Abstract
Physiological changes during gestation are important to be aware of in measurement and interpretation of thyroid function tests in women with autoimmune thyroid diseases. Thyroid autoimmune activity is decreasing in pregnancy. Measurement of serum TSH is the first-line screening variable for thyroid dysfunction also in pregnancy. However, using serum TSH for control of treatment of maternal thyroid autoimmunity infers a risk for compromised foetal development. Peripheral thyroid hormone values are highly different among laboratories, and there is a need for laboratory-specific gestational age-related reference ranges. Equally important, the intraindividual variability of the thyroid hormone measurements is much narrower than the interindividual variation (reflecting the reference interval). The best laboratory assessment of thyroid function is a free thyroid hormone estimate combined with TSH. Measurement of antithyroperoxidase and/or TSH receptor antibodies adds to the differential diagnosis of autoimmune and nonautoimmune thyroid diseases.
Highlights
Measurement of antithyroperoxidase and/or TSH receptor antibodies adds to the differential diagnosis of autoimmune and nonautoimmune thyroid diseases
Diagnosing maternal thyroid dysfunction during all stages of pregnancy is very important for the outcome for both mother and foetus [1, 2]
The measurement of thyroid autoantibodies in pregnant women is mainly useful to substantiate the probability of thyroid dysfunction in biochemically unclear cases, to ensure a correct differential diagnosis in case of maternal dysfunction, to predict the risk for development or deterioration of maternal thyroid dysfunction, and in few situations to predict for intrauterine and/or neonatal dysfunction [10, 14, 15]
Summary
Diagnosing maternal thyroid dysfunction during all stages of pregnancy is very important for the outcome for both mother and foetus [1, 2]. Women with hypothyroidism treated insufficiently with levothyroxine (high serum concentration of thyrotropin (TSH) or serum free thyroxine (T4) in the low normal range) deliver babies with significantly lower IQ and/or other inhibited neuropsychological development [3, 4]. Such offspring outcome has even been demonstrated in women with a serum concentration of T4 in the low normal range during pregnancy [5]. There is a huge risk of false interpretation of thyroid function tests in pregnancy [16]
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