endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2025-6-3-09endofocus-180Research ArticleОБЗОР ЛИТЕРАТУРЫLITERATURE REVIEWГипотиреоз и беременность: диагностические и терапевтические дилеммы в современных алгоритмах веденияHypothyroidism and pregnancy: Diagnostic and therapeutic dilemmas in modern management algorithmshttps://orcid.org/0000-0001-5512-6899УшановаФ. О.UshanovaF. O.

Ушанова Фатима Омариевна – к.м.н., доцент кафедры эндокринологии ИКМ

г. Москва

Fatima O. Ushanova – C. Sci. (Med.), Associate Prof., Department of Endocrinology, Institute of Clinical Medicine 

Moscow

fati_2526@mail.ruhttps://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна – д.м.н., профессор, заведующая кафедрой эндокринологии ИКМ

Scopus Author ID: 7003771623

г. Москва

Tatyana Yu. Demidova – D. Sci. (Med.), Prof., Head of the Department of Endocrinology, Institute of Clinical Medicine

Scopus Author ID: 7003771623 

Moscow

t.y.demidova@gmail.comБагиловаA. Р.BagilovaA. R.

Багилова Амина Расуловна – клинический ординатор кафедры эндокринологии ИКМ \г. Москва

Amina R. Bagilova – clinical resident, Department of Endocrinology, Institute of Clinical Medicine

Moscow

amina.190199@mail.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России (Пироговский университет)Pirogov Russian National Research Medical University2025131120256396103Copyright © Ушанова Ф.О., Демидова Т.Ю., Багилова A.Р., 20252025Ушанова Ф.О., Демидова Т.Ю., Багилова A.Р.Ushanova F.O., Demidova T.Y., Bagilova A.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/180

Гипотиреоз, характеризующийся дефицитом тиреоидных гормонов, является распространенной эндокринной патологией у женщин репродуктивного возраста, представляющей значимую проблему в период беременности. Недостаточная функция щитовидной железы оказывает негативное влияние на материнское здоровье и развитие плода, увеличивая риск гестационной гипертензии, преждевременных родов, отслойки плаценты и нарушений нейрокогнитивного развития потомства. Своевременная диагностика и адекватная заместительная гормональная терапия (ЗГТ) играют ключевую роль в предотвращении неблагоприятных исходов.

Гипотиреоз, характеризующийся дефицитом тиреоидных гормонов, является распространенной эндокринной патологией у женщин репродуктивного возраста и представляет собой значимую проблему в период беременности. Недостаточная функция щитовидной железы оказывает негативное влияние на материнское здоровье и развитие плода, увеличивая риск гестационной гипертензии, преждевременных родов, отслойки плаценты и нарушений нейрокогнитивного развития потомства. Своевременная диагностика и адекватная заместительная гормональная терапия играют ключевую роль в предотвращении неблагоприятных исходов при беременности. Статья содержит обзор современных данных о патогенезе, диагностике и лечении гипотиреоза в период беременности, включая вопросы скрининга, целевые уровни тиреотропного гормона и особенности интерпретации лабораторных показателей. Особое внимание уделено выбору оптимальной формы левотироксина натрия, являющегося препаратом первой линии для заместительной гормональной терапии гипотиреоза. Рассмотрены потенциальные преимущества использования жидкой формы левотироксина, характеризующейся улучшенной абсорбцией, минимизацией влияния факторов, снижающих биодоступность, и возможностью точного дозирования, что особенно актуально в условиях физиологических изменений, происходящих в организме беременной женщины.

Hypothyroidism, characterized by a deficiency of thyroid hormones, is a common endocrine pathology in women of reproductive age, which is a significant problem during pregnancy. Insufficient thyroid function has a negative impact on maternal health and fetal development, increasing the risk of gestational hypertension, premature birth, placental abruption and impaired neurocognitive development of offspring. Timely diagnosis and adequate hormone replacement therapy play a key role in preventing adverse outcomes. The article provides an overview of current data on the pathogenesis, diagnosis, and treatment of hypothyroidism during pregnancy, including screening issues, target levels of thyroid-stimulating hormone, and features of interpretation of laboratory parameters. Special attention is paid to the choice of the optimal form of levothyroxine, which is the first-line drug for hormone replacement therapy of hypothyroidism. The potential advantages of using the liquid form of levothyroxine, characterized by improved absorption, minimizing the influence of factors that reduce bioavailability, and the possibility of accurate dosage, which is especially important in conditions of physiological changes occurring in the body of a pregnant woman, are considered.

