The thyroid is an endocrine gland capable of secreting and synthesizingnumerous hormones starting with iodine, the main ones being two: T4 and T3. They modulate, for example, temperature and bodyweight, appetite and mood, tiredness, lazi-ness and sleep, heartbeat, lipid and glucose metabolism, intestinal and reproductive system functioning and even calcium metabolism. Thyroid functions on body development are important especially with regard to the nervous system. In detail, thyroid hormones are needed in the fetus and in the first week of life, because they play a very important role in the differentiation and growth of nerve structures, as well as guaranteeing the normal development of the brain. The diseases affecting the thyroid are manifold, include: goiter, hyperthyroidism, hypothyroidism and thyroid carcinoma. Among these, the most widespread pathology is auto-immune thyroiditis, , also known as Hashimoto's thyroiditis, from the name of its discoverer. Hashimoto’s thyroidits falls under the category “hypothyroidism” in which a reduced thyroid function is witnessed. It is an autoimmune disorder of the thyroid (AITD) organ- specific, characterized by diffuse goiter, with presence of lymphocytic infiltration and thyroid antibodies. The etiopathology is not yet fully known, but it is thought that the genesis of HT is multifactorial and that can play a critical epigenetic role and many environmental factors. The diagnosis is based on hematologic analyses (dosage of TSH, FT3 and FT4 and that antiTG antibodies), on thyroid ultrasonography to eximine glandular morphologyand to highlight the presence or not of nodules. A normal thyroid function isessential in pregnancy to avoid complications in gestation and to ensure anormal development of the child. Low levels of thyroid hormone during pregnancy may have a detrimental effect on the development of the fetal central nervous system, and predispose to pre-term birth, and increase the risk of miscarriage. During normal pregnancy increase the needs of iodine ofthe maternal thyroid gland: for this, according to Endocrine Society Clinical Practice guidelines of 2018 in pregnancy it is necessary to increase the intakeof iodine from 150 μg/day normally Expected at 250 μg/day in gestation. For women with HT in pregnancy it is essential to increase the dosage of Levo-thyroxine, that is the drug used for the treatment of the disease. The dosageis usually increased by 25% compared to normal dosage, after consultation with the specialist, and blood tests must be performed for the duration of the pregnancy in order to fic the dosage promptly. During embryogenesis the thyroid gland begins to sketch around the seventh week, while "trapping" of iodine with production of thyroid hormones begins around the 10-12 week of gestation. Before the fetus's ability to produce thyroid hormones, he is based on the transplacental passage of maternal thyroid hormones. Insufficient production, or dysfunction of thyroid hormones, has a significant impact on growth and neurological development. In fact, congenital hypothyroidism is the most common cause of preventable mental retardation in children. Hypothyroidism in infants and children can have significant advers effects on health, growth and development. The Therefore, recognizing and promptly treating hypothyroidism in infants is essenzial tooptimize the physical and neurological development of the newborn. Treatment of hypothyroidism consists of a thyroid hormone replacementtherapy. As in adults, levothyroxine (LT4) is the recommended treatment for hypothroidism in children.
La tiroide è una ghiandola endocrina in grado di secernere e sintetizzare numerosi ormoni a partire dallo iodio, i cui principali sono due: tiroxina T4 e triiodotionina T3. Essi modulano ad esempio temperatura e peso corporeo, appetito ed umore, stanchezza, pigrizia e sonno, battito cardiaco, metabolismo lipidico e glucidico, funzionamento intestinale e del sistema riproduttivo e persino il metabolismo del calcio. Le funzioni svolte dalla tiroide sullo sviluppo corporeo sono importanti soprattutto per quanto riguarda il sistema nervoso. Nel dettaglio, gli ormoni tiroidei sono necessari nel feto e nelle prime settimane di vita, perché svolgono un importantissimo ruolo nel differenziamento e nella crescita delle strutture nervose, oltre a garantire il normale sviluppo del cervello. Le patologie che interessano la tiroide sono molteplici, comprendono: gozzo, ipertiroidismo, ipotiroidismo e carcinoma tiroide. Fra questi la patologia più diffusa è la tiroidite autoimmune, anche conosciuta come tiroidite di Hashimoto, dal nome del suo scopritore. La tiroidite di Hashimoto rientra nella categoria “ipotiroidismo” in cui si assiste ad una ridotta funzionalità tiroidea. Essa è un disordine autoimmune della tiroide (AITD) organo-specifico, caratterizzato da gozzo diffuso, con presenza di infiltrazione linfocitaria e anticorpi tiroidei. L’eziopatologia non è ancora completamente nota, ma si pensa che la genesi della HT sia multifattoriale e che possano giocare un ruolo critico epigenetici e numerosi fattori ambientali. La diagnosi si basa su analisi ematologiche(dosaggio di TSH, FT3 e FT4 e quello degli anticorpi antiTPO e antiTG), sull’ecografia tiroidea per esaminare la morfologia ghiandolare e per evidenziare la presenza o meno di noduli. Una normale funzione della tiroide è essenziale in gravidanza per evitare complicazioni in gestazione e per garantire un normale sviluppo del bambino. Bassi livelli di ormone tiroideo durante la gravidanza possono avere un effetto dannoso sullo sviluppo del sistema nervoso centrale