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According to the Endocrinological Research Center of the Russian Academy of Medical Sciences for 1995-1999, the actual average consumption of iodine by a resident of Russia was 40-80 micrograms per day, which is 2-3 times less than the recommended norm.

Diseases of the thyroid gland, accompanied by a violation of its function, often lead to menstrual disorders, reduced fertility. In women with thyroid pathology, there is a high probability of developing complications of pregnancy and childbirth: early toxicosis, preeclampsia, intrauterine fetal hypoxia, threatened miscarriage, premature birth, discordant labor activity.

How does iodine work in the body?

Iodine in the form of organic and inorganic compounds enters the gastrointestinal tract with food and drinking water and is absorbed in the intestine in the form of iodides. Iodides in the bloodstream reach the thyroid gland, the tissue of which has a unique ability to capture and concentrate iodide. In the future, with the participation of iodine, the synthesis of thyroid hormones occurs. Lack of iodine affects the decrease in the synthesis of thyroid hormones.

Why do I need iodine during pregnancy

Pregnancy is a factor that exacerbates iodine deficiency, which in turn adversely affects the development of the fetus.

Thyroid hormones, which are produced only in the presence of iodine, are the most important regulators of the formation and maturation of the fetal brain at the stage of intrauterine development. No other hormones give a similar effect. Only maternal thyroid hormones provide a full-fledged anatomical and morphological laying of the main components of the central nervous system in the first trimester of pregnancy (cortex, subcortical nuclei, corpus callosum, striatum, subarachnoid tract), the formation of the cochlea of ​​the auditory analyzer, eyes, facial skeleton, lung tissue.

Severe iodine deficiency leads to disorders in the mental development of the child up to cretinism. In early pregnancy, iodine deficiency increases the risk of miscarriage or pregnancy regression.

Signs of hypothyroidism in a newborn are a large mass, swelling, lethargy, signs of immaturity in full-term and even sometimes post-term pregnancy, and prolonged jaundice.

In a child, iodine is responsible not only for the development of intelligence, but also for the growth of the skeleton and the harmonious functioning of internal organs.

In addition, a lack of iodine leads to dysfunction of the thyroid gland in the mother, which can lead to the development of hypothyroidism. This condition is characterized by a decrease in physical and mental activity, depression, weight gain, edema, impaired condition of nails and hair, and a decrease in general immunity.

With a lack of iodine during pregnancy, a compensatory increase in the size of the thyroid gland and the formation of a goiter are possible, which after childbirth is only partially reversed.

In lactating women, iodine deficiency can cause a decrease in milk production.

Symptoms of iodine deficiency appear already with a fairly pronounced deficiency, so it may not be noticed in time, while it should be remembered that the fetus's body is more sensitive to iodine deficiency than the mother's body, it is necessary to start prophylactic iodine intake (in food or in the form of medicines).

The increased need for iodine during pregnancy is due to the increased need for thyroxine to maintain the normal metabolism of the mother's body; the presence of the transfer of the hormone T4 and iodine from mother to fetus; possible increased loss of iodine during pregnancy due to increased renal clearance.

Pregnancy in conditions of iodine deficiency becomes a goiter factor and carries the risk of the formation and progression of goiter in women, the creation of relative gestational hypothyroxinemia and impaired fetal development.

The actual intake of iodine is no more than 40-80 mcg per day, and the pregnant woman receives 2.5-3 times less iodine than necessary.

Products containing iodine

Most common foods contain very little iodine. The exception is seafood.

Table of iodine-containing foods

The most popular is iodized salt, but pregnant women should not eat a lot of salt, especially in the second half of pregnancy. In addition, iodine is rapidly destroyed upon contact with air and light, so the shelf life of iodized salt, even under proper storage conditions, does not exceed 6 months.

Organic iodine from seaweed and other seafood is better absorbed and retained in the body longer than iodine preparations.

Thyme, swede, turnip, red and cauliflower, mustard and soy block the absorption of iodine by the body.

Iodine preparations

When taking iodine preparations, you need to take into account that you get some amount of iodine with food (on average, it is 40 mcg / day). In addition, many prenatal multivitamins also contain iodine. The amount of iodine taken should not exceed 200-250 mcg / day. Usually during pregnancy, drugs are prescribed with a dose of 200 mcg of iodine, but if iodine is contained in a multivitamin that a woman takes, this dosage should be adjusted.

In modern preparations, iodine is contained in the form of potassium iodide and iodocasein.

Who should not use iodine

A contraindication for the appointment of iodine preparations during pregnancy is hyperthyroidism (a pathological increase in thyroid function, expressed in excessive production of thyroid hormones).

