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Chapter 36 - Thyroid Disease in Pregnancy

from Section 4 - Maternal Medicine

Published online by Cambridge University Press:  20 November 2021

By
Anastasios Malakasis  and
Francoise H. Harlow
Edited by
Tahir Mahmood ,
Charles Savona Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
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Summary

Thyroid disease is a common finding in the female population. The prevalence of hypothyroidism is 1–2 per 100 women and the prevalence of hyperthyroidism is between 5 and 20 per 1000 women in iodine-replete communities [1]. These numbers may be higher in areas with iodine insufficiency. Thyroid disease is 10-fold higher in the female population in comparison to the male [1]. Considering the high prevalence in the female population, we understand that thyroid disease is very common in pregnant women, with the overall rate of overt thyroid dysfunction being as high as 1% of all pregnancies [2]. In this chapter, we will review the physiology in pregnancy, the normal adaptations of the thyroid gland and hormones and will mention the challenges in thyroid function tests in pregnancy. Furthermore, we will also concentrate on the impact of hypothyroidism and hyperthyroidism on pregnancy, and the diagnosis and management of both. We will also briefly overview postpartum thyroiditis and thyroid cancer in pregnancy.

Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Obstetrics & Maternal-Fetal Medicine
 , pp. 304 - 310
Publisher: Cambridge University Press
Print publication year: 2021

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References

Vanderpump, MPJ. The epidemiology of thyroid disease. Br Med Bull. 2011;99:39–51.Google Scholar
Klein, RZ, Haddow, JE, Faix, JD, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxford). 1991;35:41–6.CrossRefGoogle ScholarPubMed
Schussler, GC. The thyroxine-binding proteins. Thyroid. 2000;10(2):141–9.CrossRefGoogle ScholarPubMed
Stathatos, N. Thyroid physiology. Med Clin North Am. 2012 Mar;96(2):165–73.CrossRefGoogle ScholarPubMed
Shahid, MA, Sharma, S. Physiology, thyroid hormone. In StatPearls Internet. Treasure Island, FL: StatPearls Publishing; 2018 Jan–. Updated 2018 Oct 27.Google Scholar
Hershman, JM. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab. 2004;18:249-65.CrossRefGoogle ScholarPubMed
Powrie, RO, Greene, MF, Camman, W. De Swiet’s Medical Disorders in Obstetric Practice, 5th ed. London: Wiley-Blackwell; 2010. pp. 322–34CrossRefGoogle Scholar
Lazarus, J. Thyroid regulation and dysfunction in the pregnant patient. In De Groot, LJ, Chrousos, G, Dungan, K, et al., eds. Endotext Internet. South Dartmouth, MA: MDText.com, Inc.; 2000–. Updated 2016 Jul 21.Google Scholar
Liberman, CS, Pino, SC, Fang, SL, Braverman, LE, Emerson, CH. Circulating iodide concentrations during and after pregnancy. J Clin Endocrinol Metab. 1998;83:3545–9.Google Scholar
Delange, FM, Dunn, JT. Iodine deficiency. In Braverman, LE, Utiger, RD, eds. Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text, 9th ed. Philadelphia: Lippincott, Williams and Wilkins; 2005. pp 264–88.Google Scholar
World Health Organization/International Council for the Control of the Iodine Deficiency Disorders/United Nations Children’s Fund (WHO/ICCIDD/UNICEF) Assessment of the Iodine Deficiency Disorders and Monitoring Their Elimination. Geneva:World Health Organization;2007.Google Scholar
Alexander, EK, Pearce, EN, Brent, GA, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar;27(3):315–89.CrossRefGoogle ScholarPubMed
Stagnaro-Green, A, Abalovich, M, Alexander, E, et al., 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.CrossRefGoogle ScholarPubMed
Tingi, E, Syed, AA, Kyriacou, A, Mastorakos, G, Kyriacou, A. Benign thyroid disease in pregnancy: a state of the art review. J Clin Transl Endocrinol. 2016;6:37–49.Google ScholarPubMed
van den Boogaard, E, Vissenberg, R, Land, JA, et al. Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review. Hum Reprod Update.2011;17:605–19.CrossRefGoogle ScholarPubMed
Smith, A, Eccles-Smith, J, D’Emden, M, Lust, K. Thyroid disorders in pregnancy and postpartum. Aust Prescr. 2017;40(6):214–19.CrossRefGoogle ScholarPubMed
Lazarus, J, Brown, RS, Daumerie, C, et al. European Thyroid Association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3:76–94.Google Scholar
Yassa, L, Marqusee, E, Fawcett, R, Alexander, EK. Thyroid hormone early adjustment in pregnancy (the THERAPY) trial. J Clin Endocrinol Metab. 2010;95:3234–41.Google Scholar
Chan, S, Boelaert, K. Optimal management of hypothyroidism, hypothyroxinaemia and euthyroid TPO antibody positivity preconception and in pregnancy. Clin. Endocrinol (Oxford). 2015;82:313–26.Google Scholar
Liu, H, Shan, Z, Li, C, et al. Maternal subclinical hypothyroidism, thyroid autoimmunity, and the risk of miscarriage: a prospective cohort study. Thyroid. 2014;24:1642–9.CrossRefGoogle ScholarPubMed
Moleti, M, Trimarchi, F, Vermiglio, F. Doubts and concerns about isolated maternal hypothyroxinemia. J Thyroid Res. 2011;2011:463029.CrossRefGoogle ScholarPubMed
Marx, H, Amin, P, Lazarus, JH. Hyperthyroidism and pregnancy. Brit Med J. 2008;336:663–7.CrossRefGoogle ScholarPubMed
Hershman, JM. Human chorionic gonadotropin and the thyroid: hyperemesis gravidarum and trophoblastic tumors. Thyroid. 1999;9:653–7.Google Scholar
Davis, LE, Lucas, MJ, Hankins, GD, Roark, ML, Cunningham, FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol. 1989;160:63–70.Google Scholar
Yoshihara, A, Noh, J, Yamaguchi, T, et al. Treatment of Graves’ disease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. J Clin Endocrinol Metab. 2012;97:2396–2403.Google Scholar
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;98:4373–81.Google Scholar
Patil-Sisodia, K, Mestman, JH. Graves hyperthyroidism and pregnancy: a clinical update. Endocr Pract. 2010;16:118–29.Google Scholar
Alamdari, S, Azizi, F, Delshad, H, et al. Management of hyperthyroidism in pregnancy: comparison of recommendations of american thyroid association and endocrine society. J Thyroid Res. 2013;2013:878467.Google Scholar
Bouillon, R, Naesens, M, Van Assche, FA, et al. Thyroid function in patients with hyperemesis gravidarum. Am J Obstet Gynecol. 1982;143:922–6.CrossRefGoogle ScholarPubMed
Ross, DS, Burch, HB, Cooper, DS, et al. American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26:1343–421.CrossRefGoogle ScholarPubMed
Muller, AF, Drexhage, HA, Berghout, A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev. 2001;22:605–30.CrossRefGoogle ScholarPubMed
Nicholson, WK, Robinson, KA, Smallridge, RC, Ladenson, PW, Powe, NR. Prevalence of postpartum thyroid dysfunction: a quantitative review. Thyroid. 2006;16:573–82.Google Scholar
Kung, AW, Chau, MT, Lao, TT, Tam, SC, Low, LC. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab. 2002;87:1010–14.Google Scholar
Smith, LH, Danielsen, B, Allen, ME, Cress, R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003;189:1128–35.Google Scholar

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