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
...ng For Thyroid Dysfunction In Pregnancy...
...creening for Thyroid Dysfunction Befo...
...pregnant women should be verbally screened a...
...sal screening to detect low free thyrox...
...eeking pregnancy, or newly pregnant, shou...
...e is insufficient evidence to recomme...
...s insufficient evidence to recommen...
...Function Testing and Pregnancy...
...population-based trimester-specific reference ra...
...uracy of serum Free T4 measurement by the...
...of measuring free T4, total T4 measurement...
...odine Status and Nutriti...
...ary iodine concentrations can be used to asse...
...t women should ingest approximately 250 μg iodine...
...gions, including the United States, women who...
...w-resource countries and regions where neither sal...
...here is no need to initiate iodine supple...
...s of iodine exposure during pregnancy sho...
...tained iodine intake from diet and dietary s...
...roid Auto-Antibodies & Pregnancy Complicat...
...hyroid, but thyroid peroxidase (TPO) or thyroglob...
...lementation is NOT recommended for...
...venous immunoglobulin treatment of euthyroid women...
...insufficient evidence to conclusively determ...
...insufficient evidence to recommend for or...
Infertility
...fertility...
...Thyroid Illness upon Infertility and Assisted...
...n of serum TSH concentration is recommended for...
...eatment is recommended for inferti...
There is insufficient evidence to deter...
...icient evidence to determine if LT4 therapy impro...
...hypothyroid women undergoing in vitro fertilizat...
...icient evidence to determine whether LT...
...therapy is NOT recommended for euthyroid, thyro...
...e, thyroid function testing should be performed...
...n who achieve pregnancy following controlled ova...
Maternal Disorders
...nal Disorders...
...pothyroidism and Pregnancy
...tting of pregnancy, maternal hypothy...
...hen available, population and trimester-specific r...
...n this is not feasible, pregnancy-specific...
...f internal or transferable pregnancy-specifi...
...reatment of overt hypothyroidism is recommende...
...omen with TSH concentrations >2.5 mU...
Subclinical hypothyroidism in pregnancy s...
...ve women with a TSH greater than the pregnancy...
...women with a TSH >10.0 mU/L. ( L ,...
...egative women TPO antibody negative women...
...-positive women with TSH concentrations >2.5 mU...
c. LT4 therapy is NOT recommended for TPOAb...
...pothyroxinemia should NOT be routinely...
...e recommended treatment of maternal hypothyroid...
...he treatment of hypothyroidism in a general pop...
...ith overt and subclinical hypothyroidis...
...ed hypothyroid women of reproductive age shoul...
...women treated with LT4 who are planning pregnancy...
...delivery, LT4 should be reduced to the patie...
...whom LT4 is initiated during pregnancy ma...
...are of women with adequately treate...
Thyrotoxicosis in Pregnancy
...d serum TSH is detected in the first...
Radionuclide scintigraphy or radioiodine u...
...opriate management of abnormal maternal thyroid t...
...childbearing age who are thyrotoxic, the p...
...n should be rendered stably euthyroid...
...omen taking methimazole (MMI) or prophylthi...
...wly-pregnant woman with Graves’ dise...
...lowing cessation of antithyroid medic...
...At each assessment, the decision to continue co...
...ommended for the treatment of maternal hyperthyr...
...n receiving MMI who are in need of continuing the...
...hifting from MMI to PTU, a dose ratio of a...
...rapy is required after 16 weeks gestation,...
...n women being treated with antithyroid drugs...
...tithyroid medication during pregnancy...
...on regimen of LT4 and an antithyroid drug...
...pregnancy may be indicated for unique scen...
We concur with the American College of Obstetr...
...t has a past history of Graves’ disease treat...
...nal TRAb concentration is elevated...
c. If maternal TRAb is undetectable...
...If a patient is taking ATDs for treatment...
...the patient requires treatment with ATDs for Grave...
...If elevated TRAb is detected at weeks 18–22...
...surveillance should be performed in wom...
...centesis should be used in rare circumstances and...
...y is given for hyperthyroidism caused b...
...ble 1. Advantages and Disadvantages of The...
...id Nodules and Thyroid Cancer During Pregnan...
...h suppressed serum TSH levels that...
...lity of measuring calcitonin in pr...
...e FNA is generally recommended for newly dete...
...ntigraphy or radioiodine uptake determi...
...regnant women with cytologically b...
...women with cytologically indeterminate (AUS/FL...
...egnancy, if there is clinical suspicion of an aggr...
...r testing is NOT recommended for eva...
...pillary thyroid carcinoma (PTC) detecte...
...he impact of pregnancy on women with...
...en with thyroid cancer should be managed at the sa...
...ould be deferred for 6 months after a...
...thyroglobulin monitoring during pre...
...und and thyroglobulin monitoring should be perfor...
...rasound monitoring of the maternal thyroid should...
...e 2. ATA Sonographic Patterns and Est...
...um Thyroiditis (PPT...
...atients with depression, including p...
During the thyrotoxic phase of PPT, symptomatic...
...id drugs are NOT recommended for the treatment o...
...ng the resolution of the thyrotoxic phase o...
...uld be considered for women with symptomati...
...ated for PPT, discontinuation of therapy shou...
...ior history of PPT should have TSH testing an...
...nt of euthyroid thyroid antibody-posi...
Fetal and Neonatal Considerations
...tal and Neonatal Considerations
...istory of maternal thyroid illness, use of...
...severity of maternal and fetal thyroi...
...rns should be screened for hypothyroidism by...
Thyroid Disease and Lactat...
...ternal hypothyroidism can adversely...
...iven its adverse impact upon milk p...
The impact of maternal hyperthyroidism u...
...use of 131I is contraindicated during lactat...
...ing treatment decisions specifically made...
...antithyroid medication is indicated for women wh...
...ren of women who are treated with antithyroid dr...
...ng women should ingest approximately 250 mcg...
...men should supplement their diet with...
...iodine deficient, low-resource regions, where...
...he case during pregnancy, sustained i...