Allergic reactions to iodine preparations are possible, in which case they should be canceled.

Sometimes during pregnancy, symptoms of liver dysfunction are observed. At the same time, the number of drugs should be minimized, so iodine preparations are also canceled for some time, and iodine should be tried to be obtained from food.

With caution, iodine preparations are taken for kidney diseases.

Endemic goiter during pregnancy harms not only the woman herself, but also the unborn child. Why is this happening and how to deal with it? Find the answers in this article.

You need iodine during pregnancy!

Due to iodine deficiency, a woman develops endemic diffuse goiter during pregnancy, and the fetus has a whole range of pathologies, such as:

• congenital anomalies
• neurological cretinism (mental retardation, deafness, strabismus)
• myxedematous cretinism (hypothyroidism, dwarfism)
• psychomotor disorders
• neonatal hypothyroidism

In addition, iodine deficiency affects the course of pregnancy itself, causing abortions, stillbirths, and infant mortality.

As you can see, iodine deficiency is not such a harmless problem as it seems at first glance. Iodine deficiency diseases are a serious public health problem in many countries of the world.

According to WHO, 30% of the world's population is at risk of developing iodine deficiency diseases. About 20 million people already have mental retardation due to iodine deficiency. How the work of the thyroid gland affects mental activity, read the article "Human Intelligence and the Thyroid Gland".

According to G.A. Gerasimov (1997), almost the entire territory of Russia is endemic for goiter. According to their geochemical composition, soil and water contain little iodine. The greatest lack of iodine is observed in the North Caucasus, the Urals, Altai, the Siberian Plateau, the Far East, the Upper and Middle Volga regions and the Central region of the European part of the country.

Based on this, the issue of providing a sufficient amount of iodine during pregnancy is extremely relevant, because during pregnancy the physiological need for thyroid hormones increases, and iodine is the substrate for them. In case of a lack of this trace element, it develops during pregnancy.

A goiter is an enlargement of the thyroid gland. This happens in response to a decrease in iodine intake, due to which the production of thyroid hormones decreases, which in turn stimulates the production of TSH by the pituitary gland. And TSH has a powerful goiter effect. The goiter that appeared during pregnancy does not always disappear after its completion, which all the more requires close attention to this problem.

Iodine deficiency during pregnancy also attracts attention because there is a risk of developing goiter in the fetus, since iodine comes to it exclusively at the expense of the mother. This iodine deficiency can lead to a decrease in intelligence due to adverse effects during the formation of the central nervous system.

Thus, the IQ index in a population that lives in a region with iodine deficiency is 10-15% lower than in regions without deficiency.

Prevention of iodine deficiency in pregnant women

To prevent iodine deficiency during pregnancy, use:

1. Bulk method.
2. Individual method.

Why were these products chosen for iodization? Because they are the products of mass consumption, especially salt.

But for a pregnant woman, one mass prevention is not enough.. Therefore, individual prophylaxis is used in the form of precisely dosed drugs, such as iodomarin, or vitamin-mineral complexes for pregnant women.

The daily requirement for iodine for pregnant and lactating mothers is 200 mcg per day. I would like to point out in principle that the use of dietary supplements containing iodine during pregnancy and lactation is highly contraindicated . Because these additives are not properly tested in Russia, and the true composition is unknown. They may contain a large dose of iodine, which can harm both the mother and the fetus.

The only contraindication to the prophylactic use of iodine is thyrotoxicosis.

Carrying antibodies to TPO is also not a contraindication to individual prophylaxis with iodine preparations. You will find out who is indicated to donate for these antibodies from other articles, so that you do not miss important information.

The use of iodine preparations is carried out against the background of the use of iodized salt in the same volume.

How to treat an existing endemic goiter in a pregnant woman?

First of all, it should be noted that the presence of endemic goiter is not a contraindication for planning pregnancy. The main thing is that there should be a reliable maintenance of euthyroidism, which, if necessary, can be provided by the appointment of L-thyroxine.

The principles of goiter treatment in pregnant women are no different from the treatment of non-pregnant women.

There are 3 treatment options:

1. Only iodine preparations.
2. Only L-thyroxine.
3. Combined method.

It is important to remember that during pregnancy they do not achieve a complete cure for goiter, you just need to monitor the level of hormones (TSH, free T4)

The most optimal is the first treatment option - iodine preparations during pregnancy. In this case, "two birds with one stone" are killed - the prevention of iodine deficiency diseases in the fetus and the treatment of the mother from endemic goiter.

