Thyroid Dysfunction In Pregnancy Research Articles

Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum

Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2011, significant clinical and scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period.The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members.The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research.We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.

Screening for thyroid dysfunction in pregnancy: is it worthwhile?

There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal (miscarriages, anaemia in pregnancy, preeclampsia, abruptio placenta and post-partum haemorrhage) and fetal effects (premature birth, low birth weight, increased neonatal respiratory distress) which may justify screening for thyroid function during early pregnancy with interventional levothyroxine therapy for thyroid hypofunction. There is a greater prevalence of subclinical hypothyroidism in women with delivery before 32 weeks and there is even an association between thyroid autoimmunity and adverse obstetric outcome, which is independent of thyroid function. Higher maternal TSH levels even within the normal reference range are associated with an increased risk of miscarriages, fetal and neonatal distress and preterm delivery. There are few prospective randomised trials to substantiate the benefit of screening and the recently reported CATS study did not show a benefit in child IQ at age 3 years. Nevertheless there seems to be a case for screening to prevent adverse obstetric outcomes. The clinical epidemiological evidence base does not justify universal screening at the present time. However, it is probable that more evidence will be produced which may alter this view in the future.

Disfunción tiroidea en las pacientes abortadoras. ¿Existen argumentos para el cribado?

Objectives Normal thyroid function is crucial for adequate maternal and fetal development in pregnancy. There is solid evidence of the pernicious effects of thyroid dysfunction in pregnancy for both mother and fetus. One of these effects is miscarriage and recurrent pregnancy losses. Nevertheless, there is no general agreement on the advisability of screening for thyroid dysfunction in pregnant women, even when there is a previous history of pregnancy loss. This study aimed to determine the prevalence of thyroid dysfunction (including anti-thyroid autoimmunity without abnormal T3/T4/TSH levels) in patients with spontaneous abortion. Subjects and methods T3-T4-TSH-antithyroid antibodies (thyroglobulin and thyroperoxidase) were determined at diagnosis in 132 consecutive women with spontaneous miscarriage. Results Nearly 25% of the patients had undiagnosed and untreated thyroid disturbance. Conclusion The results obtained suggest that the prevalence of thyroid dysfunction in patients with spontaneous miscarriage is higher than previously reported in our environment.

Thyroid dysfunction in pregnancy: optimizing fetal and maternal outcomes

Recent decades have seen a growing awareness of the threat posed by thyroid dysfunction in pregnancy on maternal, fetal and neonatal well-being. Uncontrolled hypothyroidism and hyperthyroidism are associated with adverse obstetrics and fetal outcomes and also affect neurointellectual development in the offspring. Excellent outcomes are, however, achievable with appropriate management. An understanding of the changes in thyroid hormone economy in pregnancy is crucial to the evaluation of thyroid status in pregnant patients with thyroid dysfunction. Furthermore, a balance must be maintained between the control of maternal disease and the requirements of the developing fetus. Careful monitoring of patients in a multidisciplinary care setting, and appropriate adjustments of treatment, is essential throughout pregnancy and the puerperium. In this special report we summarize best practice in the management of thyroid dysfunction in pregnancy.

Thyroid dysfunction in pregnancy: definition of TSH cut-off should precede the decision of screening in low-risk pregnant women

Objective. To evaluate the frequency of elevated TSH in pregnant women of low risk for thyroid dysfunction. Subjects and methods. TSH was measured in 838 pregnant women during the first trimester of gestation (from 6 to 14 weeks, median 9 weeks) and who were considered to be of low risk for thyroid dysfunction because they did not meet any of the following criteria: known or clinically suspected thyroid disease; history of head and neck radiotherapy; personal history of autoimmune diseases; family history of thyroid disease; history of abortion or prematurity. Results. The frequency of elevated TSH was 0.25%, 1.2% and 5.5% at cut-off values of 4, 3 and 2.5 mIU/l, respectively. These rates increase to 1.43%, 2.4% and 6.2% if cases of TSH > 2 mIU/l with TPOAb are included. TSH was undetectable in 18 women (2.1%), but only six (0.71%) had elevated T4. Conclusions. The definition of a TSH cut-off that defines subclinical hypothyroidism (SCH) should precede the decision of screening pregnant women without any risk factors for thyroid dysfunction.

206: An evaluation of risk-factor based screening for thyroid peroxidase antibody positivity in pregnancy

To determine whether or not risk factor-based screening for thyroid dysfunction in pregnancy performs well for the detection of thyroid peroxidase antibodies (TPO Ab), a marker for autoimmune thyroid disease.

Thyroid Dysfunction in Pregnancy: The Basic Science and Clinical Evidence Surrounding the Controversy in Management

Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York Financial Disclosure: The authors did not report any potential conflicts of interest.