беременностьгипотиреозсубклинический гипотиреозлевотироксинжидкая форма левотироксинатиреотропный гормонpregnancyhypothyroidismsubclinical hypothyroidismlevothyroxineliquathyrolthyroid-stimulating hormoneReferencesVerma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2(1):17–19. doi: 10.4103/2229-516X.96795.Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012;2(1):17–19. doi: 10.4103/2229-516X.96795.Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022;18(3):158–71. doi: 10.1038/s41574-021-00604-z.Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022;18(3):158–71. doi: 10.1038/s41574-021-00604-z.Puthiyachirakal MA, Hopkins M, AlNatsheh T, Das A. Overview of thyroid disorders in pregnancy. Matern Health Neonatol Perinatol. 2025;11(1):9. doi: 10.1186/s40748-025-00208-9.Puthiyachirakal MA, Hopkins M, AlNatsheh T, Das A. Overview of thyroid disorders in pregnancy. Matern Health Neonatol Perinatol. 2025;11(1):9. doi: 10.1186/s40748-025-00208-9.Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H et al. Effects of subclinical hypo-thyroidism on maternal and perinatal outcomes during pregnancy: A single-center cohort study of a Chinese population. PLoS One. 2014;9(10):e109364. doi: 10.1371/journal.pone.0109364.Chen LM, Du WJ, Dai J, Zhang Q, Si GX, Yang H et al. Effects of subclinical hypo-thyroidism on maternal and perinatal outcomes during pregnancy: A single-center cohort study of a Chinese population. PLoS One. 2014;9(10):e109364. doi: 10.1371/journal.pone.0109364.Li H, Wang Y, Zheng J, Wang Y, Huang D, Liang L et al. Analysis on iodine nutritional status and thyroid function in pregnant women. Wei Sheng Yan Jiu. 2012;41(4):532– 35 (In Chinese)].Li H, Wang Y, Zheng J, Wang Y, Huang D, Liang L et al. Analysis on iodine nutritional status and thyroid function in pregnant women. Wei Sheng Yan Jiu. 2012;41(4):532– 35 (In Chinese)].Yap YW, Onyekwelu E, Alam U. Thyroid disease in pregnancy. Clin Med (Lond). 2023;23(2):125–28. doi: 10.7861/clinmed.2023-0018.Yap YW, Onyekwelu E, Alam U. Thyroid disease in pregnancy. Clin Med (Lond). 2023;23(2):125–28. doi: 10.7861/clinmed.2023-0018.Yang Y, Guo T, Fu J, Kuang J, Wang Y, Zhang Y et al. Preconception thyrotropin levels and risk of adverse pregnancy outcomes in Chinese women aged 20 to 49 years. JAMA Netw Open. 2021;4(4):e215723. doi: 10.1001/jamanetworkopen.2021.5723.Yang Y, Guo T, Fu J, Kuang J, Wang Y, Zhang Y et al. Preconception thyrotropin levels and risk of adverse pregnancy outcomes in Chinese women aged 20 to 49 years. JAMA Netw Open. 2021;4(4):e215723. doi: 10.1001/jamanetworkopen.2021.5723.Urgatz B, Poppe KG. Update on therapeutic use of levothyroxine for the management of hypothyroidism during pregnancy. Endocr Connect. 2024;13(3):e230420. doi: 10.1530/EC-23-0420.Urgatz B, Poppe KG. Update on therapeutic use of levothyroxine for the management of hypothyroidism during pregnancy. Endocr Connect. 2024;13(3):e230420. doi: 10.1530/EC-23-0420.Kiran Z, Sheikh A, Humayun KN, Islam N. Neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism. Ann Med. 2021;53(1):1560–68. doi: 10.1080/07853890.2021.1970798.Kiran Z, Sheikh A, Humayun KN, Islam N. Neonatal outcomes and congenital anomalies in pregnancies affected by hypothyroidism. Ann Med. 2021;53(1):1560–68. doi: 10.1080/07853890.2021.1970798.Ge GM, Leung MTY, Man KKC, Leung WC, Ip P, Li GHY et al. Maternal thyroid dysfunction during pregnancy and the risk of adverse outcomes in the off A systematic review and meta-analysis. J Clin Endocrinol Metab. 2020;105(12):dgaa555. doi: 10.1210/clinem/dgaa555.Ge GM, Leung MTY, Man KKC, Leung WC, Ip P, Li GHY et al. Maternal thyroid dysfunction during pregnancy and the risk of adverse outcomes in the off A systematic review and meta-analysis. J Clin Endocrinol Metab. 2020;105(12):dgaa555. doi: 10.1210/clinem/dgaa555.Dong AC, Morgan J, Kane M, Stagnaro-Green A, Stephenson MD. Subclinical hypothyroidism and thyroid autoimmunity in recurrent pregnancy loss: A systematic review and meta-analysis. Fertil Steril. 