Combination therapy comes second. If a woman took combined drugs before pregnancy, then it is not worth transferring her to iodine preparations.

If a woman before pregnancy received L-thyroxine to treat goiter, then it is advisable to add iodine preparations at a dose of 200 mcg per day for the purpose of prevention.

Regardless of the method of treatment, monitoring of TSH and free T4 every 8 weeks is necessary.

Important! If, with the chosen treatment tactics, there is a decrease in thyroid function or an increase in its volume, the dose of L-thyroxine is increased.

Conclusion: in any case, a pregnant woman should take iodine preparations at a dose of 200 mcg per day. This can only be precisely dosed iodine preparations, for example, iodomarin 200 or multivitamins for pregnant women containing potassium iodide 200 mcg. The use of dietary supplements is highly discouraged.

With warmth and care, endocrinologist Dilyara Lebedeva

It promotes the rapid formation of bone substance (the baby's skeleton will develop correctly).
The development of the brain and nervous system of the unborn child directly depends on the content of this microelement in the body of a pregnant woman (lack can lead to cretinism in the child).
One of the terrible consequences of a lack of a substance in the body of a pregnant woman can be missed pregnancy, which subsequently leads to miscarriage.
The development of such a disease as endemic goiter (carries a danger to the body of the expectant mother and the fetus of the child).
Iodine deficiency that occurred during fetal development cannot be compensated in the future.

Symptoms indicating a lack of a substance

At home, you can easily and quickly establish that your body lacks this trace element to work. It is necessary to carry out a simple, but quite reliable test. To do this, use a cotton swab to apply several strips of iodine solution to the skin. If these lines disappear within half an hour, then the lack of iodine in your body is obvious.

Its deficiency leads to a decrease in body temperature (the patient is cool even in hot weather).
The lack of this element in the body can be judged by the following signs: headache, weakness, memory problems, indigestion, swelling, sleep disturbance, depression, memory impairment, nail and hair problems (fragility), lethargy.

Accurate definition of iodine deficiency

In order to accurately determine the deficiency of a substance, it is necessary to donate blood for the content of thyroxine hormones. This analysis is most often taken in each trimester of pregnancy. Based on the results, his doctor prescribes vitamins for pregnant women with iodine.
An ultrasound of the thyroid gland is also performed (an enlarged thyroid gland is the main sign of a trace element deficiency - endemic goiter). During pregnancy, there is a rapid assimilation of iodine by the fetus and placenta and the occurrence of goiter. In this case, the course of pregnancy can be complicated by early toxicosis, the threat of termination of this pregnancy, increased pressure, placental abruption and postpartum hemorrhage.
Foods high in iodine

More than others, the residents of coastal towns and villages were lucky. They get a large amount of iodine from air saturated with sea water spray. Residents of other regions should eat more foods containing this microelement. These products will reduce the lack of this element in their body.

Products containing iodine elements can be divided into three groups:

1. Products from the sea (they contain the most of this substance).
2. Products of animal origin.
3. Herbal products.

Particularly rich in iodine:

• Laminaria or seaweed. This algae was given to women before and after the birth of a child in ancient China. Due to the high content of iodine, it is taken with endemic goiter, with problems with the menstrual cycle, to improve the functioning of the digestive tract.
• Your diet can be well replenished with sea fish (for example, cod or tuna) and seafood (squid, mussels, shrimp). They should be on the menu of a pregnant woman at least twice a week.
• Iodized salt and Himalayan salt (it is believed that it is better than the first in terms of saturation of the body with iodine).
• Milk (a lot of substances are found in milk and dairy products).
• Quail and chicken eggs.
• Green vegetables (green beans, fresh herbs) and fruits (bananas, strawberries, cranberries and prunes).
• Baked potatoes are also a source of iodine (it is better to use potatoes baked in their skins, mashed potatoes are less effective).
• Baked turkey breasts (this dietary dish contains the same amount of substance as shrimp).

Preparations with iodine for pregnant women

How much iodine a pregnant woman needs for the successful functioning of the thyroid gland is up to the endocrinologist to decide. In no case should you self-medicate (for example, eat sugar with a drop of iodine solution, the pharmacy solution is not intended for oral administration), this can lead to serious problems associated with an overdose.
An excess of this trace element is much less common, but it is just as dangerous as a deficiency. An excess of iodine can lead to serious malformations in the development of the fetus, suspension in the development of the fetus and miscarriage.
Signs of an overdose are: a taste of metal in the mouth, swelling and rash, and there may also be a runny nose. The doctor may prescribe regular vitamins for pregnant women with iodine (if the lack of this trace element is small). Or he can offer special iodine-containing preparations (if there is a serious lack of iodine).

