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 Preg...
...ening for Thyroid Dysfunction Before or During...
All pregnant women should be verball...
...screening to detect low free thyroxin...
...ients seeking pregnancy, or newly pregnant, sh...
...is insufficient evidence to recommend for o...
...ere is insufficient evidence to recommend for or...
...nction Testing and Pregnancy...
..., population-based trimester-specific reference...
...ccuracy of serum Free T4 measurement by the...
...uring free T4, total T4 measurement (with...
...atus and Nutrition...
...odine concentrations can be used to as...
...women should ingest approximately...
...ost regions, including the United States, wom...
...ource countries and regions where n...
...is no need to initiate iodine supplem...
...s of iodine exposure during pregnancy sho...
...ained iodine intake from diet and dietary...
...roid Auto-Antibodies & Pregnancy Complications...
...ut thyroid peroxidase (TPO) or thyroglobulin (Tg)...
...enium supplementation is NOT recom...
...ntravenous immunoglobulin treatment of euthyr...
...fficient evidence to conclusively de...
...sufficient evidence to recommend for or a...
Infertility
Infertility
...of Thyroid Illness upon Infertility and As...
...uation of serum TSH concentration is recommende...
...reatment is recommended for infertile wo...
...re is insufficient evidence to determine...
...insufficient evidence to determine if LT4...
...hypothyroid women undergoing in vitro f...
...s insufficient evidence to determine whether...
...d therapy is NOT recommended for euthyroid, t...
...e, thyroid function testing should be...
...omen who achieve pregnancy following control...
Maternal Disorders
...al Disorders...
...thyroidism and Pregnancy...
...etting of pregnancy, maternal hypothyroidism is...
...en available, population and trimes...
...hen this is not feasible, pregnanc...
...transferable pregnancy-specific TSH re...
...tment of overt hypothyroidism is recommended duri...
...egnant women with TSH concentrations >2.5 mU/L...
...al hypothyroidism in pregnancy should be...
...omen with a TSH greater than the pre...
...-negative women with a TSH >10.0 mU/L. ( L ,...
...gative women TPO antibody negative...
...ive women with TSH concentrations >...
...is NOT recommended for TPOAb-negative...
...ypothyroxinemia should NOT be routinely treated...
...ded treatment of maternal hypothyroidis...
...n parallel to the treatment of hypothyroidism...
...h overt and subclinical hypothyroidism (treated o...
...d hypothyroid women of reproductive age s...
...roid women treated with LT4 who are planning...
...ng delivery, LT4 should be reduced to th...
...ome women in whom LT4 is initiated during...
...e care of women with adequately treated hypothyroi...
...oxicosis in Pregnanc...
...en a suppressed serum TSH is detected...
...scintigraphy or radioiodine uptake determina...
...riate management of abnormal matern...
...l women of childbearing age who are thyrotoxic...
...c women should be rendered stably euthyroid befo...
...methimazole (MMI) or prophylthiouracil (PTU) sh...
...newly-pregnant woman with Graves’...
...Following cessation of antithyroid medication, ma...
...each assessment, the decision to continue...
PTU is recommended for the treatment...
Pregnant women receiving MMI who are in...
...ng from MMI to PTU, a dose ratio of a...
...ATD therapy is required after 16 w...
...treated with antithyroid drugs in pregnan...
...hyroid medication during pregnancy should...
...ination regimen of LT4 and an antithyroid...
...ctomy in pregnancy may be indicate...
...e concur with the American College of Obstet...
...patient has a past history of Grave...
...RAb concentration is elevated in earl...
...maternal TRAb is undetectable or low in ear...
...patient is taking ATDs for treatment of Gr...
...ent requires treatment with ATDs f...
.... If elevated TRAb is detected at weeks 18–...
...urveillance should be performed in women who ha...
...centesis should be used in rare circumstanc...
...ATD therapy is given for hyperthyroidism caused b...
.... Advantages and Disadvantages of Therapeut...
...id Nodules and Thyroid Cancer During Pre...
For women with suppressed serum TSH...
...utility of measuring calcitonin in preg...
...nodule FNA is generally recommended fo...
...onuclide scintigraphy or radioiodine upt...
...en with cytologically benign thyroid nodules do n...
...omen with cytologically indeterminate (A...
...pregnancy, if there is clinical suspicion of an...
...testing is NOT recommended for evaluati...
...id carcinoma (PTC) detected in early pregnancy...
...t of pregnancy on women with newly diagnosed...
...nt women with thyroid cancer shoul...
...be deferred for 6 months after a...
...thyroglobulin monitoring during pre...
...and thyroglobulin monitoring should be performed...
...onitoring of the maternal thyroid shoul...
...able 2. ATA Sonographic Patterns and Estimated Ri...
...artum Thyroiditis (P...
...patients with depression, including postp...
...he thyrotoxic phase of PPT, symptomatic...
...ugs are NOT recommended for the treatment of...
...lowing the resolution of the thyrotoxic p...
...onsidered for women with symptomatic...
...LT4 is initiated for PPT, discontinuation of...
...omen with a prior history of PPT should have TS...
...euthyroid thyroid antibody-positive pregnant woma...
Fetal and Neonatal Considerations
...d Neonatal Considerations
...ory of maternal thyroid illness, use...
...he severity of maternal and fetal thyroid i...
...ould be screened for hypothyroidism by blood spot...
...yroid Disease and Lactation
...ypothyroidism can adversely impact lactation,...
...dverse impact upon milk production and letdown, su...
...maternal hyperthyroidism upon lactation is no...
The use of 131I is contraindicated during lactati...
...atment decisions specifically made on the gro...
...en antithyroid medication is indicat...
...tfed children of women who are treated with ant...
...feeding women should ingest approxim...
...omen should supplement their diet wi...
...y iodine deficient, low-resource regio...
...e during pregnancy, sustained iodine i...