Thyroid Dysfunction in Pregnancy: The Basic Science and Clinical Evidence Surrounding the Controversy in Management

Thyroid Dysfunction in Pregnancy: The Basic Science and Clinical Evidence Surrounding the Controversy in Management

Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome

Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt, but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from India about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome in Indian population. Six hundred and 33 pregnant women in second trimester were registered. Detailed history and examination was done. Apart from routine obstetrical investigations, TSH level estimation was done. If TSH level was deranged then free T4 and thyroperoxidase antibody level estimation were done. Patients were managed accordingly and followed till delivery. Their obstetrical and perinatal outcomes were noted. Prevalence of thyroid dysfunction was high in this study, with subclinical hypothyroidism in 6.47% and overt hypothyroidism in 4.58% women. Overt hypothyroids were prone to have pregnancy-induced hypertension (P=0.04), intrauterine growth restriction (P=0.01) and intrauterine demise (P=0.0004) as compared to control. Cesarean section rate for fetal distress was significantly higher among pregnant subclinical hypothyroid women (P=0.04). Neonatal complications and gestational diabetes were significantly more in overt hyperthyroidism group (P=0.03 and P=0.04, respectively). Prevalence of thyroid disorders, especially overt and subclinical hypothyroidism (6.47%) was high. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.

Thyroid Dysfunction in Pregnancy

Maternal hypothyroidism is known to result in neurodevelopmental disorders in offspring, but whether subclinical hypothyroidism results in lower intelligence quotient (IQ) performance in progeny is an area of debate. Animal studies have shown that fetal thyroxine and triiodothyronine are primarily maternally derived before mid gestation. Other animal data reveal that fetal brain damage at a time that is analogous to the first trimester in humans can be linked to irreversible future brain damage. A large study conducted on an unselected population of pregnant women, both with known diagnosis of hypothyroidism and those who were screened but not diagnosed, found a four-point difference in the IQ levels of the offspring, raising the question of clinical significance. The endocrine community has accepted that subclinical hypothyroidism causes a significant decrease in IQ scores and has advocated for routine screening of pregnant women. However, obstetric authorities have cautioned that more research is needed before a causal relationship between subclinical hypothyroidism and lower IQ performance can be verified. Consequently, the American College of Obstetricians and Gynecologists has stated that routine screening and treatment of subclinical hypothyroidism cannot be recommended. We will review the basic science and clinical evidence for the neurodevelopmental effects of thyroid dysfunction in pregnancy.

Medical management of thyroid dysfunction in pregnancy and the postpartum

Background: Uncontrolled thyroid dysfunction in pregnancy is associated with adverse fetal and maternal outcomes. Objectives: To review relevant literature and developments in the medical management of thyroid dysfunction in pregnancy. Results: Hyperthyroidism in pregnancy requires careful control of maternal disease whilst avoiding fetal hypothyroidism. Propylthiouracil is the preferred antithyroid drug in pregnancy although thiamazole can be used where propylthiouracil is unavailable. Synthetic levothyroxine is the treatment of choice in hypothyroidism. Patients with pre-existing hypothyroidism will generally require an increase in thyroxine dose in pregnancy. Most patients with postpartum thyroiditis will require treatment during the hypothyroid phase. Long-term follow-up of patients with this syndrome is essential owing to the risk of permanent hypothyroidism. Conclusion: Excellent maternal and fetal outcomes can be achieved with appropriate management of thyroid dysfunction in pregnancy.

Thyroid Disease in Pregnancy

The spectrum of thyroid disease in pregnancy has implications for both the mother and the developing fetus. Here we review the interpretation of thyroid function test values, thyrotoxicosis, hypothyroidism, iodine requirements, autoimmune thyroid disease, and thyroid screening recommendations as they pertain to pregnant women. It should be noted that the management of thyroid dysfunction in pregnancy should be closely co-ordinated with obstetricians and other providers.

Thyroid dysfunction during pregnancy and in the first postpartum year in women with diabetes mellitus type 1

The prevalence of thyroid dysfunction in pregnancy and in the first postpartum year (postpartum thyroid dysfunction (PPTD)) in women with diabetes mellitus type 1 (DM1) is known to be higher than in the general population. To assess prevalence, incidence and risk factors in The Netherlands we performed a prospective cohort study. From 1994 to 1998, 126 women with DM1 from eight Dutch clinics were included. TSH, free thyroxine, free tri-iodothyronine and anti-thyroid peroxidase antibodies (TPO-ab) were measured pre-pregnancy, in the first and last trimester of pregnancy and at 1.5, 3, 6, 9 and 12 months after delivery. Eighty-two women completed the study. Thyroid dysfunction during pregnancy was observed in 22.5% (first trimester) and 18.4% (third trimester), and mostly consisted of subclinical hypothyroidism. Baseline characteristics of women with thyroid dysfunction in pregnancy did not differ from those without thyroid dysfunction. Overt PPTD was seen in 15.9%. Incidence of PPTD was 10%. Patients with PPTD were slightly older than those without PPTD and the prevalence of TPO-ab was higher in these women. In women with DM1 the prevalence of thyroid dysfunction during pregnancy and overt PPTD is 3-fold higher than in the general Dutch population. Risk factors are age and TPO-ab. Given the possible impact on psychomotor development of the offspring and on well-being of the mother these data suggest there is a case for screening (pre-)pregnant women with DM1 for TSH and TPO-ab.

