Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-04T21:01:55.885Z Has data issue: false hasContentIssue false

Chapter 41 - Thyroid Disease in Pregnancy (Content last reviewed: 14th December 2020)

from Section 5 - Late Pregnancy – Maternal Problems

Published online by Cambridge University Press:  15 November 2017

By
Sheba Jarvis  and
Catherine Nelson-Piercy
Edited by
David James ,
Philip Steer ,
Carl Weiner ,
Bernard Gonik  and
Stephen Robson
David James
Affiliation:
University of Nottingham
Philip Steer
Affiliation:
Imperial College London
Carl Weiner
Affiliation:
University of Kansas
Bernard Gonik
Affiliation:
Wayne State University, Detroit
Stephen Robson
Affiliation:
University of Newcastle
Get access

Summary

Thyroid hormones play a crucial role during fetal development, and are especially important for growth and neurodevelopment in utero. The maternal physiological alterations that occur during pregnancy help regulate an adequate supply to the growing fetus, and pregnancy provides a “stress test” to the maternal thyroid gland. Thyroid disease is the second most common cause of endocrine dysfunction in women of childbearing age, after diabetes. Hypothyroidism is the more prevalent thyroid disorder, present in up to 2–5% of pregnancies, while hyperthyroidism (usually Graves’ disease) complicates another ~0.2%. It can often be challenging to diagnose and manage, because many of the symptoms of the disease are common symptoms in pregnancy. Physiological changes in pituitary and thyroid hormone levels may add complexity to the diagnosis, and a clear understanding of these changes is needed when managing women with suspected or known thyroid disease. The management of hypo- and hyperthyroid states is discussed in detail in this chapter, with an overview of thyroid cancer management.

Type
Chapter
Information
High-Risk Pregnancy
Management Options
 , pp. 1191 - 1216
Publisher: Cambridge University Press
First published in: 2017

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Glinoer, D. Pregnancy and iodine. Thyroid 2001; 11: 471–81.CrossRefGoogle ScholarPubMed
Zimmermann, MB. Symposium on “Geographical and geological influences on nutrition”: iodine deficiency in industrialised countries. Proc Nutr Soc 2010; 69: 133–43.Google Scholar
Vanderpump, MP, Lazarus, JH, Smyth, PP, et al. Iodine status of UK schoolgirls: a cross–sectional survey. Lancet 2011; 377: 2007–12.CrossRefGoogle ScholarPubMed
Lazarus, JH, Smyth, PP. Iodine deficiency in the UK and Ireland. Lancet 2008; 372: 888.CrossRefGoogle ScholarPubMed
Bath, S, Walter, A, Taylor, A, et al. Iodine status of UK women of childbearing age. J Hum Nutr Diet 2008; 21: 379–80.Google Scholar
WHO, UNICEF, ICCIDD. Assessment of Iodine Deficiency Disorders and Monitoring their Elimination, 3rd edn. Geneva: World Health Organization, 2007.Google Scholar
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
Alexander, EK, Pearce, EN, Brent, GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid 2017; 27: 315–89. doi: 10.1089/thy.2016.0457.Google Scholar
De Groot, L, Abalovich, M, Alexander, EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2012; 97: 2543–65.Google Scholar
Shi, X, Han, C, Li, C, et al. Optimal and safe upper limits of iodine intake for early pregnancy in iodine-sufficient regions: a cross-sectional study of 7190 pregnant women in China. J Clin Endocrinol Metab 2015; 100: 1630–8.Google Scholar
Zimmermann, MB. Iodine deficiency. Endocr Rev 2009; 30: 376–408.CrossRefGoogle ScholarPubMed
