J Korean Med Assoc.  2016 Jan;59(1):31-38. 10.5124/jkma.2016.59.1.31.

Thyroid disease in pregnancy

  • 1Department of Obstetrics and Gynecology, Dongsan Medical Center, Keimyung University School of Medcine, Daegu, Korea. k1011@dsmc.or.kr


Thyroid disease is common in young women, and thus frequently managed in pregnancy, affecting 1% to 2% of pregnant women. Pregnancy may modify the course of thyroid disease, and pregnancy outcomes can depend on optimal management of thyroid disorders. Moreover, thyroid autoantibodies have been associated with increased early pregnancy wastage, and uncontrolled thyrotoxicosis and untreated hypothyroidism are both associated with adverse pregnancy outcomes. Consequently, obstetric providers must be familiar with thyroid physiology, as well as screening and management of thyroid diseases in pregnancy. Following a brief overview of physiology, this article provides a review of the diagnosis and management of the spectrum of thyroid disease occurring in pregnancy.


Thyroid gland; Pregnancy; Disease management

MeSH Terms

Disease Management
Mass Screening
Pregnancy Outcome
Pregnant Women
Thyroid Diseases*
Thyroid Gland*


1. Nader S. Thyroid diseases and pregnancy. In : Creasy RK, Resnik R, Iams JD, editors. Maternal-fetal medicine. 5th ed. Philadelphia: WB Saunders;2004. p. 996–997.
2. Fisher DA. Hypothyroxinemia in premature infants: is thyroxine treatment necessary? Thyroid. 1999; 9:715–720.
3. Lee RH, Spencer CA, Mestman JH, Miller EA, Petrovic I, Braverman LE, Goodwin TM. Free T4 immunoassays are flawed during pregnancy. Am J Obstet Gynecol. 2009; 200:260.e1–260.e6.
4. American College of Obstetricians and Gynecologists, Committee on Practice Bulletins. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 32, November 2001 (replaces Technical Bulletin Number 181, June 1993, and Committee Opinion Number 241, September 2000): thyroid disease in pregnancy. Obstet Gynecol. 2001; 98:879–888.
5. Gilbert RM, Hadlow NC, Walsh JP, Fletcher SJ, Brown SJ, Stuckey BG, Lim EM. Assessment of thyroid function during pregnancy: first-trimester (weeks 9-13) reference intervals derived from Western Australian women. Med J Aust. 2008; 189:250–253.
6. Haddow JE, Knight GJ, Palomaki GE, McClain MR, Pulkkinen AJ. The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen. 2004; 11:170–174.
7. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, O'Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, Faix JD, Klein RZ. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999; 341:549–555.
8. Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988; 72:108–112.
9. Hallengren B, Lantz M, Andreasson B, Grennert L. Pregnant women on thyroxine substitution are often dysregulated in early pregnancy. Thyroid. 2009; 19:391–394.
10. Wartofsky L, Van Nostrand D, Burman KD. Overt and 'subclinical' hypothyroidism in women. Obstet Gynecol Surv. 2006; 61:535–542.
11. Alvarez-Marfany M, Roman SH, Drexler AJ, Robertson C, Stagnaro-Green A. Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus. J Clin Endocrinol Metab. 1994; 79:10–16.
12. Garner PR, Burrow GN. Pituitary and adrenal disorders of pregnancy. In : Burrow GN, Duffy TP, Copel JA, editors. Medi-cal complications during pregnancy. 6th ed. Philadelphia: Saunders;2004. p. 163–180.
13. Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkkinen A, Mitchell ML. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf). 1991; 35:41–46.
14. Jayme JJ, Ladenson PW. Subclinical thyroid dysfunction in the elderly. Trends Endocrinol Metab. 1994; 5:79–86.
15. Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. 2004; 351:241–249.
16. Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol. 2006; 108:1283–1292.
17. Momotani N, Ito K, Hamada N, Ban Y, Nishikawa Y, Mimura T. Maternal hyperthyroidism and congenital malformation in the offspring. Clin Endocrinol (Oxf). 1984; 20:695–700.
18. Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol. 2006; 107:337–341.
19. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997; 18:404–433.
20. Tan JY, Loh KC, Yeo GS, Chee YC. Transient hyperthyroidism of hyperemesis gravidarum. BJOG. 2002; 109:683–688.
21. Cooper DS. Hyperthyroidism. Lancet. 2003; 362:459–468.
22. Marx H, Amin P, Lazarus JH. Hyperthyroidism and pregnancy. BMJ. 2008; 336:663–667.
23. Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, Mandel SJ, Stagnaro-Green A. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007; 92:8 Suppl. S1–S47.
24. Johnsson E, Larsson G, Ljunggren M. Severe malformations in infant born to hyperthyroid woman on methimazole. Lancet. 1997; 350:1520.
25. Public Health Committee of the American Thyroid Association. Becker DV, Braverman LE, Delange F, Dunn JT, Franklyn JA, Hollowell JG, Lamm SH, Mitchell ML, Pearce E, Robbins J, Rovet JF. Iodine supplementation for pregnancy and lactation-United States and Canada: recommendations of the American Thyroid Association. Thyroid. 2006; 16:949–951.
26. Rosenfeld H, Ornoy A, Shechtman S, Diav-Citrin O. Pregnancy outcome, thyroid dysfunction and fetal goitre after in utero exposure to propylthiouracil: a controlled cohort study. Br J Clin Pharmacol. 2009; 68:609–617.
27. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19:1167–1214.
28. American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001; 108:776–789.
29. Laurberg P, Bournaud C, Karmisholt J, Orgiazzi J. Management of Graves' hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol. 2009; 160:1–8.
30. America College of Radiology. ACR standard for the performance of therapy with unsealed radionuclide sources. America College of Radiology. Standards 1999-2000. Reston: American College of Radiology;1999. p. 265–270.
31. Schlumberger M, De Vathaire F, Ceccarelli C, Delisle MJ, Francese C, Couette JE, Pinchera A, Parmentier C. Exposure to radioactive iodine-131 for scintigraphy or therapy does not preclude pregnancy in thyroid cancer patients. J Nucl Med. 1996; 37:606–612.
32. Garsi JP, Schlumberger M, Rubino C, Ricard M, Labbe M, Ceccarelli C, Schvartz C, Henri-Amar M, Bardet S, de Vathaire F. Therapeutic administration of 131I for differentiated thyroid cancer: radiation dose to ovaries and outcome of pregnancies. J Nucl Med. 2008; 49:845–852.
33. Yasmeen S, Cress R, Romano PS, Xing G, Berger-Chen S, Danielsen B, Smith LH. Thyroid cancer in pregnancy. Int J Gynaecol Obstet. 2005; 91:15–20.
34. Johnson NA, Tublin ME. Postoperative surveillance of differentiated thyroid carcinoma: rationale, techniques, and controversies. Radiology. 2008; 249:429–444.
35. Kaplan MM, Meier DA. Thyroid diseases in pregnancy. In : Gleicher N, Buttino L, editors. Principles and practice of medical therapy in pregnancy. 3rd ed. Stamford: Appleton & Lange;1998. p. 441–442.
36. Burrow GN. Thyroid disorders. In : Burrow GN, Duffy TP, editors. Medical complications during pregnancy. 5th ed. Philadelphia: WB Saunders;1999. p. 145–146.
Full Text Links
  • JKMA
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr