Диагностика и лечение субклинического гипотиреоза при планировании и во время беременности: современный подход к проблеме

В настоящее время в России и в мире отсутствует единый подход к диагностике и лечению субклинического гипотиреоза (СГТ) при планировании и во время беременности. Обусловлено это отличиями в референсных значениях тиреотропного гормона (ТТГ) для различных популяций и сроков беременности, влиянием маркеров аутоиммунного процесса в щитовидной железе (ЩЖ) на риски осложнений беременности, укоренившимся в России представлением о фиксированных нормах ТТГ во время беременности, предложенных Американской тиреоидологической ассоциацией (АТА) в 2011 и Европейской тиреоидологической ассоциацией (ЕТА) в 2014 гг., а также с отсутствием до недавнего времени Российских клинических рекомендаций по данному вопросу. Свой вклад вносит и мультидисциплинарный подход к таким больным, включающий наблюдение врачами нескольких специальностей — гинекологом, эндокринологом и, во многих случаях, репродуктологом, у каждого из которых может оказаться свое представление о целевых показателях тиреоидных гормонов для данной ­пациентки. Как следствие, имеет место проблема отсутствия единого подхода к терапии СГТ во время беременности в различных медицинских учреждениях, избыточной лекарственной, финансовой и психологической нагрузки на беременных.
Согласно последним рекомендациям АТА 2017 г. и проекту российских клинических рекомендаций по лечению ­гипотиреоза 2019 г., решение вопроса о терапии левотироксином при СГТ во время беременности во многих случаях остается на усмотрение лечащего врача. В данном обзоре систематизируется накопленный к настоящему времени научный и клинический опыт, который позволит специалистам, встречающимся с проблемами СГТ во время беременности, принять решение о диагностике и терапии данного заболевания, основываясь на принципах доказательной медицины.

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