Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction. Thyroid hormones are necessary for the babys brain development while in the womb. It is also used to treat or prevent goiter enlarged thyroid gland, and is also given as part of a medical tests for thyroid disorders. However, not all medicines are safe to take during pregnancy. The thyroid diseaseshyperthyroidism and hypothyroidismare relatively common in pregnancy and important to treat. Pregnancy has a considerable effect on maternal thyroid function. Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery. The thyroid is a small, butterflyshaped gland in the front of your neck that makes thyroid hormones. Acog practice bulletin on thyroid disease in pregnancy.
These conditions must be evaluated in a timely and costeffective manner. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. Thyroid function and thyroid disorders during pregnancy. August 16, 2018 in 2018 news releases, basic science research, news releases, thyroid disease and pregnancy, thyroid research grants research grant to study the action of tregulatory cells in thyroid antibodypositive pregnant women awarded to stephanie behringermassera, md, by the american thyroid association. It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. Moreover, thyroid disorders and their management may affect both the pregnant woman and the developing fetus. Almost every pregnant woman will face a decision about taking medicines before and during pregnancy.
International federation of gynecology and obstetrics. Pregnancy related hormones raise the level of thyroid hormones in the blood. Since the guidelines for the man agement of these disorders by the american thyroid. Both disorders mostly increased in size as the pregnancy progressed, returning to their pre. However, pregnancyassociated goiters occur much more frequently in iodinedeficient areas of the world. Healthcare providers should check thyroid levels in their pregnant patients. According to recent american thyroid association ata guidelines, the recommended reference ranges for tsh are 0. May 02, 2019 desiccated thyroid treats hypothyroidism low thyroid hormone. The thyroid gland can increase in size during pregnancy enlarged thyroid goiter. This medicine should not be used to treat obesity or weight problems. New guidelines for thyroid disease during pregnancy.
Thyroid disorders and pregnancy childrens hospital of. The gland increases 10% in size during pregnancy in iodinereplete countries and by 20%40% in areas of iodine deficiency. Guidelines for diagnosis and management of thyroid disease. Another separate issue relates to screening for thyroid dysfunction before and during pregnancy.
Thyroid disorders in pregnancy present a unique opportunity for health care professionals to use a team approach, similar to that of the care of diabetic women during gestation. A nationwide populationbased study representing the three treatment options for graves disease with different failure rates and associated complication. Treating for two is a program that aims to improve the health of women and babies by. Thyroid disease is a group of disorders that affects the thyroid gland. Thyroid disease is the second most common endocrine condition encountered in women of childbearing age after diabetes. Learning objectives to gain an overview of the effect of thyroid disorders on reproductive health. Stimulation of thyroid function by hcg during pregnancy. Thyroid hormones control how your body uses energy, so they affect the way nearly every organ in your body workseven the way your heart beats. Jul 08, 2019 a growing body of evidence confirms that thyroid disorders are strongly associated with autism risk. The evaluation and treatment of pregnant women with thyroid disease parallel that of nonpregnant women and men but present some unique problems. P regnancy has a profound impact on the thyroid gland and thyroid function. As per who guidelines, the recommended total dietary intake of iodine is 250. It is in this context that the american thyroid association ata charged a task force with developing clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and the postpartum. For women known to have hypothyroidism, an increase in thyroxine dose by 2040% when pregnancy is confirmed usually ensures they remain euthyroid.
In addition to other usual causes of hyperthyroidism see hyperthyroidism brochure, very high levels of hcg, seen in severe forms of morning sickness hyperemesis. Four key changes in the new guidelines are highlighted. Current guidelines recommend targeted screening of women at high risk, including those with a history of thyroid disease, type 1 diabetes. Management of antenatal subclinical hypothyroidism and subclinical hyperthyroidism. The guidelines were compiled by american thyroid association guidelines taskforces selected for their expertise on the topic. Thyroid hormones control how your body uses energy, so they affect the way nearly every organ in your body. Maternal early pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy. Thyroid disorders, mostly hypothyroidism, being one of the common diseases during pregnancy, if untreated, affect the neuropsycho development of neonates. Thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental. Physiology during pregnancy the thyroid gland undergoes hyperplasia and increased vascularity. Thyroid dysfunction in pregnancy has consequences for mother and baby. Thyroid problems can be hard to diagnose in pregnancy due to higher levels of thyroid hormones and other symptoms that occur in both pregnancy and thyroid disorders. If very sensitive imaging techniques ultrasound are used.