Taylor, PN, Okosieme, OE, Dayan, CM, Lazarus, JH. Therapy of endocrine disease: impact of iodine supplementation in mild-to-moderate iodine deficiency: systematic review and meta-analysis. Eur J Endocrinol 2013; 170: R1–R15. doi: 10.1530/EJE-13-0651.Google Scholar
Hibbeln, JR, Davis, JM, Steer, C, et al. Maternal seafood consumption in pregnancy and neurodevelopmental outcomes in childhood (ALSPAC study): an observational cohort study. Lancet 2007; 369: 578–85.CrossRefGoogle ScholarPubMed
Hynes, KL, Otahal, P, Hay, I, et al. Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-year follow-up of the Gestational Iodine Cohort. J Clin Endocrinol Metab 2013; 98: 1954–62.CrossRefGoogle ScholarPubMed
Bath, SC, Steer, CD, Golding, J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet 2013; 382: 331–7.Google Scholar
Bray, GA. Increased sensitivity of the thyroid in iodine depleted rats to the goitrogenic effects of thyrotropin. J Clin Invest 1968; 47: 1640–7.Google Scholar
Pisarev, M, Gärtner, R. Autoregulatory actions of iodine. In Braverman, LE, Utiger, RD (eds), The Thyroid. Philadelphia, PA: Lippincott Williams & Wilkins, 2000, pp. 85–90.Google Scholar
Studer, H, Derwahl, M. Mechanisms of nonneoplastic endocrine hyperplasia: a changing concept. A review focused on the thyroid gland. Endocr Rev 1995; 16: 411–26.Google Scholar
De Geyter, C, Steimann, S, Muller, B, et al. Pattern of thyroid function during early pregnancy in women diagnosed with subclinical hypothyroidism and treated with l-thyroxine is similar to that in euthyroid controls. Thyroid 2009; 19: 53–9.CrossRefGoogle ScholarPubMed
Alexander, EK, Marqusee, E, Lawrence, J, et al. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 2004; 351: 241–9.Google Scholar
Haddow, JE, Knight, GJ, Palomaki, GE, et al. The reference range and within-person variability of thyroid stimulating hormone during the first and second trimesters of pregnancy. J Med Screen 2004; 11: 170–4.Google Scholar
Larsson, A, Palm, M, Hansson, LO, Axelsson, O. Reference values for clinical chemistry tests during normal pregnancy. BJOG 2008; 115: 874–81.Google Scholar
Derakhshan, A, Shu, H, Broeren, MAC, et al. Reference ranges and determinants of thyroid function during early pregnancy: the SELMA study. J Clin Endocrinol Metab 2018 Jul 2. doi: 10.1210/jc.2018-00890.CrossRefGoogle Scholar
Cotzias, C, Wong, SJ, Taylor, E, et al. A study to establish gestation-specific reference intervals for thyroid function tests in normal singleton pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 137:61–6.CrossRefGoogle ScholarPubMed
Khalid, AS, Marchocki, Z, Hayes, K et al. Establishing trimester-specific maternal thyroid function reference intervals. Ann Clin Biochem 2014; 51: 277–83.CrossRefGoogle ScholarPubMed
Pop, V, Broeren, M, Wijnen, H, et al. Longitudinal trajectories of gestational thyroid function: a new approach to better understand changes in thyroid function. J Clin Endocrinol Metab 2018; 103: 2889–900. doi: 10.1210/jc.2017-02556.Google Scholar
Li, C, Shan, Z, Mao, J, et al. 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: 73–9.Google Scholar
Marwaha, RK, Chopra, S, Gopalakrishnan, S et al. Establishment of reference range for thyroid hormones in normal pregnant Indian women. Br J Obstet Gynaecol 2008; 115: 602–6.Google Scholar
Moon, HW, Chung, HJ, Park, CM, Hur, M, Yun, YM. Establishment of trimester-specific reference intervals for thyroid hormones in Korean pregnant women. Ann Lab Med 2015; 35: 198–204. doi: 10.3343/alm.2015.35.2.198.CrossRefGoogle ScholarPubMed
Casey, BM, Thom, EA, Peaceman, AM, et al. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 2017; 376: 815–25. doi: 10.1056/NEJMoa1606205.Google Scholar
