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
...Assessment...
...1. Testing For Thyroid Dysfunction In Pr...
...Screening for T...
...pregnant women should be verbally screened at the...
...iversal screening to detect low free thyrox...
All patients seeking pregnancy, or...
...nsufficient evidence to recommend for...
...insufficient evidence to recommend fo...
...Thyro...
..., population-based trimester-specific reference...
The accuracy of serum Free T4 measurement by...
...lieu of measuring free T4, total T4 measur...
...Iodine Status an...
...nary iodine concentrations can be used to ass...
...women should ingest approximately 2...
..., including the United States, women who ar...
...esource countries and regions where ne...
...to initiate iodine supplementation in pregnan...
...oses of iodine exposure during pregnanc...
...ustained iodine intake from diet and diet...
...Thyroid...
...hyroid peroxidase (TPO) or thyroglobu...
...pplementation is NOT recommended for the treatm...
...s immunoglobulin treatment of euthyroi...
...cient evidence to conclusively determ...
...here is insufficient evidence to recom...
Infertility
...Infertilit...
...The Im...
...luation of serum TSH concentration is re...
LT4 treatment is recommended for infertile wome...
...insufficient evidence to determine if LT4 therapy...
...insufficient evidence to determine if...
...ally hypothyroid women undergoing in vitro...
...insufficient evidence to determine whether L...
...cocorticoid therapy is NOT recommended for eu...
...sible, thyroid function testing should be perform...
...chieve pregnancy following controlled ovarian h...
Maternal Disorders
...Maternal Disorders...
...Hypothy...
...the setting of pregnancy, maternal h...
...available, population and trimester-spe...
...en this is not feasible, pregnancy-specific TSH...
...al or transferable pregnancy-specific...
...of overt hypothyroidism is recomme...
...n with TSH concentrations >2.5 mU/L should...
...Subclinical...
...sitive women with a TSH greater than...
...egative women with a TSH >10.0 mU/...
...OAb-negative women TPO antibody negative w...
TPOAb-positive women with TSH conce...
...y is NOT recommended for TPOAb-negative wo...
...thyroxinemia should NOT be routinel...
...he recommended treatment of matern...
...allel to the treatment of hypothyroidism...
...and subclinical hypothyroidism (treat...
...pothyroid women of reproductive age should be co...
...women treated with LT4 who are plan...
...elivery, LT4 should be reduced to the patientâ€...
...whom LT4 is initiated during pregna...
...n the care of women with adequately treat...
...Thyrotoxicosis in Pr...
When a suppressed serum TSH is det...
...de scintigraphy or radioiodine uptake determin...
...ropriate management of abnormal maternal thyroi...
...of childbearing age who are thyro...
...c women should be rendered stably euthyr...
...himazole (MMI) or prophylthiouracil (PTU) shou...
...-pregnant woman with Graves’ disease, who i...
...cessation of antithyroid medication, mate...
...each assessment, the decision to con...
...ended for the treatment of maternal hyperthy...
...omen receiving MMI who are in need of con...
...ifting from MMI to PTU, a dose ratio of approxim...
...ATD therapy is required after 16...
...women being treated with antithyroid d...
...medication during pregnancy should be adm...
...ion regimen of LT4 and an antithyroid dru...
...dectomy in pregnancy may be indicate...
...r with the American College of Obst...
...e patient has a past history of Gravesâ...
...maternal TRAb concentration is elevated in...
.... If maternal TRAb is undetectable or low in ear...
...atient is taking ATDs for treatment...
...ient requires treatment with ATDs for Graves...
...If elevated TRAb is detected at weeks 18–22 or t...
...rveillance should be performed in...
...should be used in rare circumstances and...
...ATD therapy is given for hyperthyroidism caus...
...ages and Disadvantages of Therapeutic Options f...
...Thyroid N...
...suppressed serum TSH levels that persi...
...f measuring calcitonin in pregnant women with thyr...
...oid nodule FNA is generally recommended for...
...scintigraphy or radioiodine uptake determinat...
...n with cytologically benign thyroid nodules d...
...ith cytologically indeterminate (AUS/FLUS,...
...cy, if there is clinical suspicion of an aggr...
...ecular testing is NOT recommended for evaluatio...
...thyroid carcinoma (PTC) detected in early...
...t of pregnancy on women with newly diagnose...
...nt women with thyroid cancer should be ma...
Pregnancy should be deferred for 6 months after...
...asound and thyroglobulin monitoring du...
...trasound and thyroglobulin monitoring should be pe...
...asound monitoring of the maternal thyroid sho...
...nographic Patterns and Estimated Risk of Malignan...
...Postpartum Thyroidit...
...ith depression, including postpartum depression,...
...e thyrotoxic phase of PPT, symptomatic women may b...
...ugs are NOT recommended for the treatment of the t...
...esolution of the thyrotoxic phase of PPT, serum T...
...uld be considered for women with symptomatic hypot...
...initiated for PPT, discontinuation of the...
...a prior history of PPT should hav...
...euthyroid thyroid antibody-positive pr...
Fetal and Neonatal Considerations
Fetal and...
...f maternal thyroid illness, use of antithyroid...
...y of maternal and fetal thyroid illness shoul...
...hould be screened for hypothyroidism by blood spot...
...Thyroid Disease...
...ernal hypothyroidism can adversely impa...
...its adverse impact upon milk production and le...
...f maternal hyperthyroidism upon lactation is not...
...he use of 131I is contraindicated during lact...
...treatment decisions specifically made on the gr...
...ntithyroid medication is indicated...
...eastfed children of women who are treat...
...breastfeeding women should ingest a...
...g women should supplement their diet with a...
...rely iodine deficient, low-resource re...
...during pregnancy, sustained iodine intake...