Mielikova T. Optimization of diagnostic methods and treatment of miscarriage in autoimmune thyroid diseases.

The thesis presents a complex clinical and laboratory examination of 149 pregnant women with the autoimmune pathology of the thyroid gland (TG); the women were divided into three groups depending on the functional state of the thyroid gland, аnd 30 somatically healthy women. To fully understand the pathogenesis of disorders in the examined pregnant women, in addition to determining the hormonal status, it is necessary to identify the characteristics of metabolic processes, the lipid spectrum, the parameters of the hemostasis system, and determine the serum level of homocysteine. It was determined that the change in hormonal parameters of the function of the pituitary-thyroid system leads to a significant change in the parameters of the fetoplacental complex. A consequence of this is the development of placental insufficiency and an increase in newborns with hypotrophy and hypoxia. The conducted studies of the system of hemostasis make it possible to conclude that all pregnant women with the autoimmune pathology of the thyroid gland have changes not typical of physiological pregnancy. In general, they are manifested in pregnant women with hypo- and hyperthyroidism as a chronic DIC syndrome. For pregnant women with euthyroidism, structural hypo-coagulation is characteristic. We confirmed a direct dependence in the violation of blood rheology and the state of hyperhomocysteinemia and its role in the pathogenesis of obstetric complications. We revealed violations of lipid metabolism in pregnant women with the examined pathology. This is manifested by atherogenic dyslipidemia with activation of lipid peroxidation processes, as well as disturbances in the antioxidant defense system, which leads to a decrease in the adaptive capacity of the organism, obstetric and perinatal complications. Treatment of pregnant women with miscarriages and autoimmune thyroid abnormalities with the inclusion of natural anticoagulant and vitamin complex of folic acid and potassium iodide into the complex therapy contributed to the elimination of symptoms of threatening abortion, improvement of hemodynamics, haemostasiological parameters, normalization of homocysteine imbalance, balancing lipidograms, which allowed prolonging pregnancies in 91, 1 % of cases and the birth of viable children.