Potassium iodide preparations are recognized as the most popular drugs for pregnant women:

• Iodide.
• Iodomarin. Assign for the prevention and treatment of the thyroid gland. The use of this drug compensates for the lack of iodine in the body. This is especially important during pregnancy and lactation.
• Potassium iodide. This drug is well absorbed by the body and quickly crosses the placenta, so be sure to follow the right dose so as not to cause an overdose.
• Iodine active. Biological supplement to replenish iodine in the body. With iodine deficiency, the component is quickly absorbed, and with an excess, the active substance does not pass into the blood, but is excreted from the body naturally, without entering the thyroid gland.

These drugs are prescribed at a dosage of 200-250 mcg per day. Tablets are taken once after meals (preferably in the morning) and washed down with plenty of liquid. For prevention, it is necessary to start taking iodine preparations for pregnant women at least a few months before the planned pregnancy. This will reduce the lack of trace elements in the most important first semester of pregnancy.

At the planning stage and throughout pregnancy, it is necessary to carefully monitor the amount of iodine in the body. Be sure to take the necessary blood tests to be sure that the body of the expectant mother and the future baby will have enough for the development and further growth of this microelement.

This is a group of pathological conditions caused by iodine deficiency and occurring during the gestational period. In normal thyroidogenesis, they are manifested by an increase in the circumference of the neck, difficulty in swallowing and breathing, periodic coughing, decreased performance, headaches and precordial pains. In patients with impaired thyroid function, signs of hypothyroidism or hyperthyroidism are additionally determined. It is diagnosed on the basis of data on the content of iodine in urine samples, the levels of T4, T3, TSH, and the results of ultrasound of the thyroid tissue. For treatment, iodine-containing drugs, L-thyroxine, and less commonly, antithyroid drugs and β-blockers are used.

ICD-10

E01 Thyroid diseases associated with iodine deficiency and related conditions

General information

Iodine belongs to the category of essential trace elements, is an essential component of thyroid hormones. For normal development and maintenance of metabolism, a healthy person needs 100-150 micrograms of iodine per day. During pregnancy, the daily requirement increases to 200 mcg. The territory of Russia, as well as other European countries, is endemic for iodine deficiency pathological conditions caused by a lack of a microelement in water and natural diet products. In most regions, in the absence of iodine prophylaxis, the daily intake of iodine does not exceed 50-80 mcg. Therefore, iodine deficiency is diagnosed in almost 80% of pregnant women. The relevance of timely detection and correction of iodine deficiency is associated with a high risk of losing the intellectual potential of the nation due to impaired embryogenesis of the nervous system in moderate and severe iodine deficiency.

The reasons

Iodine deficiency during gestation is provoked by a deficiency of a microelement in food and its increased consumption due to the peculiarities of the physiological state of the body. In the absence of planned iodine prophylaxis and poor nutrition, a pregnant woman initially receives less of this microelement. At the same time, during pregnancy, a woman's body significantly increases iodine consumption. The reasons for the increased need of a pregnant woman for iodine are:

• Hormonal changes in the body. Estrogens and chorionic gonadotropin in the 1st trimester of gestational age have a stimulating effect on the thyroid gland. The resulting physiological hyperthyroidism is accompanied by an increased consumption of a microelement, which is necessary for the synthesis of thyroid hormones, and an aggravation of the existing alimentary iodine deficiency.
• Meeting the needs of the child. In the 1st half of pregnancy, iodine is spent on increased secretion of thyroid hormones necessary for the functioning of the woman's body, the development of the fetus and the placental complex. From the 15th week, thyroid hormones begin to be secreted by the child's thyroid gland, which contributes to the additional consumption of the trace element.
• Increased renal clearance of iodine. During pregnancy, renal blood flow and glomerular filtration rate gradually increase by 30-50%, reaching maximum values ​​by 20-26 weeks of gestational age and decreasing by 10-15% by the 36th week. Against the background of unchanged tubular reabsorption, this provokes increased loss of iodine in the urine, which is especially significant in the 1-2 trimesters.

The occurrence of iodine deficiency during pregnancy is facilitated by the use of penicillin, cordarone, sulfonamides, bromine, aspirin, glucocorticosteroids and other drugs that prevent the absorption of the trace element in the gastrointestinal tract or accelerate its excretion, diseases of the digestive tract, helminthic invasions, dysbacteriosis, chronic infectious and inflammatory diseases. The assimilation of the microelement is disturbed with a low content of selenium, zinc, manganese, molybdenum in products, and the use of chlorinated water.

