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Study of Thyroid Disease in Pregnancy: A Review

Marefa Tuz Zohora Lima, Tanvir Ahmed Tamim, Fatema Tuz Zohora Toma

Abstract


Pregnancy-related thyroid conditions, the second most prevalent endocrine disorders following diabetes, demand effective management to mitigate adverse consequences for both mother and fetus. Thyroid disease is associated with obstetric and child development complications, necessitating consideration from clinical and scientific viewpoints. This review consolidates current knowledge on thyroid disease in pregnancy, encompassing management, physiological changes, pathological functions, diagnosis, and treatment. Physiological alterations include thyroid stimulation by hCG, placental expression of deiodinases, and increased thyroid vascularity. Hypothyroidism, occurring in 0.6% of pregnancies, poses risks if untreated. Hyperthyroidism, affecting 0.2%, demands careful diagnosis due to TSH suppression in early pregnancy. Adverse outcomes include preterm labor, low birth weight, and impaired neurodevelopment. Post-delivery, monitoring and adjusting levothyroxine are essential, and anti-thyroid drug risks must be considered. Fetal and neonatal outcomes, influenced by maternal TRAb levels, require vigilance. Iodine's role in pregnancy, especially deficiency implications, underscores the importance of monitoring and supplementation. Postpartum care includes thyroid function tests and addressing postpartum thyroiditis, impacting 8% of women. Breastfeeding with antithyroid drugs requires cautious consideration, ensuring minimal impact on neonatal thyroid function. Screening for thyroid disorders during pregnancy remains debated, with case-finding limitations. Thyroid antibodies in euthyroid pregnant women correlate with adverse outcomes, necessitating careful monitoring. Recent research reveals a prevalence of thyroid peroxidase antibody (TPO Ab) in women of childbearing age, emphasizing the need for meticulous monitoring due to the elevated risk of hypothyroidism during pregnancy. Despite inconclusive evidence, levothyroxine supplementation may be considered for TPO Ab-positive euthyroid pregnant women with a history of miscarriage. Effective management, early diagnosis, and tailored care contribute to improved maternal and fetal health, emphasizing the need for continued research and evidence-based guidelines.


Keywords


Pregnancy, Hyperthyroidism, Hypothyroidism, Postpartum thyroiditis, Thyroid antibodies

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References


Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev (1997); 18:404–33.

Pharoah PO, Buttfield IH, Hetzel BS. Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. Lancet. (1971 Feb); 1(7694): 308–10.

Grüters A, Krude H. Detection and treatment of congenital hypothyroidism. Nat Rev Endocrinol. (2011 Oct); 8(2): 104–13.

Vulsma T, Gons MH, de Vijlder JJ. Maternalfetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis. N Engl J Med. (1989 Jul); 321(1): 13–6.

Yamamoto T, Amino N, Tanizawa O, Doi K, Ichihara K, Azukizawa M, et al. Longitudinal study of serum thyroid hormones, chorionic gonadotrophin Mahadik et al. BMC Pregnancy and Childbirth (2020) 20:769 Page 6 of 7 and thyrotrophin during and after normal pregnancy. Clin Endocrinol (Oxf). 1979; 10:459–68.

Stagnaro-Green A, Abalovich M, Alexander E, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. (2011) ;21(10):1081–125. https://doi.org/10.1089/thy.2011.0087.

Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, et al. Regulation of maternal thyroid function during pregnancy. J Clin Endocrinol Metab. (1990); 71:276–87.

Terry, F.D. and Rhoda, H.C. Thyroid disease in pregnancy and post-partum period. In: Cherry and Merkatz’s complications of pregnancy 5th edition Wayne, R.C. Shelden H.C. Ivcuin R.M. (ed) Lippincott, Williams and Wilkins (pub) (2000). www.isilo. Chapter 22: 29-68.

Cunningham, F.G., Leveno, K.J., Bloom, et al. (ed). Thyroid and other endocrine disorder. In: William’s obstetric. McGramr - Hill (pub) (2005); 1190-1198.

Gerard, N.B. and Lauren, H.G. Thyroid disease during pregnancy file/ pregnancy. htm. (2002); 1- 9.

Mariacarla Moleti, MD, PhD; Francesco Trimarchi, MD; Francesco Vermiglio, MD; Thyroid physiology in pregnancy; Endocrine practice Vol 20 No. (6 June 2014); 589-596.

