Palabras clave
enfermedad de Graves
embarazo
antitiroideos
metimazol
propiltiouracilo
defectos de nacimiento
Cómo citar
Resumen
Introducción: la orbitopatía tiroidea (OT) es una manifestación frecuente de la enfermedad de Graves. En el embarazo, la enfermedad de Graves no controlada representa un reto para el tratamiento por los riesgos que puede ocasionar a la madre y al feto.
Objetivo: revisión actualizada de la enfermedad de Graves y la orbitopatía tiroidea en el embarazo.
Metodología: búsqueda en PubMed, Lilacs y Scielo, incluyendo literatura publicada hasta el 2022, tanto en inglés como en español.
Discusión: la enfermedad de Graves afecta hasta el 0,2?% de los embarazos, donde cualquier valor de TSH sérico inferior al límite de normalidad debe evaluarse junto con los valores séricos de T4 total (TT4) o T4 libre y anticuerpos antirreceptor de TSH (TRAbs). En estos casos, el propiltiouracilo (PTU) es la terapia de primera línea en las primeras 12 semanas de embarazo. Por su parte, la actividad de la OT debe evaluarse con la puntuación de actividad clínica (CAS) y la severidad con la clasificación EUGOGO. Los casos leves requieren de manejo local, mientras que los casos severos requerirán de manejo con corticoides endovenosos. Además, existe el riesgo de defectos congénitos con el uso de ATD, siendo mayor para metimazol (MMI) versus PTU.
En comparación con los controles sanos, el riesgo relativo (RR) de anomalías congénitas fue mayor para CMZ/MMI (RR, 1,28; IC 95?%, 1,06-1,54) y PTU (RR, 1,16; IC 95?%, 1,08-1,25). El riesgo de CMZ/MMI fue mayor en comparación con el PTU (RR, 1,20; IC 95?%, 1,01-1,43).
Conclusión: el diagnóstico y el tratamiento temprano evita desenlaces catastróficos y disminuye la morbimortalidad materno fetal.
Citas
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