Thyroid dysfunction in pregnancy.

Thyroid dysfunction is the second most common endocrine disorder among women of childbearing age. When thyroid dysfunction is well controlled, pregnancy outcomes are similar to those of women without thyroid disease. Perinatal nurses can support the woman affected by a thyroid dysfunction by being knowledgeable about the disorder and by providing support and education. The article provides an introduction to the physiology and pathophysiology of the thyroid, the effect of common thyroid disorders on pregnancy, and clinical management implications for perinatal nurses.

Thyroid Disorders of Pregnancy

Practical aspects in the management of thyroid diseases in pregnancy are reviewed. Information on the hypothalamic-pituitary thyroid axis function in pregnancy and transplacental passages of thyroid hormones is discussed. Diagnosis and management of thyroid dysfunction in pregnancy are updated together with the management of women on thyroid replacement therapy at the time of conception. A practical evaluation of thyroid nodules in pregnancy is suggested. Finally, the syndrome of postpartum thyroid dysfunction is reviewed, stressing the importance of proper diagnosis and the need for long-term follow-up evaluation of these patients.

Transient post-partum thyroid dysfunction and postnatal depression

In the course of a population study of thyroid dysfunction in pregnancy and the post-partum period, 65 women, considered to be antibody-positive (microsomal and thyroglobulin), and 82 antibody-negative women were assessed for postnatal depression at 6–8 weeks post partum. The women were also assessed for the development of post-partum thyroid dysfunction. Of the 147 women, 22 met DSM-III criteria for major depression. The presence of autoantibodies showed little association with depressed mood but there was a minor association of postnatal depression with actual thyroid dysfunction in that the incidence of the latter condition was higher in depressed women (Raskin scale P < 0.01; Edinburgh scale P < 0.05; Montgomery–åsberg scale P < 0.1). Three of eight mothers with thyroid dysfunction had major depression and were depressed on all three scales.

Thyroid Disease In Pregnancy

The recognition of thyroid dysfunction in pregnancy is important, since, untreated, it may cause maternal and fetal morbidity and mortality. In this article, the author reviews the relationship of maternal and fetal-placental thyroid function, the interpretation of thyroid tests during gestation, and the management of common thyroid problems that may complicate pregnancy.

Prevalence of thyroid dysfunction in gestational hypertensive Nigerians

Background: Thyroid physiology changes significantly during pregnancy. Consequently, thyroid disorders are prevalent in women of child-bearing age and commonly present in pregnancy and puerperium. Untreated thyroid dysfunction in pregnancy has adverse effects on fetal and maternal well-being, including miscarriage, placental abruption, preterm delivery and preeclampsia. Aim: The aim of this study was to determine the prevalence of thyroid dysfunction among patients with gestational hypertension in Nigeria. Materials and Methods: Plasma concentrations of thyroid stimulating hormone, free thyroxine, and free tri-iodothyronine (fT 3 ) were measured in 165 pregnant women (aged 18-40 years) with gestational hypertension and 126 age-matched normotensive pregnant women, who served as controls. All laboratory analyses were conducted on Elecsys 2010 immunology analyzer, using a highly sensitive and specific chemiluminescence immunoassay method. Results: The prevalence of thyroid dysfunction was 23.6% and 10.3% in women with gestational hypertension and the normotensive pregnant women respectively. The most common thyroid dysfunction among the study participants was subclinical hypothyroidism accounting for 41.0% and 46.2% of all cases of thyroid abnormalities among the gestational hypertensive women and their normotensive counterparts, respectively. Conclusion: In view of the relatively high prevalence of thyroid dysfunction found in this study, it is suggested that all pregnant women (especially those with gestational hypertension) should be routinely screened for thyroid function abnormalities.

Thyroid dysfunction in pregnancy: Greenman et al.: p. 426

Thyroid dysfunction in pregnancy: Greenman et al.: p. 426

Thyroid dysfunction in pregnancy. Fetal loss and follow-up evaluation of surviving infants.

THE ability of a woman with a thyroid disorder to become pregnant, to carry a pregnancy to term and to produce an infant with adequate endowment for good development is diminished unless the disease is well controlled.1 2 3 4 5 6 7 8 9 10 The delivery of an apparently normal live-born infant at term does not necessarily indicate that the product of the pregnancy is satisfactory. No matter how careful the appraisal, it is not possible at birth to recognize all congenital malformations, to evaluate mental retardation critically or to determine the infant's developmental capabilities.11 12 13 14 15 16 The outcome of any pregnancy can be better assessed if the baby . . .