Thyroid Disease During Pregnancy
Key Points
Key Points
- Pregnancy has a profound impact on the thyroid gland and its function.
- During pregnancy, the thyroid gland increases in size by 10% in iodine replete countries, but by 20%–40% in areas of iodine deficiency.
- Production of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3), increases by nearly 50%, in conjunction with a separate 50% increase in the daily iodine requirement.
- These physiological changes happen seamlessly in healthy women, but thyroid dysfunction can occur in many pregnant women due to pathologic processes.
- Furthermore, other thyroid illnesses such as nodular disease and thyroid cancer are occasionally detected during pregnancy, and may require treatment.
Assessment
...sessment...
...ting For Thyroid Dysfunction In Pregnancy...
...ing for Thyroid Dysfunction Before or D...
...pregnant women should be verbally sc...
...ening to detect low free thyroxine concentra...
...king pregnancy, or newly pregnant, should un...
...ficient evidence to recommend for or...
...fficient evidence to recommend for or against un...
...oid Function Testing and Preg...
...population-based trimester-specific reference r...
The accuracy of serum Free T4 meas...
...easuring free T4, total T4 measurement (with...
...ne Status and Nutrition
...dian urinary iodine concentrations...
...ll pregnant women should ingest appro...
...most regions, including the United Sta...
...countries and regions where neither s...
...no need to initiate iodine supplement...
...s of iodine exposure during pregnancy should b...
...dine intake from diet and dietary suppl...
...Antibodies & Pregnancy Complications...
...ut thyroid peroxidase (TPO) or thyroglobuli...
...mentation is NOT recommended for the treatment...
...immunoglobulin treatment of euthyroid women with...
...is insufficient evidence to conclus...
...insufficient evidence to recommend for or aga...
Infertility
...nfertility...
...hyroid Illness upon Infertility and Ass...
...ion of serum TSH concentration is rec...
...T4 treatment is recommended for inferti...
...cient evidence to determine if LT4 therapy impr...
There is insufficient evidence to determine...
...ypothyroid women undergoing in vitro ferti...
...icient evidence to determine whether LT...
...id therapy is NOT recommended for...
..., thyroid function testing should be performed...
...men who achieve pregnancy following co...
Maternal Disorders
Maternal Disorders
...pothyroidism and Pregnancy...
...n the setting of pregnancy, maternal hypothyroidi...
...ailable, population and trimester-specific refer...
...is not feasible, pregnancy-specifi...
...ernal or transferable pregnancy-specific TSH refe...
...overt hypothyroidism is recommended during...
...regnant women with TSH concentrations >2...
...othyroidism in pregnancy should be approached a...
...women with a TSH greater than the pregnan...
...ve women with a TSH >10.0 mU/L. ( L , S )624...
...tive women TPO antibody negative wome...
...sitive women with TSH concentrations >2.5 mU/L...
...therapy is NOT recommended for TPOAb-negative w...
...yroxinemia should NOT be routinely t...
...d treatment of maternal hypothyroi...
...the treatment of hypothyroidism in a general...
...n with overt and subclinical hypothyroidism (treat...
...roid women of reproductive age should be counsele...
...omen treated with LT4 who are plan...
...ivery, LT4 should be reduced to the...
...n whom LT4 is initiated during pregnancy may...
...n the care of women with adequately...
...otoxicosis in Pregnanc...
...ssed serum TSH is detected in the first tri...
Radionuclide scintigraphy or radioiodine uptake...
...riate management of abnormal maternal thyroid test...
...women of childbearing age who are thyr...
...ic women should be rendered stably euthy...
Women taking methimazole (MMI) or prophylthi...
...a newly-pregnant woman with Graves’ disease,...
...lowing cessation of antithyroid medication, mate...
...t each assessment, the decision to...
...nded for the treatment of maternal hyperthyr...
...receiving MMI who are in need of continu...
...ifting from MMI to PTU, a dose ratio of...
...ATD therapy is required after 16 we...
In women being treated with antithyroid...
...medication during pregnancy should be admin...
A combination regimen of LT4 and an...
...my in pregnancy may be indicated for uniq...
...e concur with the American College of Obs...
a. If the patient has a past history of...
...If maternal TRAb concentration is elev...
...al TRAb is undetectable or low in early pregn...
...f a patient is taking ATDs for treatment of...
...he patient requires treatment with A...
...TRAb is detected at weeks 18–22...
...llance should be performed in women who have unco...
...entesis should be used in rare circumstances and p...
...TD therapy is given for hyperthyroidism caused by...
...vantages and Disadvantages of Therap...
...and Thyroid Cancer During Pregnancy...
...ith suppressed serum TSH levels that...
...f measuring calcitonin in pregnant wo...
...roid nodule FNA is generally recomme...
...ntigraphy or radioiodine uptake determination...
...with cytologically benign thyroid nodules do not...
...women with cytologically indeterminate (...
...ncy, if there is clinical suspicion o...
...ting is NOT recommended for evaluation o...
...thyroid carcinoma (PTC) detected in early p...
The impact of pregnancy on women with n...
...n with thyroid cancer should be managed at...
...ncy should be deferred for 6 months after a woma...
...und and thyroglobulin monitoring during pregnan...
...und and thyroglobulin monitoring should be...
...itoring of the maternal thyroid sh...
...2. ATA Sonographic Patterns and Estimated Ris...
...tpartum Thyroiditis...
...patients with depression, includi...
...uring the thyrotoxic phase of PPT, symptomatic...
...ntithyroid drugs are NOT recommended for t...
...e resolution of the thyrotoxic phase of PPT, serum...
...should be considered for women wi...
...ted for PPT, discontinuation of therap...
...a prior history of PPT should have TSH testing a...
...nt of euthyroid thyroid antibody-pos...
Fetal and Neonatal Considerations
...Neonatal Considerations...
...ternal thyroid illness, use of antith...
...y of maternal and fetal thyroid illnes...
...orns should be screened for hypothyroidism by bl...
...yroid Disease and Lacta...
...ternal hypothyroidism can adversely impact lactat...
...ts adverse impact upon milk production...
...impact of maternal hyperthyroidism upon lactation...
...e use of 131I is contraindicated duri...
...eatment decisions specifically made on th...
When antithyroid medication is indic...
...children of women who are treated with a...
...l breastfeeding women should ingest...
Breastfeeding women should supplement thei...
...n severely iodine deficient, low-resource regi...
...case during pregnancy, sustained iodine intake w...