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...
...Testing For Thyroid Dysfunction In Pregnancy...
...creening for Thyroid Dysfunction Before or D...
...men should be verbally screened at the initial...
...rsal screening to detect low free thyro...
All patients seeking pregnancy, or newly...
...s insufficient evidence to recommend...
...is insufficient evidence to recommend for...
...tion Testing and Pregnancy...
...sible, population-based trimester-spe...
...y of serum Free T4 measurement by...
...lieu of measuring free T4, total T4 measurement (w...
...ne Status and Nutrition...
...odine concentrations can be used t...
...ant women should ingest approximately 250...
...most regions, including the United States,...
In low-resource countries and regions where...
...ed to initiate iodine supplementation in pregnant...
...essive doses of iodine exposure during pre...
...ed iodine intake from diet and dietary...
...hyroid Auto-Antibodies & Pregnancy...
...uthyroid, but thyroid peroxidase (TPO...
...pplementation is NOT recommended for...
...avenous immunoglobulin treatment of euthyroid...
...re is insufficient evidence to conclusiv...
...re is insufficient evidence to recommend f...
Infertility
...ertility...
...of Thyroid Illness upon Infertility and Assisted...
...ation of serum TSH concentration is recomme...
...is recommended for infertile women with ov...
...insufficient evidence to determine i...
...re is insufficient evidence to determine if LT4...
...ubclinically hypothyroid women undergoin...
There is insufficient evidence to...
...id therapy is NOT recommended for euthyroid, t...
...e, thyroid function testing should...
...o achieve pregnancy following controlled ovari...
Maternal Disorders
...ernal Disord...
...oidism and Pregnancy
...of pregnancy, maternal hypothyroidis...
...le, population and trimester-specific...
...ot feasible, pregnancy-specific TSH reference ra...
...or transferable pregnancy-specific TSH ref...
...overt hypothyroidism is recommended during pr...
...omen with TSH concentrations >2.5 mU/L should...
...nical hypothyroidism in pregnancy should be approa...
...Ab-positive women with a TSH greate...
TPOAb-negative women with a TSH >10.0 mU/L. ( L ,...
...women TPO antibody negative women...
...-positive women with TSH concentrations >2.5 m...
...py is NOT recommended for TPOAb-negative women wit...
...pothyroxinemia should NOT be routinely treated in...
...ded treatment of maternal hypothyroidism...
...el to the treatment of hypothyroidism in a ge...
...n with overt and subclinical hypothyroid...
...d hypothyroid women of reproductive age shou...
...hypothyroid women treated with LT4 who...
...elivery, LT4 should be reduced to the patie...
...women in whom LT4 is initiated during pregn...
...are of women with adequately treated hypothyroi...
...yrotoxicosis in Pregnancy
...ssed serum TSH is detected in the first tr...
...dionuclide scintigraphy or radioiodine uptak...
...e management of abnormal maternal thyroid test...
...en of childbearing age who are thyrotox...
...yrotoxic women should be rendered sta...
...en taking methimazole (MMI) or prophylth...
...wly-pregnant woman with Graves’ diseas...
...cessation of antithyroid medication, mate...
...At each assessment, the decision to continue co...
...is recommended for the treatment of maternal hyper...
...ant women receiving MMI who are in nee...
When shifting from MMI to PTU, a dose...
...ATD therapy is required after 16 we...
...reated with antithyroid drugs in preg...
...ntithyroid medication during pregna...
...combination regimen of LT4 and an antithyroid...
...oidectomy in pregnancy may be indicat...
...the American College of Obstetricians and G...
...ent has a past history of Graves’ disea...
.... If maternal TRAb concentration is elev...
...TRAb is undetectable or low in early pregnancy...
...patient is taking ATDs for treatment of Gr...
...t requires treatment with ATDs for...
...elevated TRAb is detected at weeks 18–22 or...
...urveillance should be performed in women who have...
Cordocentesis should be used in rar...
...py is given for hyperthyroidism caus...
...1. Advantages and Disadvantages of Thera...
...d Nodules and Thyroid Cancer During Pregnancy...
...suppressed serum TSH levels that persis...
...easuring calcitonin in pregnant women with t...
...le FNA is generally recommended for newly...
...dionuclide scintigraphy or radioiodine uptak...
...gnant women with cytologically benign thyro...
...with cytologically indeterminate (AUS/FLUS, SFN...
...nancy, if there is clinical suspicion of a...
...cular testing is NOT recommended for...
...lary thyroid carcinoma (PTC) detect...
...egnancy on women with newly diagnosed medu...
...regnant women with thyroid cancer should be manage...
...egnancy should be deferred for 6 months a...
...ltrasound and thyroglobulin monitoring duri...
...rasound and thyroglobulin monitoring sho...
...rasound monitoring of the maternal thyroid should...
.... ATA Sonographic Patterns and Est...
...ostpartum Thyroiditis (P...
...ents with depression, including postpartum depress...
...the thyrotoxic phase of PPT, symptomatic women...
...gs are NOT recommended for the treatment of the...
...owing the resolution of the thyroto...
...ld be considered for women with symptomat...
...s initiated for PPT, discontinuation of t...
...ith a prior history of PPT should hav...
...reatment of euthyroid thyroid antibo...
Fetal and Neonatal Considerations
...d Neonatal Considerati...
...aternal thyroid illness, use of antithyroid...
...maternal and fetal thyroid illness should gu...
...newborns should be screened for hypoth...
Thyroid Disease and L...
...ernal hypothyroidism can adversely imp...
...its adverse impact upon milk production and let...
The impact of maternal hyperthyroidism...
...of 131I is contraindicated during lactati...
...tment decisions specifically made on the g...
...thyroid medication is indicated for women who are...
...astfed children of women who are treated with a...
...breastfeeding women should ingest...
...women should supplement their diet with a daily...
...severely iodine deficient, low-resource re...
...e during pregnancy, sustained iodine intake whi...