assessment of gestational transient thyrotoxicosis. Gynecological Endocrinology. 2020;36(8):662-7.
Nader S. Thyroid disease and other endocrine disorders in pregnancy. Obstetrics and Gynecology Clinics. 2004;31(2):257-85.
Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, et al. The role of propylthiouracil in the management of Graves' disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009;19(7):673-4.
Albaar MT, Adam J. Gestational transient thyrotoxicosis. Acta Med Indones. 2009;41(2):99-104.
Mestman JH. Hyperthyroidism in pregnancy. Best Practice & Research Clinical Endocrinology & Metabolism. 2004;18(2):267-88.
