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Resumo
Pregnancy is a critical period in which maternal health directly influences fetal development. Hypothyroidism, a condition characterized by insufficient production of thyroid hormones, can have a significant impact on this process. We investigated the risks, mechanisms and management strategies of hypothyroidism during pregnancy, focusing on the administration of levothyroxine sodium. This topic is crucial due to the potential adverse effects of untreated hypothyroidism on the mother and fetus, including complications such as miscarriage, pre-eclampsia, premature birth and deficits in the neurological development of the fetus. Objective: To conduct a systematic review of the literature to analyze the effects of hypothyroidism on pregnancy and fetal development, evaluate the effectiveness of levothyroxine sodium as a management strategy, and identify gaps in knowledge to guide future research. Methodology: Using the PRISMA checklist, the PubMed, Scielo and Web of Science databases were searched for articles published in the last 10 years. The descriptors used were "hypothyroidism", "pregnancy", "fetal development", "levothyroxine sodium" and "management". The inclusion criteria were original studies published in English, Portuguese or Spanish that investigated the effects of hypothyroidism on pregnancy and fetal development, as well as the effectiveness of levothyroxine sodium as a treatment. Exclusion criteria were duplicate studies, literature reviews and studies with small samples or inappropriate methodologies. Results: The studies reviewed highlighted the impacts of hypothyroidism during pregnancy, including an increased risk of obstetric complications and adversities in fetal development. Levothyroxine sodium has been shown to be effective in normalizing maternal hormone levels and reducing these risks, although questions about dosing and monitoring remain. More research is needed to fully elucidate the underlying mechanisms and optimize management strategies. Conclusion: Hypothyroidism during pregnancy represents a significant clinical challenge, but adequate administration of levothyroxine sodium can mitigate many of the associated risks. However, careful monitoring and additional research are essential to better understand and fully address the impacts of this condition on pregnancy and fetal development.
Referências
Taylor PN, Lazarus JH. Hypothyroidism in Pregnancy. Endocrinol Metab Clin North Am. 2019 Sep;48(3):547-556. doi: 10.1016/j.ecl.2019.05.010.
Eng L, Lam L. Thyroid Function During the Fetal and Neonatal Periods. Neoreviews. 2020 Jan;21(1):e30-e36. doi: 10.1542/neo.21-1-e30.
Albuquerque YML, Silva WED, Souza FAL, Teixeira VW, Teixeira ÁAC. Melatonin on hypothyroidism and gonadal development in rats: a review. JBRA Assist Reproduction. 2020 Oct 6;24(4):498-506. doi: 10.5935/1518-0557.20200053.
Sullivan SA. Hypothyroidism in Pregnancy. Clin Obstet Gynecol. 2019 Jun;62(2):308-319. doi: 10.1097/GRF.0000000000000432.
van Trotsenburg ASP. Management of neonates born to mothers with thyroid dysfunction, and points for attention during pregnancy. Best Pract Res Clin Endocrinol Metab. 2020 Jul;34(4):101437. doi: 10.1016/j.beem.2020.101437.
Coperchini F, Croce L, Ricci G, Magri F, Rotondi M, Imbriani M, Chiovato L. Thyroid Disrupting Effects of Old and New Generation PFAS. Front Endocrinol (Lausanne). 2021 Jan 19;11:612320. doi: 10.3389/fendo.2020.612320.
Toloza FJK, Derakhshan A, Männistö T, Bliddal S, Popova PV, Carty DM, Chen L, Taylor P, Mosso L, Oken E, Suvanto E, Itoh S, Kishi R, Bassols J, Auvinen J, López-Bermejo A, Brown SJ, Boucai L, Hisada A, Yoshinaga J, Shilova E, Grineva EN, Vrijkotte TGM, Sunyer J, Jiménez-Zabala A, Riaño-Galan I, Lopez-Espinosa MJ, Prokop LJ, Singh Ospina N, Brito JP, Rodriguez -Gutierrez R, Alexander EK, Chaker L, Pearce EN, Peeters RP, Feldt-Rasmussen U, Guxens M, Chatzi L, Delles C, Roeters van Lennep JE, Pop VJM, Lu X, Walsh JP, Nelson SM, Korevaar TIM, Maraka S. Association between maternal thyroid function and risk of gestational hypertension and pre-eclampsia: a systematic review and individual-participant data meta-analysis. Lancet Diabetes Endocrinol. 2022 Apr;10(4):243-252. doi: 10.1016/S2213-8587(22)00007-9.
Xu D, Zhong H. Correlation Between Hypothyroidism During Pregnancy and Glucose and Lipid Metabolism in Pregnant Women and Its Influence on Pregnancy Outcome and Fetal Growth and Development. Front Surg. 2022 Mar 28;9:863286. doi: 10.3389/fsurg.2022.863286.
Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, Reddy UM, Wapner RJ, Thorp JM Jr, Saade G, Tita AT, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa J, Caritis SN, VanDorsten JP; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. N Engl J Med 2017 Mar 2;376(9):815-825. doi: 10.1056/NEJMoa1606205.
Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022 Mar;18(3):158-171. doi: 10.1038/s41574-021-00604-z.
Thyroid Disease in Pregnancy: ACOG Practice Bulletin, Number 223. Obstet Gynecol. 2020 Jun;135(6):e261-e274. doi: 10.1097/AOG.0000000000003893.
Lee SY, Pearce EN. Testing, Monitoring, and Treatment of Thyroid Dysfunction in Pregnancy. J Clin Endocrinol Metab. 2021 Mar 8;106(3):883-892. doi: 10.1210/clinem/dgaa945.
Springer D, Jiskra J, Limanova Z, Zima T, Potlukova E. Thyroid in pregnancy: From physiology to screening. Crit Rev Clin Lab Sci. 2017 Mar;54(2):102-116. doi: 10.1080/10408363.2016.1269309.
Pande A, Anjankar A. A Narrative Review on the Effect of Maternal Hypothyroidism on Fetal Development. Cureus. 2023 Feb 9;15(2):e34824. doi: 10.7759/cureus.34824.
Korevaar TIM, Medici M, Visser TJ, Peeters RP. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017 Oct;13(10):610-622. doi: 10.1038/nrendo.2017.93.
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Copyright (c) 2024 Lethícia Costa Pardinho, Barbosa Tavares, Hudson Vasconcelos de Oliveira, Ane Beatriz Jesus Oliveira, Renata Barbosa Tavares, Murilo Dell Eugenio Costa Filho, Eduardo Henrique Mendes Rezende, Mariana Millena Pereira Ananias, Thayssa Souza Sandes, Carolina Ázara Andrade, Fernanda Rego da Silva, Isadora Pedroche Ferrari, Beatriz Ferreira Ricato