Production of thyroxine t 4 and triiodothyronine t 3 increases by 50%, along with a 50% increase in the daily iodine requirement. Postpartum thyroiditis may present months after delivery. Most of these conditions are treatable, and may affect mother and fetus adversely if they are not evaluated and managed appropriately. Ask to see the results and make sure the doctor is using the most up to date references. January 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy. Key issues remain regarding the clinical usefulness of diagnosis and treatment of thyroid disorders during pregnancy that should be addressed in future studies. Managing thyroid disease during pregnancy, new ata guidelines. Sometimes the body produces too much or too little thyroid hormone. Current guidelines recommend targeted screening of women at high risk, includ ing those with a history of thyroid disease, type 1 diabetes mellitus, or other. South australian perinatal practice guidelines thyroid disorders in pregnancy. You may not be able to use desiccated thyroid if you. Pregnancy provides an opportunity for ongoing health promotion in women with endocrine disorders such as diabetes. Managing thyroid problems during pregnancy or before reduces the risk of autism in children.
Women with thyroid disorders in pregnancy should be followed up by their gp in the postpartum period. Thyroid disease isnt something to mess around with, especially before and during pregnancy. Thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. The thyroid gland, located at the front of the neck just below the voice box, is part of the endocrine system, which produces all of the hormones in your body. Thyroid disorders are common in pregnancy, and the most common disorder is subclinical hypothyroidism. Evidence suggests that treating thyroid disorders and keeping thyroid stimulating hormone levels at the lower end of normal in euthyroid women may improve conception rates in subfertile women and reduce early pregnancy loss. Thomas wharton in 1656 gave the thyroid gland its modern name meaning oblong shield, because he thought that the gland fills the vacant spaces and contributes to the shape and beauty of the neck, especially in women. Oct 16, 2015 thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. Is there a connection between thyroid disorders and autism. Since the guidelines for the management of these disorders by the american thyroid association ata were first published in 2011, significant clinical and scientific advances have occurred in the field. Antenatal, antithyroid drug, hyperthyroidism, hypothyroidism, thyroid cancer, thyroid nodules. Pdf adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. Ata professional guidelines american thyroid association.
Treatment guidelines during pregnancy treating for two. This guideline covers investigating all suspected thyroid disease and managing primary thyroid disease related to the thyroid rather than the pituitary gland. But theres another side of pregnancy that can be heartbreaking and devastatingand that is infertility and loss. According to current guidelines, universal screening is recommended in individuals at high risk for thyroid illness. Since the guidelines for the management of these disorders by the american thyroid association ata were.
Potential problems include preeclampsia, prematurity and congenital abnormality. Pregnancy may affect the course of these thyroid disorders and, conversely, thyroid diseases may affect the course of pregnancy. Thyroid hormone deficiencies are known to be detrimental for. The members of the american thyroid association are thyroid specialists dedicated to transforming thyroid care through clinical excellence, education, scientific discovery and advocacy in a collaborative community. Routine thyroid screening in pregnancy is not recommended thyroid testing in pregnancy should be conducted for women at risk, including known thyroid disease, symptoms of overt thyroid disease, suspected goiter, autoimmune medical disorders such as type 1 diabetes mellitus. Thyroid dysfunction affects 23% of pregnant women and one in 10 women of childbearing age with normal thyroid function have underlying thyroid autoimmunity, which may indicate reduced functional reserve. Hyperthyroidism in pregnancy american thyroid association. Your doctor will check your thyroid hormone levels every 6 to 8 weeks during pregnancy and 4 weeks after a change in dose. Obstetricians, endocrinologists, and perinatologists are often called upon to interact in the management of complex thyroid problems. The american thyroid association ata has published new guidelines that cover most aspect of thyroid function and dysfunction during pregnancy and the postpartum period. Anyone who even suspects thyroid disease should get tested, preferably before pregnancy or as soon as possible. Thyroid disorders in pregnancy metro north hospital and. Feb 15, 2014 thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental. A severe, lifethreatening form of hyperthyroidism, called thyroid storm, may complicate pregnancy.
Management of thyroid dysfunction during pregnancy and postpartum. Among the recommendations is that all pregnant women should ingest approximately 250. Notably normal thyroid test values change in pregnancy treatment for hypothyroidism is recommended when tsh levels are 2. As a result, diagnosing both hypo and hyperthyroidism can be challenging. Tsh and ft4 concentrations differ over the course of pregnancy, so results should be evaluated in the context of trimesterspecific reference intervals tsri. Thyroid disease is a disorder that affects the thyroid gland. Thyroid status in the newborn is also influenced by maternal thyroid disease, with maternal thyroid disease associated with adverse pregnancy outcomes including neonatal encephalopathy 1, 2, and infants of mothers with graves disease at risk of neonatal. Thyroid disorders are among the common endocrine disorders in pregnant women after diabetes mellitus. Any patient discovered to have a thyroid nodule should be asked about any positive family history for the occurrence of a benignmalignant thyroid. Pregnancy hormones can cause changes in thyroid hormone levels. It lists the recommendations in a readerfriendly way, and facilitates rational therapy of thyroid disorders, in relation to obstetric health, at the primary care level. Pre pregnancy care significantly improves pregnancy outcomes especially for women with preexisting medical conditions such as diabetes and thyroid disorders. During gestation, women with hyperthyroidism should have their thyroid function checked every 34 weeks. An overview of thyroid physiology and disease during pregnancy is presented here.