Ashleigh Smith, Jade Eccles-Smith, Michael D’Emden, Karin Lust; Thyroid disorders in pregnancy and postpartum; Australian Prescriber; (2017), 40(6).

Abalovich M, Amino N, Barbour LA, Cobin RH, De Groot LJ, Glinoer D, et al. Management of thyroid dysfunction during pregnancy and postpartum: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab (2007); 92 Suppl: s1-47. https://doi.org/10.1210/jc.2007-0141

Lazarus JH. Thyroid function in pregnancy. Br Med Bull (2011); 97:137-48, https://doi.org/10.1093/bmb/ldq039

Patil-Sisodia K, Mestman JH. Graves hyperthyroidism and pregnancy: a clinical update. Endocr Pract (2010); 16:118-29, https://doi.org/10.4158/EP09233.RA

Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev (2010); 31:702-55, https://doi.org/10.1210/er.2009-0041.

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, 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, https://doi.org/10.1089/thy.2016.0457.

Cooper D.S. Hyperthyroidism. Lancet (2003); 362: 459-468.

Marx H, Amin P, Lazarus JH. Hyperthyroidism and pregnancy.61T BMJ (2008); 336: 663-667

Wang W, Teng W, Shan Z, Wang S, Li J, Zhu L, et al. The prevalence of thyroid disorders during early pregnancy in China: the benefits of universal screening in the first trimester of pregnancy. Eur J Endocrinol (2011); 164: 263-268.

Gaberscek, zaletel. Thyroid physiology and autoimmunity in pregnancy and after delivery. Expert Rev Clin Immunol. (2011); 7(5): 697–707.

Corinne R, Fantz, Samuel Dagogo-Jack, et al. Thyroid function during pregnancy. Clinical Chemistry. (1999); 45(12):2250–2258.

Alexander EK, Pearce EN, Sullivan S, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of thyroid disease during pregnancy and the postpartum. Thyroid. (2017); 27:315–389.

Lazarus J, Mestman J. Thyroid disorders during pregnancy and postpartum. In: Braverman L, Utiger R, eds. Werner and Ingbar’s The Thyroid: A Fundamental & Clinical Text. Philadelphia: Lippincott, Williams and Wilkins; (2013); 815–834.

Lambert-Messerlian G, McClain M, D’Alton ME, et al. FaSTER Research Consortium. 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); 199:62e1–62e6; Erratum in: Am J Obstet Gynecol. (2008);199(3):326.

Corinne R, Fantz, Samuel Dagogo-Jack, et al. Thyroid function during pregnancy. Clinical Chemistry. (1999);45 (12):2250–2258.

Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. (2002 Jan); 12(1):63-8.

Kriplani A, Buckshee K, Bhargava VL, Takkar D, Ammini AC. Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy. Eur J Obstet Gynecol Reprod Biol. (1994 May) 18;54(3):159-63.

Pietro Cignini,1 organic compound Valentina Cafà, Claudio Giorlandino, Frank Philip Stella Capriglione, Pakistani monetary unit Spata, and Nella Dugo; Thyroid physiology and customary diseases in pregnancy: review of literature; J Prenat Med. (2012 Oct-Dec); 6(4): 64–71.

Clementi M, DiGianantonio E, Cassina M, et al. Treatment of hyperthyroidism in pregnancy and birth defects. Journal of Clinical Endocrinology and Metabolism. (2010) ;95: E337–E341.

Bahn RS, Burch HS, Cooper DS, et al. The role of propylthiouracil in the management of Graves’ disease in adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. (2009); 19:673–674.

Millar LK, Wing DA, Leung AS, et al. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstetrics & Gynecology. 1994; 84:946–949.

Davis LE, Lucas MJ, Hankins GDV, et al. Thyrotoxicosis complicating pregnancy. American Journal of Obstetrics and Gynecology. (1989); 160:63–70.

Phoojaroenchanachai M, Sriussadaporn S, Peerapatdit T, et al. Effect of maternal hyperthyroidism during late pregnancy on the risk of neonatal low birth weight. Clinical Endocrinology. (2001); 54:365–370.

Luton D, Le Gac I, Vuillard E, et al. Management of Graves’ disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab. (2005); 90:6093.

McKenzie JM, Zakarija M. Fetal and neonatal hyperthyroidism and hypothyroidism due to maternal TSH receptor antibodies. Thyroid. (1992); 2:155–159.

Zimmerman D. Fetal and neonatal hyperthyroidism. Thyroid. (1999); 9:727–733.

Van Vliet G, Polak M, Ritzen EM. Treating fetal thyroid and adrenal disorders through the mother. Nature Clinical Practice. (2008); 4:675–682.

Ribault V, Castanet M, Bertrand AM, et al. French Fetal Goiter Study Group. Experience with intraamniotic thyroxine treatment in nonimmune fetal goitrous hypothyroidism in 12 cases. Journal of Clinical Endocrinology and Metabolism. (2009); 94:3731–3739.

Mandel SH, Hanna C, LaFranchi SH. Neonatal hypopituitary hypothyroidism associated with maternal thyrotoxicosis. Journal of Pediatric. (1990); 117:169–170.

Kempers MJ, van Trotsenburg AS, van Rijn RR, et al. Loss of integrity of thyroid morphology and function in children born to mothers with inadequately treated Graves’ disease. Journal of Clinical Endocrinology and Metabolism. (2007); 92:2984–2991.

Polak M, Le Gac I, Vuillard E, et al. Fetal and neonatal thyroid function in relation to maternal Graves’ disease. Best Practice & Research Clinical Endocrinology & Metabolism. (2004); 18:289– 302.

Polak M. Hyperthyroidism in early infancy: pathogenesis, clinical features and diagnosis with a focus on neonatal hyperthyroidism. Thyroid (1998); 8:1171–7.

Polak M, Le Gac I, Vuillard E, Guibourdenche J, Leger J, Toubert ME, et al. Fetal and neonatal thyroid function in relation to maternal Graves' disease. Best Pract Res Clin Endocrinol Metab (2004); 18:289–302.

Luton D, Le Gac I, Vuillard E, Castanet M, Guibourdenche J, Noel M, et al. Management of Graves' disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab (2005); 90:6093–8.

Tan JY, Loh KC, Yeo GS, et al. Transient hyperthyroidism of hyperemesis gravidarum. British Journal of Obstetrics and Gynaecology. (2002); 109:683–688.

Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, 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.

Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab (2012); 97:334-42. https://doi.org/10.1210/jc.2011-2576

Lauberg P, Anderson S, Bjarnadottir RI, et al. Evaluating iodine deficiency in pregnant women and young infants-complex physiology with a risk of is interpretation. Public Health Nutr. (2009);10 (12A):1547–1552.

Glinoer D, De Nayer P, Bourdoux P, et al. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab. (1990);71(2):276–287.

Bebhaim RD, Davis TF. Increased risk of Graves’ disease after pregnancy. Thyroid. (2005); 15:1287–1290.

Rotondi M, Pirali B, Lodigiani S, et al. The post-partum period and the onset of Graves’ disease: an overestimated risk factor. European Journal of Endocrinology. (2008); 159:161–165.

Momotani N, Noh J, Ishikawa N, et al. Relationship between silent thyroiditis and recurrent Graves’ disease in the postpartum period. Journal of Clinical Endocrinology and Metabolism. (1994); 79:285–289.

Azizi F, Khoshmiat M, Bahrainian M, et al. Thyroid function and intellectual development of infants nursed by mothers taking methimazole. Journal of Clinical Endocrinology and Metabolism. (2000); 85:3233–3238.

Negro R, Mestman JH. Thyroid disease in pregnancy. Best practice & research. Clinical endocrinology & metabolism. (2011 Dec); 25(6):927–43.

Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. Journal of Clinical Endocrinology and Metabolism. (2010); 95:1699–1707.

Dosiou C, Sanders GD, Araki SS, et al. Screening pregnant women for autoimmune thyroid disease: a cost-effectiveness analysis. European Journal of Endocrinology. (2008); 158:841–851.

Thung SF, Funai EF, Grobman WA. The cost-effectiveness of universal screening in pregnancy for subclinical hypothyroidism. American Journal of Obstetrics and Gynecology. (2009); 200:267. e1– 267.e7.

Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. (2007); 92: S1–S47.

Poppe K, Velkeniers B, Glinoer D. The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab. (2008 Jul); 4(7):394-405.

Bussen S, Steck T. Thyroid autoantibodies in euthyroid non-pregnant women with recurrent spontaneous abortions. Hum Reprod. (1995 Nov);10(11):2938-40.




DOI: https://doi.org/10.37591/rrjols.v13i3.3790

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