Springer, D, Bartos, V, Zima, T. Reference intervals for thyroid markers in early pregnancy determined by 7 different analytical systems. Scand J Clin Lab Inv 2014; 74: 95–101.Google Scholar
Lambert-Messerlian, G, McClain, M, Haddow, JE, et al. First- and second-trimester thyroid hormone reference data in pregnant women: a FaSTER (First- and Second-Trimester Evaluation of Risk for aneuploidy) Research Consortium study. Am J Obstet Gynecol 2008; 199: 62.e1–6.Google Scholar
Teng, W, Shan, Z, Patil-Sisodia, K, et al. Hypothyroidism in pregnancy. Lancet Diabetes Endocrinol 2013; 1: 228–3.CrossRefGoogle ScholarPubMed
Brabant, G, Peeters, R, Chan, S, et al. Management of subclinical hypothyroidism in pregnancy. Are we too simplistic? Eur J Endocrinol 2015; 173: P1–11.Google Scholar
Thorpe-Beeston, JG, Nicolaides, KH, Felton, CV, Butler, J, McGregor, AM. Maturation of the secretion of thyroid hormone and thyroid-stimulating hormone in the fetus. N Engl J Med 1991; 324: 532–6.Google Scholar
Garber, JR, Cobin, RH, Gharib, H, et al. American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults. Endocr Pract 2012; 18: 988–1028.Google Scholar
Hall, R, Richards, CJ, Lazarus, JH. The thyroid and pregnancy. Br J Obstet Gynaecol 1993; 100: 512–15.CrossRefGoogle ScholarPubMed
Medici, M, Korevaar, TI, Schalekamp-Timmermans, S, et al. Maternal early-pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy: the Generation R study. J Clin Endocrinol Metab 2014; 99: E2591–8.Google Scholar
Leung, AS, Millar, LK, Koonings, PP, et al. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993; 81: 349–53.Google Scholar
Haddow, JE, Palomaki, GE, Allan, WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549–55.Google Scholar
Pop, VJ, Brouwers, EP, Vader, HL, et al. Maternal hypothyroxinemia during early pregnancy and subsequent child development: a 3-year follow-up study. Clin Endocrinol 2003; 59: 282–8.CrossRefGoogle ScholarPubMed
Liu, H, Momotani, N, Noh, JY, et al. Maternal hypothyroidism during early-pregnancy and intellectual development of the progeny. Arch Intern Med 1994; 154: 785–7.Google Scholar
Momotani, N, Iwama, S, Momotani, K. Neurodevelopment in children born to hypothyroid mothers restored to normal thyroxine (T4) concentration by late pregnancy in Japan: no apparent influence of maternal T4 deficiency. J Clin Endocrinol Metab 2012; 97: 1104–8.CrossRefGoogle ScholarPubMed
Lazarus, JH, Bestwick, JP, Channon, S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med 2012; 366: 493–501.Google Scholar
Hales, C, Taylor, PN, Channon, S, et al. Controlled Antenatal Thyroid Screening II: effect of treating maternal suboptimal thyroid function on child cognition. J Clin Endocrinol Metab 2018; 103: 1583–91. doi: 10.1210/jc.2017-02378.Google Scholar
Korevaar, TI, Muetzel, R, Medici, M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol 2016; 4: 35–43. doi: 10.1016/S2213-8587(15)00327-7.Google Scholar
Levie, D, Korevaar, TIM, Bath, SC, et al. Thyroid function in early pregnancy, child IQ, and autistic traits: a meta-analysis of individual participant data. J Clin Endocrinol Metab 2018; 103: 2967–79. https://doi.org/10.1210/jc.2018-00224.Google Scholar
Nelson, SM, Haig, C, McConnachie, A, et al. Maternal thyroid function and child educational attainment: prospective cohort study. BMJ 2018; 360: k452. https://doi.org/10.1136/bmj.k452.CrossRefGoogle ScholarPubMed
Krassas, GE, Pontikides, N, Kaltsas, T, et al. Disturbances of menstruation in hypothyroidism. Clin Endocrinol 1999; 50: 655–9.Google Scholar
National Collaborating Centre for Women’s and Children’s Health, National Institute for Health and Care Excellence. Heavy Menstrual Bleeding: Assessment and Management. Clinical Guideline 44. London: NICE, 2007.Google Scholar
Verga, U, Bergamaschi, S, Cortelazzi, D, et al. Adjustment of L-T4 substitutive therapy in pregnant women with subclinical, overt or post-ablative hypothyroidism. Clin Endocrinol 2009; 70: 798–802.Google Scholar
Abalovich, M, Gutierrez, S, Alcaraz, G, et al. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid 2002; 12: 63–8.Google Scholar
Yassa, L, Marqusee, E, Fawcett, R, et al. Thyroid hormone early adjustment in pregnancy (the THERAPY) trial. J Clin Endocrinol Metab 2010; 95: 3234–41.Google Scholar
Girling, J. Thyroid disease in pregnancy. Obstet Gynecol Reprod Med 2008; 18: 259–64.Google Scholar
Chopra, IJ, Baber, K. Treatment of primary hypothyroidism during pregnancy: is there an increase in thyroxine dose requirement in pregnancy? Metabolism 2003; 52: 122–8.Google Scholar
Taylor, PN, Minassian, C, Rehman, A, et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. J Clin Endocrinol Metab 2014; 99: 3895–902.CrossRefGoogle ScholarPubMed
Busnelli, A, Vannucchi, G, Paffoni, A, et al. Levothyroxine dose adjustment in hypothyroid women achieving pregnancy through IVF. Eur J Endocrinol 2015; 173: 417–24. doi: 10.1530/EJE-15-0151.Google Scholar
Burch, HB, Burman, KD, Cooper, DS, et al. A 2013 survey of clinical practice patterns in the management of primary hypothyroidism. J Clin Endocrinol Metab 2014; 99: 2077–85.Google Scholar
Managing subclinical hypothyroidism. Drug Ther Bull 1998; 36: 1–3.Google Scholar
Shields, BM, Knight, BA, Hill, AV, Hattersley, AT, Vaidya, B. Five-year follow-up for women with subclinical hypothyroidism in pregnancy. J Clin Endocrinol Metab 2013; 98: E1941–5.Google Scholar
van den Boogaard, E, Vissenberg, R, 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
Dashe, JS, Casey, BM, Wells, CE,et al. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol 2005; 106: 753–7.Google Scholar
Moreno-Reyes, R, Glinoer, D, Van Oyen, H et al. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study. J Clin Endocrinol Metab 2013; 98: 3694–70.Google Scholar
Blatt, AJ, Nakamoto, JM, Kaufman, HW. National status of testing for hypothyroidism during pregnancy and postpartum. J Clin Endocrinol Metab 2012; 97: 777–84.Google Scholar
Korevaar, TI, Medici, M, de Rijke, YB, et al. Ethnic differences in maternal thyroid parameters during pregnancy: the generation R study. J Clin Endocrinol Metab 2013; 98: 3678–86.Google Scholar
Abalovich, M, Amino, N, Barbour, LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metabol 2007; 92: S1–7.Google Scholar
Karakosta, P, Alegakis, D, Georgiou, V, et al. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab 2012; 97: 4464–72.Google Scholar
Lazarus, JH. Screening for thyroid dysfunction in pregnancy: is it worthwhile? J Thyroid Res 2011; 2011: 397012.Google Scholar
Toulis, KA, Goulis, DG, Venetis, CA et al. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol 2010; 162: 643–52.Google Scholar
Negro, R, Schwartz, A, Gismondi, R, et al. Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 2010; 95: E44–8.Google Scholar
Benhadi, N, Wiersinga, WM, Reitsma, JB, et al. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol 2009; 160: 985–91.Google Scholar
Cleary-Goldman, J, Malone, FD, Lambert-Messerlian, G, et al. Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol 2008; 112: 85–92.Google Scholar
Maraka, S, Mwangi, R, McCoy, RG, et al. Thyroid hormone treatment among pregnant women with subclinical hypothyroidism: US national assessment. BMJ 2017; 356: i6865. https://doi.org/10.1136/bmj.i6865.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. doi: 10.1089/thy.2014.0029.Google Scholar
Zhang, Y, Wang, H, Pan, X, Teng, W, Shan, Z. Patients with subclinical hypothyroidism before 20 weeks of pregnancy have a higher risk of miscarriage: a systematic review and meta-analysis. PLoS One 2017; 12: e0175708. doi: 10.1371/journal.pone.0175708.Google Scholar
Allan, WC, Haddow, JE, Palomaki, GE, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000; 7: 127–30.Google Scholar
Casey, BM, Dashe, JS, Wells, CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol 2005; 105: 239–45.Google Scholar
Stagnaro-Green, A, Chen, X, Bogden, JD, et al. The thyroid and pregnancy: a novel risk factor for very preterm delivery. Thyroid 2005; 15: 351–7.Google Scholar
Chen, LM, Du, WJ, Dai, J, et al. Effects of subclinical hypothyroidism on maternal and perinatal outcomes during pregnancy: a single-center cohort study of a Chinese population. PLoS One 2014; 9: e109364.Google Scholar
Andersen, SL, Knøsgaard, L, Olsen, J, Vestergaard, P, Andersen, S. Maternal thyroid function, use of antithyroid drugs in early pregnancy, and birth defects. J Clin Endocrinol Metab 2019; 104: 6040–8. https://doi.org/10.1210/jc.2019-01343.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: 2396–403. https://doi.org/10.1210/jc.2011-2860.Google Scholar
Grattan, MJ, Thomas, DS, Hornberger, LK, et al. Maternal hypothyroidism may be associated with CHD in offspring. Cardiol Young 2015; 25: 1247–53. https://doi.org/10.1017/S1047951114001887.Google Scholar
Turunen, S, Vääräsmäki, M, Männistö, T, et al. Pregnancy and perinatal outcome among hypothyroid mothers: a population-based cohort study. Thyroid 2019; 29: 135–41. https://doi.org/10.1089/thy.2018.0311.Google Scholar
Li, Y, Shan, Z, Teng, W, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25–30 months. Clin Endocrinol 2010; 72: 825–9.Google Scholar
Williams, F, Watson, J, Ogston, S, et al.; Scottish Preterm Thyroid Group. Mild maternal thyroid dysfunction at delivery of infants born ≤34 weeks and neurodevelopmental outcome at 5.5 years. J Clin Endocrinol Metab 2012; 97: 1977–85.Google Scholar
Behrooz, HG, Tohidi, M, Mehrabi, Y, et al. Subclinical hypothyroidism in pregnancy: intellectual development of offspring. Thyroid 2011; 21: 1143–7.Google Scholar
Hales, C, Taylor, PN, Channon, S, et al. Controlled antenatal thyroid screening II: effect of treating maternal suboptimal thyroid function on child behavior. J Clin Endocrinol Metab 2020; 105(3): dgz098. https://doi.org/10.1210/clinem/dgz098.CrossRefGoogle ScholarPubMed
Wang, S, Teng, WP, Li, JX, et al. Effects maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy. J Endocrinol Invest 2012; 35: 322–5.Google Scholar
Velkeniers, B, Van Meerhaeghe, A, Poppe, K, et al. Levothyroxine treatment and pregnancy outcome in women with subclinical hypothyroidism undergoing assisted reproduction technologies: systematic review and meta-analysis of RCTs. Hum Reprod Update 2013; 19: 251–8.Google Scholar
Reid, SM, Middleton, P, Cossich, MC, et al. Interventions for clinical and subclinical hypothyroidism pre-pregnancy and during pregnancy. Cochrane Database Syst Rev 2013; (5): CD007752.CrossRefGoogle Scholar
Glinoer, D, Riahi, M, Grun, JP, Kinthaert, J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. J Clin Endocrinol Metab 1994; 79: 197–204.Google Scholar
Poppe, K, Glinoer, D, Tournaye, H, et al. Assisted reproduction and thyroid autoimmunity: An unfortunate combination? J Clin Endocrinol Metab 2003; 88: 4149–52.CrossRefGoogle ScholarPubMed
Stagnaro-Green, A, Roman, SH, Cobin, RH, et al. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 1990; 264: 1422–5.Google Scholar
Poppe, K, Glinoer, D. Thyroid autoimmunity and hypothyroidism before and during pregnancy. Hum Reprod Update 2003; 9: 149–61.Google Scholar
Muller, AF, Verhoeff, A, Mantel, MJ, Berghout, A. Thyroid autoimmunity and abortion: A prospective study in women undergoing in vitro fertilization. Fertil Steril 1999; 71: 30–4.Google Scholar
Wilson, R, Ling, H, MacLean, MA, et al. Thyroid antibody titer and avidity in patients with recurrent miscarriage. Fertil Steril 1999; 71: 558–61.Google Scholar
Negro, R, Formoso, G, Mangieri, T, et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 2006; 91: 2587–91.Google Scholar
Seror, J, Amand, G, Guibourdenche, J, et al. Anti-TPO antibodies diffusion through the placental barrier during pregnancy. PLoS One 2014; 9: e84647.Google Scholar
Mao, J, Pop, VJ, Bath, SC, et al. Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr 2016; 55: 55–61.Google Scholar
Wang, X, Zhang, Y, Tan, H, et al. Effect of levothyroxine on pregnancy outcomes in women with thyroid autoimmunity: a systematic review with meta-analysis of randomized controlled trials. Fertil Steril 2020: S0015-0282(20)30605-1. https://doi.org/10.1016/j.fertnstert.2020.06.034.Google Scholar
Dhillon-Smith, RK, Middleton, LJ, Sunner, KK, et al. Levothyroxine to increase live births in euthyroid women with thyroid antibodies trying to conceive: the TABLET RCT. Efficacy Mech Eval 2019; 6(11). https://doi.org/10.3310/eme06110.Google Scholar
Vissenberg, R, van Dijk, MM, Fliers, E, et al. Effect of levothyroxine on live birth rate in euthyroid women with recurrent miscarriage and TPO antibodies (T4-LIFE study). Contemporary Clin Trials 2015; 44: 134–8.Google Scholar
Burrow, GN. Thyroid function and hyperfunction during gestation. Endocr Rev 1993; 14: 194–202.Google Scholar
Smith, C, Thomsett, M, Choong, C, et al. Congenital thyrotoxicosis in premature infants. a. Clin Endocrinol 2001; 54: 371–6.Google Scholar
Cooper, DS, Lauberg, P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol 2013; 1: 238–49.Google Scholar
Goodwin, TM, Montoro, M, Mestman, JH. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects. Am J Obstet Gynecol 1992; 167: 648–52.Google Scholar
Glinoer, D, Soto, MF, Bourdoux, P, et al. Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab 1991; 73: 421–7.Google Scholar
Momotani, N, Ito, K, Hamada, N, et al. Maternal hyperthyroidism and congenital malformation in the offspring. Clin Endocrinol 1984; 20: 695–700.Google Scholar
Anderson, SL, Olsen, , Wu, CS, et al. Spontaneous abortion, stillbirth and hyperthyroidism: a Danish population-based study.Eur Thyroid J 2014; 3: 164–72.Google Scholar
Millar, LK, Wing, DA, Leung, AS, et al. Low-birth-weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol 1994; 84: 946–9.Google Scholar
León, G, Murcia, M, Rebagliato, M, et al. Maternal thyroid dysfunction during gestation, preterm delivery, and birthweight. The Infancia y Medio Ambiente Cohort, Spain. Paediatr Perinat Epidemiol 2015; 29: 113–22.Google Scholar
Milham, S, Elledge, W. Maternal methimazole and congenital defects in children. Teratology 1972; 5: 125. doi: 10.1002/tera.1420050117.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. doi: 10.1210/jc.2013-2831.Google Scholar
Andersen, SL, Laurberg, P. Antithyroid drugs and congenital heart defects: ventricular septal defect is part of the methimazole/carbimazole embryopathy. Eur J Endocrinol 2014; 171: C1–3.Google Scholar
