J Korean Med Assoc.  2018 Apr;61(4):253-258. 10.5124/jkma.2018.61.4.253.

Thyroid dysfunction during pregnancy

• Yim CH

• KMID: 2409045
• DOI: http://doi.org/10.5124/jkma.2018.61.4.253

Abstract

Thyroid dysfunction during pregnancy can result in serious complications for both the mother and infant. However, these complications can be prevented by the optimal treatment of overt maternal thyroid dysfunction. The serum thyroid-stimulating hormone (TSH) concentration is the most reliable measure of thyroid function during pregnancy. Due to the physiologic changes in TSH levels during pregnancy, the correct interpretation of thyroid function requires knowledge of the gestational week and the appropriate population-based reference interval. In addition to a TSH test, the measurement of thyroid peroxidase antibody helps determine whether to treat subclinical hypothyroidism during pregnancy. Since the use of antithyroid drugs during pregnancy is associated with birth defects, it is recommended to discontinue the medication and to perform repeated thyroid function testing during the first trimester. If therapy is needed during the first trimester, propylthiouracil is preferred over methimazole.

Keyword

Pregnancy; Hyperthyroidism; Hypothyroidism

MeSH Terms

Antithyroid Agents
Congenital Abnormalities
Female
Humans
Hyperthyroidism
Hypothyroidism
Infant
Iodide Peroxidase
Methimazole
Mothers
Pregnancy Trimester, First
Pregnancy*
Propylthiouracil
Thyroid Function Tests
Thyroid Gland*
Thyrotropin
Antithyroid Agents
Iodide Peroxidase
Methimazole
Propylthiouracil
Thyrotropin

Reference

1. 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.

2. Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011; 21:1081–1125.

3. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97:2543–2565.

4. Yi KH, Kim KW, Yim CH, Jung ED, Chung JH, Chung HK, Hong SC, Chung JH. Guidelines for the diagnosis and management of thyroid disease during pregnancy and postpartum. J Korean Thyroid Assoc. 2014; 7:7–39.

5. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017; 27:315–389.

6. Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, Kinthaert J, Lejeune B. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab. 1990; 71:276–287.

7. Soldin OP, Tractenberg RE, Hollowell JG, Jonklaas J, Janicic N, Soldin SJ. Trimester-specific changes in maternal thyroid hormone, thyrotropin, and thyroglobulin concentrations during gestation: trends and associations across trimesters in iodine sufficiency. Thyroid. 2004; 14:1084–1090.

8. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997; 18:404–433.

9. Glinoer D, Spencer CA. Serum TSH determinations in pregnancy: how, when and why? Nat Rev Endocrinol. 2010; 6:526–529.

10. Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, Li C, Xu B, Bi L, Meng T, Du J, Zhang S, Gao Z, Zhang X, Yang L, Fan C, Teng W. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? J Clin Endocrinol Metab. 2014; 99:73–79.

11. Choi HW, Han YJ, Kwak DW, Park SY, Kim SH, Yoon HK, Yim CH. Maternal thyroid function during the first trimester of pregnancy in Korean women. Int J Thyroidol. 2017; 10:36–41.

12. Stagnaro-Green A. Overt hyperthyroidism and hypothyroidism during pregnancy. Clin Obstet Gynecol. 2011; 54:478–487.

13. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, OʼHeir 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.

14. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005; 105:239–245.

15. Blatt AJ, Nakamoto JM, Kaufman HW. National status of testing for hypothyroidism during pregnancy and postpartum. J Clin Endocrinol Metab. 2012; 97:777–784.

16. Maraka S, Ospina NM, OʼKeeffe DT, Espinosa De Ycaza AE, Gionfriddo MR, Erwin PJ, Coddington CC 3rd, Stan MN, Murad MH, Montori VM. Subclinical hypothyroidism in pregnancy: a systematic review and metaanalysis. Thyroid. 2016; 26:580–590.

17. Cleary-Goldman J, Malone FD, Lambert-Messerlian G, Sullivan L, Canick J, Porter TF, Luthy D, Gross S, Bianchi DW, DʼAlton ME. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol. 2008; 112:85–92.

18. Mannisto T, Vaarasmaki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, Bloigu A, Jarvelin MR, Suvanto E. Thyroid dysfunction and autoantibodies during pregnancy as predictive factors of pregnancy complications and maternal morbidity in later life. J Clin Endocrinol Metab. 2010; 95:1084–1094.

19. Li Y, Shan Z, Teng W, Yu X, Li Y, Fan C, Teng X, Guo R, Wang H, Li J, Chen Y, Wang W, Chawinga M, Zhang L, Yang L, Zhao Y, Hua T. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol (Oxf). 2010; 72:825–829.

20. Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, Xu YH, Tao FB. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011; 96:3234–3241.

21. Javed Z, Sathyapalan T. Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits. Ther Adv Endocrinol Metab. 2016; 7:12–23.

22. Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, Chiusano E, John R, Guaraldo V, George LM, Perona M, DallʼAmico D, Parkes AB, Joomun M, Wald NJ. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012; 366:493–501.

23. Casey B. Effect of treatment of maternal subclinical hypothyroidism or hypothyroxinemia on IQ in offspring. Am J Obstet Gynecol. 2016; 214(1 Suppl):S2.

24. Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, Reddy UM, Wapner RJ, Thorp JM Jr, Saade G, Tita AT, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa J, Caritis SN, VanDorsten JP. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of Subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med. 2017; 376:815–825.

25. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010; 95:1699–1707.

26. 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.

27. Patil-Sisodia K, Mestman JH. Graves hyperthyroidism and pregnancy: a clinical update. Endocr Pract. 2010; 16:118–129.

28. Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cun- ningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol. 2006; 107:337–341.

29. Aggarawal N, Suri V, Singla R, Chopra S, Sikka P, Shah VN, Bhansali A. Pregnancy outcome in hyperthyroidism: a case control study. Gynecol Obstet Invest. 2014; 77:94–99.

30. Andersen SL, Olsen J, Wu CS, Laurberg P. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. J Clin Endocrinol Metab. 2013; 98:4373–4381.

31. Andersen SL, Olsen J, Laurberg P. Antithyroid drug side effects in the population and in pregnancy. J Clin Endocrinol Metab. 2016; 101:1606–1614.

32. Hamburger JI. Diagnosis and management of Gravesʼ disease in pregnancy. Thyroid. 1992; 2:219–224.

33. Polak M, Le Gac I, Vuillard E, Guibourdenche J, Leger J, Toubert ME, Madec AM, Oury JF, Czernichow P, Luton D. Fetal and neonatal thyroid function in relation to maternal Gravesʼ disease. Best Pract Res Clin Endocrinol Metab. 2004; 18:289–302.

34. Matthews DC, Syed AA. The role of TSH receptor antibodies in the management of Gravesʼ disease. Eur J Intern Med. 2011; 22:213–216.

35. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, Bilous R. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007; 92:203–207.