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
...Assessmen...
...g For Thyroid Dysfunction In Pregnancy...
...Screening for Thyro...
...ll pregnant women should be verball...
...rsal screening to detect low free thyroxine co...
...ients seeking pregnancy, or newly pregnan...
...here is insufficient evidence to recommend fo...
...fficient evidence to recommend for or again...
...Thyroid Function Tes...
...population-based trimester-specific refer...
...accuracy of serum Free T4 measurement b...
...ieu of measuring free T4, total T4 measurement (w...
...Iodine Status...
...ary iodine concentrations can be use...
...t women should ingest approximately...
In most regions, including the United States, wome...
...n low-resource countries and regions where neit...
...o need to initiate iodine supplementation...
Excessive doses of iodine exposure during...
...ustained iodine intake from diet and dietary...
...Thyroid Auto-Antibodies...
...thyroid peroxidase (TPO) or thyroglob...
...nium supplementation is NOT recomm...
...ous immunoglobulin treatment of euthyroi...
...ere is insufficient evidence to conclusiv...
...ere is insufficient evidence to recommend for...
Infertility
...Infertility...
...The Impact of Thyro...
...serum TSH concentration is recommended for al...
...eatment is recommended for infertil...
...ere is insufficient evidence to determine...
...cient evidence to determine if LT4 therap...
...cally hypothyroid women undergoing in...
...icient evidence to determine whether LT4 therapy...
...therapy is NOT recommended for euthyroid, t...
...hen possible, thyroid function testing should...
...chieve pregnancy following controlle...
Maternal Disorders
...Maternal Disorders...
...Hypothyroidism...
...ing of pregnancy, maternal hypothyroid...
...population and trimester-specific referenc...
...this is not feasible, pregnancy-specific T...
...or transferable pregnancy-specific TSH ref...
...of overt hypothyroidism is recommended...
...ant women with TSH concentrations >2.5 mU/L sh...
...Subclinical hypoth...
...b-positive women with a TSH greater...
...POAb-negative women with a TSH >10.0 mU/L. (...
...tive women TPO antibody negative women with TSH c...
...POAb-positive women with TSH concentrations >2...
...y is NOT recommended for TPOAb-negative women wit...
...thyroxinemia should NOT be routinely treated in...
...ommended treatment of maternal hypothyroidism is...
...to the treatment of hypothyroidism in a...
...h overt and subclinical hypothyroidism (trea...
...eated hypothyroid women of reprodu...
...hyroid women treated with LT4 who are pla...
...ing delivery, LT4 should be reduced to the pa...
Some women in whom LT4 is initiated d...
...n the care of women with adequately treated hypo...
...Thyrotoxicosis in...
When a suppressed serum TSH is detected i...
...de scintigraphy or radioiodine uptake determi...
The appropriate management of abnormal mater...
...f childbearing age who are thyrotox...
...women should be rendered stably euthyroid bef...
...thimazole (MMI) or prophylthiouracil (PTU) s...
...newly-pregnant woman with Graves’ disease,...
...wing cessation of antithyroid medi...
...At each assessment, the decision to continue c...
...mended for the treatment of maternal hype...
...ant women receiving MMI who are in...
...ing from MMI to PTU, a dose ratio of approxi...
...rapy is required after 16 weeks gestation, it rem...
...being treated with antithyroid drugs...
...medication during pregnancy should be administe...
...ion regimen of LT4 and an antithyroid dru...
...yroidectomy in pregnancy may be indicated for uniq...
...the American College of Obstetricians and Gyn...
...he patient has a past history of Graves’ d...
...maternal TRAb concentration is elevat...
...rnal TRAb is undetectable or low in early...
...patient is taking ATDs for treatment of...
...atient requires treatment with ATDs for Grave...
...evated TRAb is detected at weeks 18–22 o...
...etal surveillance should be performed in women who...
...ordocentesis should be used in rare circum...
...is given for hyperthyroidism caused...
...tages and Disadvantages of Therapeutic Optio...
...Thyroid Nodules...
...suppressed serum TSH levels that persis...
...f measuring calcitonin in pregnant women w...
...oid nodule FNA is generally recommend...
...clide scintigraphy or radioiodine uptake determ...
...t women with cytologically benign t...
...gnant women with cytologically indeterminate (AU...
...ancy, if there is clinical suspicion of a...
...sting is NOT recommended for evaluation of cytol...
...ary thyroid carcinoma (PTC) detected in earl...
...pregnancy on women with newly diag...
...omen with thyroid cancer should be managed at...
...egnancy should be deferred for 6 month...
...sound and thyroglobulin monitoring during pregnan...
...ltrasound and thyroglobulin monito...
...rasound monitoring of the maternal thyroi...
...ATA Sonographic Patterns and Estimated Risk of Ma...
...Postpartum Thyr...
...ients with depression, including post...
...thyrotoxic phase of PPT, symptomatic w...
...hyroid drugs are NOT recommended for the treatm...
...lowing the resolution of the thyroto...
...ld be considered for women with symptomatic h...
...4 is initiated for PPT, discontinuati...
...ior history of PPT should have TSH testin...
...eatment of euthyroid thyroid antibody-...
Fetal and Neonatal Considerations
...Fetal and Neonat...
...y of maternal thyroid illness, use of antithyro...
...ity of maternal and fetal thyroid illness s...
...ould be screened for hypothyroidism by bloo...
...Thyroid Disea...
...hypothyroidism can adversely impact...
...ts adverse impact upon milk production and...
...aternal hyperthyroidism upon lactation...
...31I is contraindicated during lacta...
...ting treatment decisions specifical...
...ithyroid medication is indicated for...
...stfed children of women who are treated with ant...
...ll breastfeeding women should ingest ap...
...ing women should supplement their d...
...erely iodine deficient, low-resource...
...uring pregnancy, sustained iodine intake whi...