fetale, e predisporre a una nascita pretermine, e aumentano il rischio di aborto spontaneo. Durante la normale gravidanza aumentano le esigenze di iodio della ghiandola tiroidea materna: per questo, in accordo con Endocrine Society clinical practice guidelines del 2018 in gravidanza si deve incrementare l’assunzione di iodio da 150 μg/die normalmente previsti a 250 μg/die previsti in gestazione. Per le donne affette da HT in gravidanza è essenziale l’incremento del dosaggio di levo-tiroxina, cioè del farmaco usato per il trattamento della malattia. Solitamente il dosaggio viene aumentato del 25% rispetto al dosaggio normale, dopo consulto con lo specialista, e devono essere eseguite analisi ematiche per tutta la durata della gravidanza al fine di aggiustare tempestivamente il dosaggio. Durante l’embriogenesi la ghiandola tiroidea inizia ad abbozzarsi intorno alle settima settimana, mentre ”l’intrappolamento” di iodio con produzione degli ormoni tiroidei inizia intorno alla 10-12 settimana di gestazione. Prima della capacità del feto di produrre ormoni tiroidei, egli si basa sul passaggio transplacentare degli ormoni tiroidei materni. La produzione insufficiente, o la disfunzione degli ormoni tiroidei hanno un impatto significativo sulla crescita e sullo sviluppo neurologico. Infatti, l’ipotiroidismo congenito è la causa più comune di ritardo mentale prevenibile nei bambini. L’ipotiroidismo nei neonati e nei bambini può avere effetti dannosi significativi sulla salute, la crescita e lo sviluppo. Pertanto, riconoscere e trattare tempestivamente l’ipotiroidismo nei neonati è essenziale per ottimizzare lo sviluppo fisico e neurologico del neonato. Il trattamento dell’ipotiroidismo consiste in una terapia sostitutiva dell’ormone tiroideo. Come negli adulti, la levotiroxina (LT4) è il trattamento raccomandato per l’ipotiroidismo nei bambini.
Tiroidite di Hashimoto: segni, sintomi e terapia in gravidanza e in età pediatrica
PIZZOCARO, IRENE
2018/2019
Abstract
The thyroid is an endocrine gland capable of secreting and synthesizingnumerous hormones starting with iodine, the main ones being two: T4 and T3. They modulate, for example, temperature and bodyweight, appetite and mood, tiredness, lazi-ness and sleep, heartbeat, lipid and glucose metabolism, intestinal and reproductive system functioning and even calcium metabolism. Thyroid functions on body development are important especially with regard to the nervous system. In detail, thyroid hormones are needed in the fetus and in the first week of life, because they play a very important role in the differentiation and growth of nerve structures, as well as guaranteeing the normal development of the brain. The diseases affecting the thyroid are manifold, include: goiter, hyperthyroidism, hypothyroidism and thyroid carcinoma. Among these, the most widespread pathology is auto-immune thyroiditis, , also known as Hashimoto's thyroiditis, from the name of its discoverer. Hashimoto’s thyroidits falls under the category “hypothyroidism” in which a reduced thyroid function is witnessed. It is an autoimmune disorder of the thyroid (AITD) organ- specific, characterized by diffuse goiter, with presence of lymphocytic infiltration and thyroid antibodies. The etiopathology is not yet fully known, but it is thought that the genesis of HT is multifactorial and that can play a critical epigenetic role and many environmental factors. The diagnosis is based on hematologic analyses (dosage of TSH, FT3 and FT4 and that antiTG antibodies), on thyroid ultrasonography to eximine glandular morphologyand to highlight the presence or not of nodules. A normal thyroid function isessential in pregnancy to avoid complications in gestation and to ensure anormal development of the child. Low levels of thyroid hormone during pregnancy may have a detrimental effect on the development of the fetal central nervous system, and predispose to pre-term birth, and increase the risk of miscarriage. During normal pregnancy increase the needs of iodine ofthe maternal thyroid gland: for this, according to Endocrine Society Clinical Practice guidelines of 2018 in pregnancy it is necessary to increase the intakeof iodine from 150 μg/day normally Expected at 250 μg/day in gestation. For women with HT in pregnancy it is essential to increase the dosage of Levo-thyroxine, that is the drug used for the treatment of the disease. The dosageis usually increased by 25% compared to normal dosage, after consultation with the specialist, and blood tests must be performed for the duration of the pregnancy in order to fic the dosage promptly. During embryogenesis the thyroid gland begins to sketch around the seventh week, while "trapping" of iodine with production of thyroid hormones begins around the 10-12 week of gestation. Before the fetus's ability to produce thyroid hormones, he is based on the transplacental passage of maternal thyroid hormones. Insufficient production, or dysfunction of thyroid hormones, has a significant impact on growth and neurological development. In fact, congenital hypothyroidism is the most common cause of preventable mental retardation in children. Hypothyroidism in infants and children can have significant advers effects on health, growth and development. The Therefore, recognizing and promptly treating hypothyroidism in infants is essenzial tooptimize the physical and neurological development of the newborn. Treatment of hypothyroidism consists of a thyroid hormone replacementtherapy. As in adults, levothyroxine (LT4) is the recommended treatment for hypothroidism in children.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/22486