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...
...gure 1. Testing For Thyroid Dysfunc...
...Thyroid Dysfunction Before or During Pre...
...pregnant women should be verbally screened a...
...rsal screening to detect low free t...
...eking pregnancy, or newly pregnant,...
...e is insufficient evidence to recommend fo...
...ufficient evidence to recommend for or aga...
...d Function Testing and Pregnancy...
...hen possible, population-based trimester-spe...
...f serum Free T4 measurement by the...
...ieu of measuring free T4, total T4 meas...
...ine Status and Nutriti...
...urinary iodine concentrations can be u...
...men should ingest approximately 250 μg iodi...
...egions, including the United States, wom...
...w-resource countries and regions where nei...
...no need to initiate iodine supplementation in p...
...e doses of iodine exposure during pregnanc...
Sustained iodine intake from diet and diet...
...hyroid Auto-Antibodies & Pregnancy Complication...
...d, but thyroid peroxidase (TPO) or thyroglobulin...
...nium supplementation is NOT recommended for the tr...
...ntravenous immunoglobulin treatment of euthyroid...
...insufficient evidence to conclusively determi...
...e is insufficient evidence to recommend fo...
Infertility
...ertility...
...mpact of Thyroid Illness upon Infertil...
...rum TSH concentration is recommended for a...
...atment is recommended for infertile women with...
...insufficient evidence to determine if LT4 th...
...fficient evidence to determine if L...
...hypothyroid women undergoing in v...
...ficient evidence to determine whether L...
...ucocorticoid therapy is NOT recommended f...
...sible, thyroid function testing should...
...chieve pregnancy following controlled ovaria...
Maternal Disorders
...rnal Disorders
Hypothyroidism and P...
...the setting of pregnancy, maternal hypothyroidi...
...n available, population and trimester-sp...
...is is not feasible, pregnancy-specific TSH refe...
...l or transferable pregnancy-specific TSH referen...
...t of overt hypothyroidism is recommende...
...women with TSH concentrations >2.5 mU...
...othyroidism in pregnancy should be approached as...
TPOAb-positive women with a TSH greater than the...
...ative women with a TSH >10.0 mU/L. ( L...
...Ab-negative women TPO antibody neg...
...itive women with TSH concentrations >2.5 mU/L and...
.... LT4 therapy is NOT recommended f...
...othyroxinemia should NOT be routinely...
...ecommended treatment of maternal h...
...allel to the treatment of hypothyr...
...with overt and subclinical hypothyroid...
...ated hypothyroid women of reproduc...
...roid women treated with LT4 who are planni...
...wing delivery, LT4 should be reduced to th...
...in whom LT4 is initiated during pregnancy may...
...women with adequately treated hypothyroid...
...toxicosis in Pregnanc...
...pressed serum TSH is detected in t...
...ionuclide scintigraphy or radioiodine upt...
...he appropriate management of abnormal mate...
...n of childbearing age who are thyrotoxic, the...
...should be rendered stably euthyroid before a...
...himazole (MMI) or prophylthiouracil (PTU) should b...
...In a newly-pregnant woman with Graves’...
...owing cessation of antithyroid medication, mat...
...each assessment, the decision to continue c...
...ded for the treatment of maternal hyperthyr...
...receiving MMI who are in need of c...
...shifting from MMI to PTU, a dose rati...
...f ATD therapy is required after 16...
...ing treated with antithyroid drugs in...
...hyroid medication during pregnancy...
A combination regimen of LT4 and an antith...
...yroidectomy in pregnancy may be indica...
...cur with the American College of Obstetrician...
...patient has a past history of Graves’ diseas...
...TRAb concentration is elevated in early pregnancy,...
...l TRAb is undetectable or low in early preg...
...If a patient is taking ATDs for trea...
...If the patient requires treatment with...
...ted TRAb is detected at weeks 18–22...
...lance should be performed in women who have...
...esis should be used in rare circumst...
...is given for hyperthyroidism caused b...
Table 1. Advantages and Disadvantages...
...yroid Nodules and Thyroid Cancer During Pre...
...with suppressed serum TSH levels that pers...
...f measuring calcitonin in pregnant...
...yroid nodule FNA is generally recommended for...
...onuclide scintigraphy or radioiodin...
...gnant women with cytologically benign thyroid nodu...
...ith cytologically indeterminate (AUS/FL...
...ncy, if there is clinical suspicion of...
...ting is NOT recommended for evaluation of...
...ry thyroid carcinoma (PTC) detected in early...
...he impact of pregnancy on women wit...
...nt women with thyroid cancer shoul...
...should be deferred for 6 months after a wo...
...nd and thyroglobulin monitoring during pregnan...
...thyroglobulin monitoring should be perform...
...monitoring of the maternal thyroid s...
...TA Sonographic Patterns and Estimated Risk of...
...tum Thyroiditis (PPT)...
...th depression, including postpartum depress...
...the thyrotoxic phase of PPT, symptomati...
...oid drugs are NOT recommended for the...
...he resolution of the thyrotoxic phase of PPT, se...
...ould be considered for women with sympto...
...LT4 is initiated for PPT, discont...
...ith a prior history of PPT should have...
...nt of euthyroid thyroid antibody-positive p...
Fetal and Neonatal Considerations
...d Neonatal Considerations...
...history of maternal thyroid illness, use...
The severity of maternal and fetal...
...ll newborns should be screened for hypothyroid...
...oid Disease and Lactation...
...ernal hypothyroidism can adversely imp...
...iven its adverse impact upon milk produ...
...of maternal hyperthyroidism upon lactati...
...of 131I is contraindicated during lactati...
...reatment decisions specifically made on...
...oid medication is indicated for wo...
...tfed children of women who are treated...
...g women should ingest approximately 250 mcg of die...
...astfeeding women should supplement their d...
...verely iodine deficient, low-resource r...
...case during pregnancy, sustained iodine...