Thyroid disorders can range from a small, harmless goiter enlarged gland that needs no treatment to lifethreatening cancer. Pregnancy can be such a wonderful and joyful time, even though it has its struggles. Thyroid disease in pregnancy american family physician. Thyroid disorders in pregnancy article pdf available in the journal of the association of physicians of india 59 supplsuppl. Thyroid disease in pregnancy is a common clinical problem. The most common cause of hyperthyroidism in pregnancy is graves disease, which accounts for 8590% of all cases. During pregnancy specific changes in thyroid physiology occur, resulting in such consequences as different course of thyroid disorders and difficulties in diagnostics of thyroid disorders. Pregnancy impacts the functioning of the thyroid gland profoundly and is. Thyroid disorders in pregnancy and postpartum australian. Thyroid disorders in pregnancy pralhad kushtagi, prashanth adiga t hyroid disorders are the second most common endocrine disorders affecting women of reproductive age, and obstetricians often care for patients who have been previously diagnosed with alterations in the thyroid gland function. It aims to improve quality of life by making recommendations on diagnosis, treatment, longterm care and support. South australian perinatal practice guidelines thyroid. Thyroid disorders are encountered frequently during pregnancy and the postpartum period. Guidelines of the american thyroid association for the.
Nov 27, 2018 luckily, thyroid disorders can be treated safely with medication during pregnancy, minimizing any risks to you or your baby. In addition, they also define areas where additional research is needed. This is a condition in which there are extremely high levels of thyroid hormone that can cause high fever, dehydration, diarrhea, rapid and irregular heart rate, shock and death, if not treated. Overall, the most common cause of hyperthyroidism in women of childbearing age is graves disease see graves disease brochure, which occurs in 0. Aug 01, 2018 changes in thyroid biochemistry during pregnancy lead to several challenges for both testing and interpreting the results of thyroid function tests. Some medicines may cause birth defects, pregnancy loss, prematurity, infant death, or developmental disabilities. Thyroid disorders in pregnancy linkedin slideshare.
The thyroid is an organ located in the front of your neck that releases hormones that regulate your metabolism the way your body uses energy, heart and nervous system, weight, body temperature, and many other processes in the. Endocrine disorders in pregnancy pdf free download. If medicine does not work, the thyroid gland may need to be removed. The thyroid enlarges slightly in healthy women during pregnancy, but usually not enough for a health care professional to feel during a physical exam. Kebebew and modified from the article by brito and colleagues patterns of use, efficacy, and safety of treatment options for patients with graves disease.
Managing thyroid disease during pregnancy, new ata guidelines the 2017 guidelines, issued after 6 years of new evidence and experience, offer more targeted recommendations for clinical management of women who have thyroid disease once they become pregnant as well as postpartum. Updated guidelines for managing thyroid disease during pregnancy and postpartum just issued by the american thyroid association, 1 in collaboration with researchers from boston university school of medicine and brigham and womens hospital include more than 100 clinical recommendations, to provide clearer guidance to clinicians. Thyroid disorders in pregnancy dr ajay sdhawle associateprofessor,obgy jnmcsawangi 2. A prospective study was undertaken during pregnancy in 120 euthyroid women presenting with mild thyroid abnormalities ta. Diagnose and manage complex thyroid disorders with comprehensive testing from quest thyroid disorders have many etiologies, manifestations, and potential therapies. Circulating iodine is reduced and thyroid binding globulin increases. Thyroid disease and pregnancy ppt linkedin slideshare. Thank you for referring your patient with an abnormal thyroid stimulating hormone tsh measurement, to the maternity outpatients department of the royal brisbane and womens hospital rbwh. Summing up, the diagnosis and management of thyroid disorders during pregnancy differ substantially from those in general population. Targeted screening for thyroid disease should be performed in pregnant women at high risk, including those with a history of thyroid disease, type 1 diabetes mellitus, or other autoimmune disease. Obstetriciangynecologists are at the forefront of the diagnosis of all forms of thyroid disease, including hypothyroidism, hyperthyroidism, thyroid nodules, multinodular goiters, and thyroid cancer. A detailed literature research on medline, cochrane library, embase, nlh, clinicaltrials. Maternal earlypregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy.