Thyroid disease in pregnancy

Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery.[1] Thyroid disorders are prevalent in women of child-bearing age and for this reason commonly present as a pre-existing disease in pregnancy, or after childbirth.[2] Uncorrected thyroid dysfunction in pregnancy has adverse effects on fetal and maternal well-being.[1] The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child. Due to an increase in thyroxine binding globulin, an increase in placental type 3 deioidinase and the placental transfer of maternal thyroxine to the fetus, the demand for thyroid hormones is increased during pregnancy.[1] The necessary increase in thyroid hormone production is facilitated by high human chorionic gonadotropin (hCG) concentrations, which bind the TSH receptor and stimulate the maternal thyroid to increase maternal thyroid hormone concentrations by roughly 50%.[3] If the necessary increase in thyroid function cannot be met, this may cause a previously unnoticed (mild) thyroid disorder to worsen and become evident as gestational thyroid disease.[1] Currently, there is not enough evidence to suggest that screening for thyroid dysfunction is beneficial, especially since treatment thyroid hormone supplementation may come with a risk of overtreatment. After women give birth, about 5% develop postpartum thyroiditis which can occur up to nine months afterwards. This is characterized by a short period of hyperthyroidism followed by a period of hypothyroidism; 20–40% remain permanently hypothyroid.[4]

  1. ^ a b c d Korevaar, Tim I. M.; Medici, Marco; Visser, Theo J.; Peeters, Robin P. (2017-08-04). "Thyroid disease in pregnancy: new insights in diagnosis and clinical management". Nature Reviews. Endocrinology. 13 (10): 610–622. doi:10.1038/nrendo.2017.93. ISSN 1759-5037. PMID 28776582. S2CID 24810888.
  2. ^ Okosieme, OE; Marx, H; Lazarus, JH (Sep 2008). "Medical management of thyroid dysfunction in pregnancy and the postpartum". Expert Opinion on Pharmacotherapy. 9 (13): 2281–93. doi:10.1517/14656566.9.13.2281. PMID 18710353. S2CID 71280624.
  3. ^ Korevaar, Tim I. M.; de Rijke, Yolanda B.; Chaker, Layal; Medici, Marco; Jaddoe, Vincent W. V.; Steegers, Eric A. P.; Visser, Theo J.; Peeters, Robin P. (March 2017). "Stimulation of Thyroid Function by Human Chorionic Gonadotropin During Pregnancy: A Risk Factor for Thyroid Disease and a Mechanism for Known Risk Factors". Thyroid. 27 (3): 440–450. doi:10.1089/thy.2016.0527. ISSN 1557-9077. PMID 28049387.
  4. ^ Spencer, Laura; Bubner, Tanya; Bain, Emily; Middleton, Philippa (2015-09-21). "Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health". The Cochrane Database of Systematic Reviews. 2015 (9): CD011263. doi:10.1002/14651858.cd011263.pub2. PMC 9233937. PMID 26387772.