Pathogenesis

With iodine deficiency in a pregnant woman, the metabolism of thyroid hormones is primarily disturbed. In serum, the level of total and free thyroxine decreases, the content of thyroglobulin and thyrotropin (TSH) increases. There is a compensatory hyperplasia of the thyroid tissue, the size of the organ increases by 16-31%, active foci (nodules) may appear in it. Since the hormones produced by the thyroid gland of a woman ensure the metabolic and plastic processes of the fetus up to the 15th week, iodine deficiency disrupts the normal development of the child's central nervous system, which is formed during this period.

Due to insufficient expression of genes involved in the synthesis of neurogranin and other specific proteins, neuronal migration, axonal and dendritic growth, myelination of nerve fibers, synaptogenesis slow down, which often leads to general underdevelopment of brain tissue and disruption of its histological structure. The lack of thyroid hormones, which arose against the background of iodine deficiency, also negatively affects the formation of cartilage of the skeleton, the growth and development of the bone tissue of the fetus - if the thyroid gland is disturbed, the division of osteoblasts necessary for the formation of bone substance slows down, the processes of mineralization of the matrix with calcium and phosphorus salts are disrupted.

Classification

When systematizing iodine deficiency conditions in pregnant women, the severity of iodine deficiency and the functionality of thyrocytes are taken into account. This approach is most justified when choosing the optimal tactics for accompanying gestation. To assess the degree of iodine deficiency, the indicator of trace element excretion in the urine is used: iodine deficiency is considered mild when its content in urine is from 50 to 99.9 µg/l, medium - from 20 to 49.9 µg/l, severe - less than 20 µg/l . Iodine deficiency may be accompanied by a change in the size, structure, and functionality of the thyroid gland. Specialists in the field of obstetrics and endocrinology distinguish the following types of iodine deficiency conditions during gestation:

• Non-toxic (euthyroid) goiter. It becomes the result of organ hyperplasia with iodine deficiency. It can be diffuse (endemic) and focal. The most common thyroid disease in Europeans, detected in 23.5-25% of women with mild iodine deficiency. To continue gestation, iodine prophylaxis is necessary.
• Hypothyroidism during pregnancy. Insufficient intake of iodine in women with subclinical enzyme deficiency (the presence of autoantibodies to thyroperoxidase) can provoke the manifestation of autoimmune thyroiditis. Hypothyroidism is detected in 1.8-2.5% of pregnant women. Usually, the disorder occurs with moderate or severe iodine deficiency, complicating the course of gestation.
• FA of the thyroid gland. Functional autonomy of the thyroid gland is a rare and least prognostic variant of an iodine deficiency state that occurs against the background of prolonged hyperstimulation of thyrocytes by thyroid-stimulating hormone in conditions of mild and moderate iodine deficiency. It is manifested by severe hyperthyroidism with frequent obstetric complications.

Symptoms

The clinical picture of iodine deficiency depends on the functional viability of the thyroid tissue. With euthyroid variants of iodine deficiency in a pregnant woman, the circumference of the lower part of the neck increases, breathing and swallowing are periodically difficult, performance decreases, and a dry obsessive cough appears. Headaches, dizziness, dry skin are possible. A pregnant woman may complain of weakness, fatigue, discomfort in the precordial region. With focal goiter, compacted areas can be felt in the tissues.

When iodine deficiency is combined with thyroid insufficiency, signs of hypothyroidism appear during pregnancy: lethargy, apathy, drowsiness, dyspeptic disorders, hypothermia, forgetfulness, pallor, characteristic swelling of the extremities, the severity of which depends on the degree of hypothyroxinemia. For a decompensated hyperthyroid state provoked by iodine deficiency, weight loss, complaints of muscle weakness, interruptions and palpitations, emotional lability, insomnia, sweating, poor heat tolerance, sometimes low-grade fever, headaches, arterial hypertension are typical.

Complications

A complicated course of pregnancy with iodine deficiency is more often observed in patients suffering from disorders of thyroidogenesis. A decrease in the level of thyroid hormones against the background of iodine deficiency leads to a violation of the formation of the fetal brain, which subsequently manifests itself as intellectual and mnestic disorders in children. Up to 25% increases the risk of other developmental anomalies. Perinatal encephalopathy is detected in 19.8% of newborns. With severe iodine deficiency in the first trimester of pregnancy, the child is more likely to develop cretinism with severe mental retardation, delayed physical development, spastic diplegia, speech disorders, and deafness. With mild and moderate endemic iodine deficiency, 10% of newborns are diagnosed with congenital (neonatal) goiter with an increase in the volume of the thyroid gland by 30-39%.

