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
...essment...
...g For Thyroid Dysfunction In Pregnancy...
...creening for Thyroid Dysfunction Bef...
...regnant women should be verbally screened at the...
...sal screening to detect low free thyroxine...
...tients seeking pregnancy, or newly...
...fficient evidence to recommend for or aga...
...sufficient evidence to recommend for or again...
Thyroid Function Testing and Pregnanc...
When possible, population-based trimester-s...
...of serum Free T4 measurement by the in...
In lieu of measuring free T4, total T4 measure...
...Status and Nutrition...
...ary iodine concentrations can be used to asse...
...nant women should ingest approximately 250 Î...
...ost regions, including the United States,...
...source countries and regions where neither salt i...
...is no need to initiate iodine suppl...
...ses of iodine exposure during pregnancy s...
...ned iodine intake from diet and diet...
...ibodies & Pregnancy Complications...
...hyroid peroxidase (TPO) or thyroglobulin (Tg) an...
...supplementation is NOT recommended for th...
...venous immunoglobulin treatment of euthyroid...
...ficient evidence to conclusively det...
...is insufficient evidence to recommend for or...
Infertility
...ertility...
...Impact of Thyroid Illness upon Infer...
...serum TSH concentration is recommend...
...ment is recommended for infertile women with o...
There is insufficient evidence to determi...
...ere is insufficient evidence to determine...
...linically hypothyroid women undergo...
...nsufficient evidence to determine whether LT...
...d therapy is NOT recommended for euthyr...
...possible, thyroid function testing should be p...
...who achieve pregnancy following controll...
Maternal Disorders
...nal Disorders...
Hypothyroidism and Pre...
...setting of pregnancy, maternal hypothyroidism...
...available, population and trimester...
...this is not feasible, pregnancy-s...
...ernal or transferable pregnancy-sp...
...nt of overt hypothyroidism is recomm...
...with TSH concentrations >2.5 mU/L...
...al hypothyroidism in pregnancy shoul...
...itive women with a TSH greater than the...
...ative women with a TSH >10.0 mU/L. ( L , S...
...b-negative women TPO antibody negative wome...
...sitive women with TSH concentrations >...
...therapy is NOT recommended for TPOAb-negativ...
Isolated hypothyroxinemia should NOT be...
...treatment of maternal hypothyroidism is adm...
...he treatment of hypothyroidism in a gen...
...and subclinical hypothyroidism (treated or untrea...
...hypothyroid women of reproductive age sh...
...id women treated with LT4 who are planning...
Following delivery, LT4 should be reduced t...
...women in whom LT4 is initiated during p...
...the care of women with adequately treated...
...cosis in Pregnancy...
...ssed serum TSH is detected in the f...
...intigraphy or radioiodine uptake determination sho...
...appropriate management of abnormal matern...
...n all women of childbearing age who a...
...women should be rendered stably euthyroid befor...
...ing methimazole (MMI) or prophylthiouracil (PT...
...-pregnant woman with Graves’ disease,...
b. Following cessation of antithyroid medi...
...each assessment, the decision to cont...
...is recommended for the treatment of mat...
...eceiving MMI who are in need of continuin...
When shifting from MMI to PTU, a do...
...therapy is required after 16 weeks ges...
...being treated with antithyroid drugs in pregnanc...
...ntithyroid medication during pregnancy...
...tion regimen of LT4 and an antithyroid drug sho...
...pregnancy may be indicated for unique scenarios....
...ncur with the American College of Obstetricia...
...patient has a past history of Graves’ disease...
b. If maternal TRAb concentration is...
...f maternal TRAb is undetectable or low in...
...is taking ATDs for treatment of Graves’ h...
...he patient requires treatment with...
...f elevated TRAb is detected at weeks 18–22 or th...
Fetal surveillance should be performed in w...
...entesis should be used in rare circu...
...apy is given for hyperthyroidism caused by auton...
...able 1. Advantages and Disadvantages...
...and Thyroid Cancer During Pregnancy...
...n with suppressed serum TSH levels...
...ility of measuring calcitonin in pregna...
...roid nodule FNA is generally recommended for...
...ide scintigraphy or radioiodine up...
...women with cytologically benign thyroid nodules do...
...nant women with cytologically indeter...
...cy, if there is clinical suspicion of an aggress...
...lar testing is NOT recommended for evaluation of...
...thyroid carcinoma (PTC) detected in ea...
...f pregnancy on women with newly diagnosed medulla...
...nant women with thyroid cancer should be managed...
...y should be deferred for 6 months after a wom...
Ultrasound and thyroglobulin monito...
...nd thyroglobulin monitoring should be per...
...itoring of the maternal thyroid should be perf...
...ble 2. ATA Sonographic Patterns and...
...tum Thyroiditis (PPT...
...tients with depression, including postpartum d...
...hyrotoxic phase of PPT, symptomatic women...
...roid drugs are NOT recommended for the treatme...
...ng the resolution of the thyrotoxi...
...4 should be considered for women wi...
...LT4 is initiated for PPT, discontinuation of...
...th a prior history of PPT should hav...
...tment of euthyroid thyroid antibody-positive p...
Fetal and Neonatal Considerations
...nd Neonatal Considerations...
...of maternal thyroid illness, use of anti...
...e severity of maternal and fetal thyroid illness...
...orns should be screened for hypothyroidism by b...
...roid Disease and Lact...
...thyroidism can adversely impact lactatio...
...adverse impact upon milk production and letdown...
...of maternal hyperthyroidism upon lacta...
...se of 131I is contraindicated during lactation. I...
...treatment decisions specifically ma...
...thyroid medication is indicated for women who a...
...dren of women who are treated with a...
...tfeeding women should ingest approximat...
...eastfeeding women should supplement their d...
...odine deficient, low-resource regions,...
...case during pregnancy, sustained iodine intake w...