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Thyroid Disease in Pregnancy (Women’s Health Series)

Shema Ahmad, MD, Stephen A. Geraci, MD, Christian A. Koch MD, PhD
Volume: 106 Issue: 9 September, 2013

Abstract:

Pregnancy is a state of many hormonal changes that can make interpretation of thyroid function tests difficult. Measuring trimester-specific reference values of thyrotropin and free thyroxine is recommended. Because overt maternal hypothyroidism negatively affects the fetus, timely recognition and treatment are important. Women taking levothyroxine prepregnancy require a ≤50% dose increase during pregnancy. Hyperthyroidism can result from excessive human chorionic gonadotropin or Graves disease. Radioactive scanning should be avoided during pregnancy. Antithyroidal drug therapy should consist of propylthiouracil during the first trimester and methimazole thereafter. If indicated, beta blockers can be administered under obstetrical supervision. Iodine deficiency is a known goitrogen and stimulus for thyroid nodular growth. Thyroid nodules may enlarge, but the incidence of thyroid cancer is not increased during pregnancy. Suspicious nodules should be biopsied and, if necessary, removed during the second trimester; otherwise, follow-up can safely be conducted postpartum. Thyroid-stimulating hormone suppression for any preexisting thyroid cancer or suspicious nodules should achieve free or total T4 in the upper normal range for pregnancy. Postpartum thyroiditis occurs more frequently in antithyroid peroxidase–positive women, who should be screened by measuring serum thyrotropin at 6 to 12 weeks’ gestation and at 3 and 6 months postpartum.

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References:

1. Golden SH, Robinson KA, Saldanha I, et al. Clinical review: prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab. 2009; 94: 1853–1878.
 
2. Altomare M, La Vignera S, Asero P, et al. High prevalence of thyroid dysfunction in pregnant women. J Endocrinol Invest. 2013; 36: 407–411.
 
3. Zimmermann MB. Iodine deficiency. Endocr Rev. 2009; 30: 376–408.
 
4. Leung AM, Pearce EN, Braverman LE. Iodine content of prenatal multivitamins in the United States. N Engl J Med. 2009; 360: 939–940.
 
5. Leung AM, Pearce EN, Braverman LE. Sufficient iodine intake during pregnancy: just do it. Thyroid. 2013; 23: 7–8.
 
6. Caldwell KL, Makhmudov A, Ely E, et al. Iodine status of the U.S. population, National Health and Nutrition Examination Survey, 2005–2006 and 2007–2008. Thyroid. 2011; 21: 419–422.
 
7. Vandenberg LN, Colborn T, Hayes TB, et al. Hormones and endocrine-disrupting chemicals: low-dose effects and nonmonotonic dose responses. Endocr Rev. 2012; 33: 378–455.
 
8. Andra SS, Makris KC. Thyroid disrupting chemicals in plastic additives and thyroid health. J Environ Sci Health C Environ Carcinog Ecotoxicol Rev. 2012; 30: 107–151.
 
9. Massart F, Ferrara P, Saggese G. Environmental thyroid disruptors and human endocrine health In: Springer D, ed. A New Look at Hypothyroidism. 2012; .New York: InTech;
 
10. Kalantaridou SN, Zoumakis E, Makrigiannakis A, et al. The role of corticotropin-releasing hormone in blastocyst implantation and early fetal immunotolerance. Horm Metab Res. 2007; 39: 474–477.
 
11. Vrekoussis T, Kalantaridou SN, Mastorakos G, et al. The role of stress in female reproduction and pregnancy: an update. Ann N Y Acad Sci. 2010; 1205: 69–75.
 
12. Yuen KC, Chong LE, Koch CA. Adrenal insufficiency in pregnancy: challenging issues in diagnosis and management. Endocrine. 2013;Feb 2 [Epub ahead of print]
 
13. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97: 2543–2565.
 
14. Stagnaro-Green A. Optimal care of the pregnant woman with thyroid disease. J Clin Endocrinol Metab. 2012; 97: 2619–2622.
 
15. Stagnaro-Green A, Pearce E. Thyroid disorders in pregnancy. Nat Rev Endocrinol. 2012; 8: 650–658.
 
16. Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012; 97: 334–342.
 
17. Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011; 21: 1081–1125.
 
18. Soldin OP. When thyroidologists agree to disagree: comments on the 2012 Endocrine Society pregnancy and thyroid disease clinical practice guideline. J Clin Endocrinol Metab. 2012; 97: 2632–2635.
 
19. Negro R. Thyroid dysfunction and pregnancy: where are we five years later? J Clin Endocrinol Metab. 2012; 97: 2629–2631.
 
20. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012; 22: 1200–1235.
 
21. Midgley JE, Hoermann R. Measurement of total rather than free thyroxine in pregnancy: the diagnostic implications. Thyroid. 2013; 23: 259–261.
 
22. Velkeniers B, Van Meerhaeghe A, Poppe K, et al. Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Hum Reprod Update. 2013; 19: 251–258.
 
23. Hackmon R, Blichowski M, Koren G. The safety of methimazole and propylthiouracil in pregnancy: a systematic review. J Obstet Gynaecol Can. 2012; 34: 1077–1086.
 
24. Brent GA. The debate over thyroid-function screening in pregnancy. N Engl J Med. 2012; 366: 562–563.
 
25. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012; 366: 493–501.
 
26. Sang Z, Wei W, Zhao N, et al. Thyroid dysfunction during late gestation is associated with excessive iodine intake in pregnant women. J Clin Endocrinol Metab. 2012; 97: E13631–E13639.
 
27. Wilson KL, Casey BM, McIntire DD, et al. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstet Gynecol. 2012; 119: 315–320.
 
28. Wang QW, Yu B, Huang RP, et al. Assessment of thyroid function during pregnancy: the advantage of self-sequential longitudinal reference intervals. Arch Med Sci. 2011; 7: 679–678.
 
29. Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med. 1994; 331: 1072–1078.
 
30. Lazarus JH. Thyroid regulation and dysfunction in the pregnant patient. http://www.thyroidmanager.org/chapter/thyroid-regulation-and-dysfunction-in-the-pregnant-patient. Published 2011. Accessed July 22, 2013.
 
31. Ballabio M, Poshychinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab. 1991; 73: 824–831.
 
32. Williams GR. Neurodevelopmental and neurophysiological actions of thyroid hormone. J Neuroendocrinol. 2008; 20: 784–794.
 
33. Auso E, Lavado-Autric R, Cuevas E, et al. A moderate and transient deficiency of maternal thyroid function at the beginning of fetal neocorticogenesis alters neuronal migration. Endocrinology. 2004; 145: 4037–4047.
 
34. Boucai L, Hollowell JG, Surks MI. An approach for development of age-, gender-, and ethnicity-specific thyrotropin reference limits. Thyroid. 2011; 21: 5–11.
 
35. Glinoer D, Spencer CA. Serum TSH determinations in pregnancy: how, when and why? Nat Rev Endocrinol. 2010; 6: 526–529.
 
36. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999; 341: 549–555.
 
37. Brucker-Davis F, Ferrari P, Gal J, et al. Iodine status has no impact on thyroid function in early healthy pregnancy. J Thyroid Res. 2012; : 168764
 
38. Chandra AK, Singh LH, Ghosh S. Role of bamboo shoot in the pathogenesis of endemic goiter in Manipur, North East India. Endocr Pract. 2013; 19: 36–45.
 
39. Pop VJ, Brouwers EP, Vader HL, et al. Maternal hypothyroxinaemia during early pregnancy and subsequent child development: a 3-year follow-up study. Clin Endocrinol. 2003; 59: 282–288.
 
40. Negro R, Formoso G, Mangieri T, et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006; 91: 2587–2591.
 
41. Negro R, Schwartz A, Gismondi R, et al. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab. 2010; 95: E44–E48.
 
42. Breese McCoy SJ. Postpartum depression: an essential overview for the practitioner. South Med J. 2011; 104: 128–132.
 
43. Aslam M, Inayat M. Fetal and neonatal Graves disease: a case report and review of the literature. South Med J. 2008; 101: 840–841.
 
44. Westphal SA. Hepatotoxicity from propylthiouracil. South Med J. 1994; 87: 943–947.
 
45. Momotani N, Hisaoka T, Noh J, et al. Effects of iodine on thyroid status of fetus versus mother in treatment of Graves’ disease complicated by pregnancy. J Clin Endocrinol Metab. 1992; 75: 738–744.
 
46. Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab. 2001; 86: 2354–2359.
 
47. Leboeuf R, Emerick LE, Martorella AJ, et al. Impact of pregnancy on serum thyroglobulin and detection of recurrent disease shortly after delivery in thyroid cancer survivors. Thyroid. 2007; 17: 543–547.

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