Andersen, SL, Olsen, J, Wu, CS, Laurberg, P. Severity of birth defects after propylthiouracil exposure in early pregnancy. Thyroid 2014; 24: 1533–40.Google Scholar
Seo, GH, Kim, TH, Chung, JH. Antithyroid drugs and congenital malformations: a nationwide Korean cohort study. Ann Intern Med 2018; 168: 405–13. https://doi.org/10.7326/M17-1398.Google Scholar
Glinoer, D, Cooper, DS. The propylthiouracil dilemma. Curr Opin Endocrinol Diabetes Obes 2012; 19: 402–7.Google Scholar
Yoshihara, A, Noh, JY, Watanabe, N, et al. Substituting potassium iodide for methimazole as the treatment for Graves’ disease during the first trimester may reduce the incidence of congenital anomalies: a retrospective study at a single medical institution in Japan. Thyroid 2015; 25: 1155–61. https://doi.org/10.1089/thy.2014.0581.CrossRefGoogle Scholar
Yoshihara, A, Noh, JY, Watanabe, N, et al. Characteristics of1patients with Graves' disease whose thyroid hormone levels increase after substituting potassium iodide for methimazole in the first trimester of pregnancy. Thyroid 2020; 30: 451–6. https://doi.org/10.1089/thy.2019.0392.Google Scholar
Donnelly, MA, Wood, C, Casey, B, Hobbins, J, Barbour, LA. Early severe fetal Graves disease in a mother after thyroid ablation and thyroidectomy. Obstet Gynecol 2015; 125: 1059–62. doi: 10.1097/AOG.0000000000000582.Google Scholar
Abeillon-du Payrat, J, Chikh, K, Bossard, N, et al. Predictive value of maternal second-generation thyroid-binding inhibitory immunoglobulin assay for neonatal autoimmune hyperthyroidism. Eur J Endocrinol 2014; 171: 451–60. doi: 10.1530/EJE-14-0254.Google Scholar
O’Doherty, MJ, McElhatton, PR, Thomas, SH. Treating thyrotoxicosis in pregnant or potentially pregnant women: the risk to the fetus is very low. BMJ 1999; 318: 5–6.Google Scholar
Cooper, DS, Rivkees, SA. Putting propylthiouracil in perspective. J Clin Endocrinol Metab 2009; 94: 1881–2.Google Scholar
Momotani, N, Noh, J, Oyanagi, H, Ishikawa, N, Ito, K. Antithyroid drug therapy for Graves' disease during pregnancy. Optimal regimen for fetal thyroid status. N Engl J Med 1986; 315: 24–8.Google Scholar
Rotondi, M, Cappelli, C, Pirali, B, et al. The effect of pregnancy on subsequent relapse from Graves’ disease after a successful course of antithyroid drug therapy. J Clin Endocrinol Metab 2008; 93: 3985–8.Google Scholar
Perros, P, Colley, S, Boelaert, K. British Thyroid Association guidelines for the management of thyroid cancer, third edition. Clin Endocrinol 2014; 81 (Suppl 1): 1–122. http://onlinelibrary.wiley.com/doi/10.1111/cen.12515/pdf (accessed March 2017).Google Scholar
Zhu, J, Zhu, X, Tu, C, et al. Parity and thyroid cancer risk: a meta-analysis of epidemiological studies. Cancer Med 2016; 5: 739–52.Google Scholar
Kim, H, Kim, KY, Baek, JH, Jung, J. Are pregnancy, parity, menstruation and breastfeeding risk factors for thyroid cancer? Results from the Korea National Health and Nutrition Examination Survey, 2010–2015. Clin Endocrinol (Oxf) 2018; 89: 233–9. doi: 10.1111/cen.13750.Google Scholar
Shindo, H, Amino, N, Ito, Y, et al. Papillary thyroid microcarcinoma might progress during pregnancy. Thyroid 2014; 24: 840–4.Google Scholar
Chen, AC, Livhits, MJ, Du, L, et al. Recent pregnancy is not associated with high-risk pathological features of well-differentiated thyroid cancer. Thyroid 2018; 28: 68–71. doi: 10.1089/thy.2017.0496.Google Scholar
Stuckey, BG, Kent, GN, Allen, JR: The biochemical and clinical course of postpartum thyroid dysfunction: the treatment decision. Clin Endocrinol 2001; 54: 377–83.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×