Gestione clinica della gravida con ipotiroidismo - Le azioni

Before pregnancy Diagnosed hypothyodism • Counseling • Increase administration of FT4 or start treatment (goal for TSH: <2.5 mU/L and FT4 within reference limits NO known hypothyroidism • Counseling and estimation of risk • Clinical and biochemical (TSH reflex) assessment and ultrasonography when goiter or nodules are present • Start l-T4 treatment if hypothyroidism is detected Pregnancy • Measure FT4 e TSH and increase l-T4 dose • Involve gynaecologist I - II trimester • Monitor TSH and FT4 bimonthly • Fetal ultrasonography (each trimester) • Thyroid ultrasonography when goiter or nodules are present III trimester • Measure TSH, FT4 and TRAb • Involve paediatrician/neonatologist Delivery • Avoid antisepsis with iodine in newborn and mother • Carry out neonatal screening indicating the mother's disease • Measure TRAb if positive in mother Post-partum Mother: • Decrease l-T4 within one month • Measure FT3, FT4, TSH after 3-9 months Newborn: • Use milk supplemented with iodine • If screening positive involve the pediatrician • Start treatment if TSH increased • In hypothyroidism carry out ultrasonography and measure thyroglobulin and TRAb.