2020;113(3):587–600.e1. doi: 10.1016/j.fertnstert.2019.11.003.Dong AC, Morgan J, Kane M, Stagnaro-Green A, Stephenson MD. Subclinical hypothyroidism and thyroid autoimmunity in recurrent pregnancy loss: A systematic review and meta-analysis. Fertil Steril. 2020;113(3):587–600.e1. doi: 10.1016/j.fertnstert.2019.11.003.Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR et al. Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid. 2016;26(4):580–90. doi: 10.1089/thy.2015.0418.Maraka S, Ospina NM, O'Keeffe DT, Espinosa De Ycaza AE, Gionfriddo MR et al. Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid. 2016;26(4):580–90. doi: 10.1089/thy.2015.0418.Toloza FJK, Derakhshan A, Mannisto T, Bliddal S, Popova PV, Carty DM et al. 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;10(4):243–52. doi: 10.1016/S2213-8587(22)00007-9.Toloza FJK, Derakhshan A, Mannisto T, Bliddal S, Popova PV, Carty DM et al. 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;10(4):243–52. doi: 10.1016/S2213-8587(22)00007-9.Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI et al.; American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200–35. doi: 10.1089/thy.2012.0205.Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI et al.; American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200–35. doi: 10.1089/thy.2012.0205.Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315–89. doi: 10.1089/thy.2016.0457.Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27(3):315–89. doi: 10.1089/thy.2016.0457.Medscape. Update coming for thyroid disease in pregnancy guidelines. URL: https://www.medscape.com/viewarticle/update-coming-thyroid-disease-pregnancy-guidelines-2024a1000kfm (date of access – 25.06.2025).Medscape. Update coming for thyroid disease in pregnancy guidelines. URL: https://www.medscape.com/viewarticle/update-coming-thyroid-disease-pregnancy-guidelines-2024a1000kfm (date of access – 25.06.2025).Poppe K, Bisschop P, Fugazzola L, Minziori G, Unuane D, Weghofer A. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction. Eur Thyroid J. 2021;9(6):281–95. doi: 10.1159/000512790.Poppe K, Bisschop P, Fugazzola L, Minziori G, Unuane D, Weghofer A. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction. Eur Thyroid J. 2021;9(6):281–95. doi: 10.1159/000512790.Клинические рекомендации. Гипотиреоз. Российская ассоциация эндокринологов. Рубрикатор клинических рекомендаций Минздрава России. 2024. ID: 531_4. Доступ: https://cr.minzdrav.gov.ru/preview-cr/531_4 (дата обращения – 25.06.2025).Клинические рекомендации. Гипотиреоз. Российская ассоциация эндокринологов. Рубрикатор клинических рекомендаций Минздрава России. 2024. ID: 531_4. Доступ: https://cr.minzdrav.gov.ru/preview-cr/531_4 (дата обращения – 25.06.2025).Korevaar TI, Schalekamp-Timmermans S, de Rij YB, Visser WE, Visser W, de Muinck et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: The generation R study. J Clin Endocrinol Metab. 2013;98(11):4382–90. doi: 10.1210/jc.2013-2855.Korevaar TI, Schalekamp-Timmermans S, de Rij YB, Visser WE, Visser W, de Muinck et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: The generation R study. J Clin Endocrinol Metab. 2013;98(11):4382–90. doi: 10.1210/jc.2013-2855.De Leo S, Pearce EN. Autoimmune thyroid disease during pregnancy. Lancet Diabetes Endocrinol. 2018;6(7):575–86. doi: 10.1016/S2213-8587(17)30402-3.De Leo S, Pearce EN. Autoimmune thyroid disease during pregnancy. Lancet Diabetes Endocrinol. 2018;6(7):575–86. doi: 10.1016/S2213-8587(17)30402-3.Taylor PN, Minassian C, Rehman A, Iqbal A, Draman MS, Hamilton W et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: A community-based study. J Clin Endocrinol Metab. 2014;99(10):3895–902. doi: 10.1210/jc.2014-1954.Taylor PN, Minassian C, Rehman A, Iqbal A, Draman MS, Hamilton W et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: A community-based study. J Clin Endocrinol Metab. 