Pregnancy in women suffering from iodine deficiency is more often complicated by the threat of interruption, preeclampsia, anemia, placental insufficiency. Early and late miscarriages are observed in 18-20% of cases. Almost 2 times (up to 10%) increases the likelihood of preterm birth. In the II-III trimesters, in 37.5% of cases, intrauterine fetal hypoxia is noted. Childbirth is complicated in 43.7% of cases of iodine deficiency. The most common disorders are premature rupture of amniotic fluid, abruption of a normally located placenta, weakness of labor forces, intimate attachment of the placenta, hypotonic and atonic bleeding. In the postpartum period, hypogalactia is possible.

With significant hyperthyroidism against the background of iodine deficiency, implantation and embryogenesis are disrupted, which leads to early spontaneous abortion. Such patients are more likely to develop placental insufficiency, premature birth, gestosis with significant arterial hypertension, coagulopathic bleeding, DIC, antenatal fetal death. A distant consequence of iodine deficiency during gestation is an increase in thyroid pathology in women of reproductive age. Diffuse goiter that developed during pregnancy does not regress in all cases, but with already existing hyperplasia in patients, the size of the gland, the number and volume of nodes increase.

Diagnostics

Iodine deficiency in euthyroid disorders is characterized by a nonspecific clinical picture. Therefore, due to the high probability of developing hypothyroidism against its background, all patients living in endemic regions and presenting characteristic complaints should be examined to rule out iodine-deficient damage to the thyroid tissue. The most informative are:

• Determination of iodine content in urine. The analysis is considered a marker for assessing the iodine saturation of the body. A decrease in the level of a microelement of less than 100 µg/l indicates the development of an iodine deficiency state. The study allows you to monitor the effectiveness of iodine prophylaxis and treatment.
• Analysis of the concentration of thyroid hormones. A decrease or increase in the content of T4, T3 indicates a manifest violation of thyroidogenesis. Positive test results serve as a sufficient basis for prescribing pregnant drugs that correct the hormonal background.
• Determination of the level of thyroid-stimulating hormone. Violation of the concentration of TSH at a normal concentration of thyroxine and triiodothyronine is characteristic of subclinical dysfunction of the thyroid gland. The analysis is recommended as a screening test for early diagnosis of hyperthyroidism and hypothyroidism.
• Sonography of the thyroid gland. During ultrasound of the thyroid gland, the dimensions of the organ, its shape, structure, and contours are visualized. The nature of changes in the thyroid tissue (diffuse hyperplasia, focal formations) is assessed. The method allows you to determine the number and features of nodes.

To conduct a differential diagnosis and assess the condition of the child, the patient may be prescribed tests that detect AT TPO, AT rTTG, fine needle biopsy of nodes, determination of levels of estradiol, hCG, ultrasound of the pelvic organs, CTG, fetal phonocardiography. During pregnancy, the disorder is differentiated with hypothyroid and hyperthyroid conditions of another origin (autoimmune thyroiditis, thyrotoxicosis), follicular neoplasia, Hürthle-Ashkenazi carcinoma, and other types of thyroid cancer. If necessary, the patient is referred for a consultation with an endocrinologist, an oncologist.

Treatment of iodine deficiency during pregnancy

When choosing medical tactics, the obstetrician-gynecologist takes into account the degree of iodine deficiency and the secretory activity of the thyroid tissue. Non-drug methods for correcting iodine deficiency involve supplementing the diet with iodine-containing seafood, feijoa, dates, currants, persimmons, prunes, baked potatoes, apples, buckwheat, millet, beef, cheese, milk, and eggs. In the diet, it is necessary to limit goitrogenic plant products that disrupt the absorption of the essential microelement - various types of cabbage, peanuts and pine nuts, turnips, radishes, legumes (soybeans, beans), peaches.

Treatment, as a rule, is carried out on an outpatient basis, indications for hospitalization are the detection of increasing signs of the threat of interruption of gestation, the III degree of increased uterine tone during pregnancy, and other severe obstetric and extragenital complications. Depending on the levels of thyroxine, triiodothyronine in iodine deficiency, two main therapeutic schemes are recommended:

• Monotherapy with iodine preparations. The use of iodine-containing drugs is justified in euthyroid forms of goiter that occurred during gestation against the background of a lung, less often moderate iodine deficiency. The dosage of drugs corresponds to the daily requirement of the patient in the microelement.
• Combined iodine replacement therapy. If hypothyroidism is detected, it is recommended to supplement the intake of iodine preparations with the appointment of L-thyroxine. A hormone-containing replacement agent, the dose of which is selected under the control of serum levels of TSH, T4, makes it possible to replenish thyroid deficiency.

A contraindication to the appointment of iodine preparations is hyperfunction of the thyroid gland, due to iodine deficiency. In case of decompensation of the hyperthyroid state, the patient is recommended thyreostatics in combination with β-blockers, which eliminate the effects of adrenergic stimulation. The decision on surgical treatment of nodular forms of pathology is usually postponed until the end of gestation. Pregnancy with iodine deficiency is completed by natural childbirth. Caesarean section is carried out only when obstetric and extragenital indications are detected.

Forecast and prevention

The outcome of pregnancy is determined by the degree of iodine deficiency and the functional viability of the thyroid gland. Timely initiation of iodine prophylaxis in women with recurrent miscarriage can reduce the frequency of miscarriages by 1.3 times, premature birth - by 1.8 times, placental insufficiency - by 1.7 times, birth defects - by 2.6 times, intranatal fetal hypoxia - 3 times. Prophylactic intake of iodine in a daily dose of 200 mcg is recommended to start 3-6 months before conception. Although a fairly effective method of iodine prophylaxis in endemic areas is the replacement of ordinary table salt with iodized salt, the administration of iodine-containing preparations makes it possible to more effectively control the dose of the microelement that a pregnant woman receives. To maintain lactation and ensure the physiological development of the child, iodine prophylaxis should be continued after childbirth.

The life growing under the heart of a woman draws resources for development from the mother's body, which is why it must be equipped with everything necessary to provide for itself and "that guy." Each element has its own role, irreplaceable and responsible, and the nutrition of a woman “in position” should contain the right amount of them. Some are synthesized in the body, and there are those that can only be obtained from the outside. Iodine is one of these elements that play an indispensable role in the formation of a healthy baby, and most often it needs to be taken additionally with.

role for the body

Three very important thyroid hormones contain iodine:

• thyroxine;
• triiodothyronine;
• thyrocalcitonin.

In fact, the first is a prohormone of the second and turns into it as needed. The proportion of their production by the thyroid gland is approximately 4:1. If triiodothyronine enters directly into the blood and is transported with its help to those places where it is needed, then thyroxine is retained in the thyroid gland and is consumed as needed.

This hormone is vital for the cells to carry out their functions, in addition, it:

• ensures their livelihoods;
• activates cellular metabolism;
• regulates cell growth.

Possible consequences for pregnancy:

• miscarriage up to 12 weeks;
• intrauterine growth retardation;
• frozen pregnancy;
• severe in the early and late periods;
• miscarriage and premature;
• weakness of labor activity;
• excess weight due to metabolic disorders.

• hypoxia or oxygen starvation;
• pathology of the development of the central nervous system;
• pathology of the development of the thyroid gland of the fetus;
• redundant;
• delayed sexual development.

How much do you need

As already mentioned, expectant mothers require an increased dose of iodine. The daily norm of iodine for adults is 150 micrograms, and for pregnant women - 200-250 micrograms.
Iodine is used especially intensively during pregnancy, since both organisms require an accelerated rate of cell growth. The fetus needs it to grow on time, develop in accordance with them and form its own thyroid gland, and the mother needs it for the growth of the uterus and its membranes in order to provide the child with the best conditions.

Consumption rates are average, they depend on various factors:

• diet of the expectant mother;
• place of residence;
• taking certain medications and so on.

Important! It is easy to check whether the body needs this important element. To do this, draw an iodine "mesh" on the inside of the forearm. If the drawn lines have almost or completely disappeared - you have a lack of iodine, if they do not turn pale within two hours - an overabundance. In both cases, you should make an appointment with an endocrinologist as soon as possible. This method only helps to identify the reason for a visit to the doctor, but does not serve as a means of filling the lack of a substance in the body.

deficiency symptoms

The lack of iodine in the body of a pregnant woman is characterized by general weakness, fatigue, decreased immunity - signs that are already inherent in most expectant mothers, so it is undesirable to miss a dangerous condition, attributing to hormonal changes and the usual malaise of a woman in position.
Further deficiency of this element will entail:

• irritability and nervous state;
• reduced memory and deterioration of intelligence;
• jumps and heart rhythm disturbance;
• migraine;
• permanent;
• decreased appetite;
• deterioration in appearance and their loss;
• fragility of nails;
• dryness and loss of skin elasticity;
• iron deficiency anemia;
• weakness in the joints, sciatica.

Did you know? Iodine does not have a liquid state of aggregation. In solid form, it has a black color with a tinge of brilliant blue, under normal temperature conditions it turns into a violet gas, from which it got its name - "iodes" - violet or violet.

Foods rich in iodine

The right amount of iodine is found in many foods, and pregnancy is an excellent occasion to review the diet and enrich it with the necessary elements.
Seafood is a generally recognized source of iodine and other valuable substances, so it is recommended to add to the daily menu:

• , red and brown algae;
• marine - herring, sardine, cod, halibut;
• shrimp;
• mussels;
• squid;

Iodine contains:

• in bananas;
• in apricots;
• in plums;
• in apples;
• in cherry;
• in persimmon;
• in feijoa;
• in beans;
• in peas;
• in the bow;
• in spinach;
• in carrots;
• in asparagus;
• in salad;
• in rhubarb;
• in radish.

There is also a lot of this useful element in buckwheat and millet.
It is believed that iodized salt is able to make up for its deficiency in the body, but there are nuances: firstly, it should not undergo heat treatment; secondly, the substance quickly evaporates from an open package, so storage conditions should be strictly observed.

For example, such a well-known supplement as "Iodine-Active" can be prescribed by a doctor during pregnancy. Not being a drug, the drug is not used in the treatment of pathological conditions.

It is stated that the iodine contained in it is in a special state and is activated only under the influence of an enzyme that the body produces as a reaction to a lack of iodine, which is why an overdose is impossible, because the excess is excreted from the body. However, it should be taken into account that this drug has not passed the necessary studies and is not recommended for use during pregnancy.

Did you know? In nature, in its pure form, iodine never occurs and is not concentrated in quantities that are sufficient to form. In a small concentration, it is found in sea water, in a larger concentration - in seafood.

Only an endocrinologist can say whether it is possible and necessary to drink "Iodomarin" during pregnancy, because this is a drug that is prescribed for treatment. And the treatment is prescribed by the doctor after the diagnosis of the disease. If you drink the drug uncontrollably, as a preventive measure, by prescribing it yourself, you may encounter bad side effects that threaten an overdose.
Some other drugs that differ in the proportion of iodine in them and each have their own side effects:

• "Iodide";
• "Iodine-balance";
• "Antistrumin";
• "Bimmunal 9".

Important! You should be aware that only an endocrinologist is engaged in the treatment of the thyroid gland, and the appointment of therapeutic drugs is within his competence. Side effects due to an overdose can cause great harm to both the mother's body and her fetus.

Iodine preparations for pregnant women can be prescribed by a doctor in the form of a single injection, which can compensate for the deficiency and prevent the consequences of an iodine deficiency state.

What is better absorbed

Compared to some other elements, the absorption of iodine by the body is quite easy. Many processes take place with its participation, and nature has taken care that there are as few interferences as possible for its consumption by the body.
The element interacts not very well with:

• chlorine;
• fluorine;
• bromine.

• swede;
• cauliflower and red cabbage;
• radish;
• turnip;
• mustard.

• manganese;
• Selena;
• cobalt;
• copper;
• zinc;
• A and E.

Important! The most effective absorption of iodine occurs in the morning, so you should try to take it before noon.

What is dangerous overdose

Lack of iodine in the body is a rather dangerous condition, but an overdose can compete with it. It can cause symptoms of thyroid hormone poisoning, so you can not take drugs containing this element without a doctor's prescription.
Symptoms may appear:

Did you know? Using iodine 100 times more than normal, the Japanese do not feel any symptoms of an overdose: their body absorbs only the amount it needs. But if a Japanese is settled in conditions of a shortage of an element, and after a while he moves back, then the symptoms will ruin his life until the body adapts again.

Prevention of iodine deficiency in pregnant women

It is easier to prevent a condition than to treat it for a long time. This is especially true for women who carry a child under their hearts.

The best prevention of an iodine deficiency state is balanced, containing the right amount of essential substances. Regular intake of seafood and other foods containing this important element will maintain the required balance in both the mother's body and the fetus.
If the doctor thinks that it would be a good idea to increase the iodine intake, he should give a referral to an endocrinologist who, based on the results, will prescribe the right drug. But most often, vitamins for pregnant women already contain the right amount of essential substances.

Sea air saturated with iodine vapor plays an exceptional role in the prevention of thyroid diseases. Staying on the sea coast will bring great benefits to both mother and child.

When planning a pregnancy, it is advisable to be responsible for future parenthood and make sure that the child, if possible, does not need anything. And to provide him with vital conditions for growth and development is the first task and duty of parents. Therefore, the expectant mother should take care of the timely provision of herself and the unborn baby with such a useful and necessary element even before.