2014;99(10):3895–902. doi: 10.1210/jc.2014-1954.Bein M, Yu OHY, Grandi SM, Frati FYE, Kandil I, Filion KB. Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: A systematic review and meta-analysis. BMC Endocr Disord. 2021;21(1):34. doi: 10.1186/s12902-021-00699-5.Bein M, Yu OHY, Grandi SM, Frati FYE, Kandil I, Filion KB. Levothyroxine and the risk of adverse pregnancy outcomes in women with subclinical hypothyroidism: A systematic review and meta-analysis. BMC Endocr Disord. 2021;21(1):34. doi: 10.1186/s12902-021-00699-5.Ding Z, Liu Y, Maraka S, Abdelouahab N, Huang HF, Fraser WD, Fan J. Pregnancy and neonatal outcomes with levothyroxine treatment in women with subclinical hypothyroidism based on new diagnostic criteria: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2021;12:797423. doi: 10.3389/fendo.2021.797423.Ding Z, Liu Y, Maraka S, Abdelouahab N, Huang HF, Fraser WD, Fan J. Pregnancy and neonatal outcomes with levothyroxine treatment in women with subclinical hypothyroidism based on new diagnostic criteria: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2021;12:797423. doi: 10.3389/fendo.2021.797423.Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76–94. doi: 10.1159/000362597.Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3(2):76–94. doi: 10.1159/000362597.Pirola I, Gandossi E, Brancato D, Marini F, Cristiano A, Delbarba A et al. TSH evaluation in hypothyroid patients assuming liquid levothyroxine at breakfast or 30 min before breakfast. J Endocrinol Invest. 2018;41(11):1301–6. doi: 10.1007/s40618-018-0867-3.Pirola I, Gandossi E, Brancato D, Marini F, Cristiano A, Delbarba A et al. TSH evaluation in hypothyroid patients assuming liquid levothyroxine at breakfast or 30 min before breakfast. J Endocrinol Invest. 2018;41(11):1301–6. doi: 10.1007/s40618-018-0867-3.Virili C, Giovanella L, Fallahi P, Antonelli A, Santaguida MG, Centanni M, Trimboli P. Levothyroxine therapy: Changes of TSH levels by switching patients from tablet to liquid formulation. A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2018:9:10. doi: 10.3389/fendo.2018.00010.Virili C, Giovanella L, Fallahi P, Antonelli A, Santaguida MG, Centanni M, Trimboli P. Levothyroxine therapy: Changes of TSH levels by switching patients from tablet to liquid formulation. A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2018:9:10. doi: 10.3389/fendo.2018.00010.Laurent I, Tang S, Astere M, Wang KR, Deng S, Xiao L et al. Liquid L-thyroxine versus tablet L-thyroxine in patients on L-thyroxine replacement or suppressive therapy: A meta-analysis. Endocrine. 2018;61(1):28–35.doi: 10.1007/s12020-018-1574-8.Laurent I, Tang S, Astere M, Wang KR, Deng S, Xiao L et al. Liquid L-thyroxine versus tablet L-thyroxine in patients on L-thyroxine replacement or suppressive therapy: A meta-analysis. Endocrine. 2018;61(1):28–35.doi: 10.1007/s12020-018-1574-8.Cappelli C, Negro R, Pirola I, Gandossi E, Agosti B, Castellano M. Levothyroxine liquid solution versus tablet form for replacement treatment in pregnant women. Gynecol Endocrinol. 2016;32(4):290–92. doi: 10.3109/09513590.2015.1113518Cappelli C, Negro R, Pirola I, Gandossi E, Agosti B, Castellano M. Levothyroxine liquid solution versus tablet form for replacement treatment in pregnant women. Gynecol Endocrinol. 2016;32(4):290–92. doi: 10.3109/09513590.2015.1113518Fallahi P, Ferrari SM, Antonelli A. In patients with subclinical hypothyroidism while in therapy with tablet l-t4, the liquid l-t4 formulation is more effective in re-storing euthyroidism. Endocr Pract. 2017;23(2):170–74. doi: 10.4158/EP161545.OR.Fallahi P, Ferrari SM, Antonelli A. In patients with subclinical hypothyroidism while in therapy with tablet l-t4, the liquid l-t4 formulation is more effective in re-storing euthyroidism. Endocr Pract. 2017;23(2):170–74. doi: 10.4158/EP161545.OR.

The authors declare that there are no conflicts of interest present.