The thyroid diseaseshyperthyroidism and hypothyroidismare relatively common in pregnancy and important to treat. Thyroid dysfunction in pregnancy is clinically important as insufficient thyroxine is associated with an increased risk of premature birth, low birth weight and miscarriage. The fetal thyroid gland begins concentrating iodine and synthesizing thyroid hormones after 12 weeks of gestation. For women with overt hypothyroidism who are planning pregnancy, guidelines recommend optimisation of tsh before conception. Tsh and ft4 concentrations differ over the course of pregnancy, so results should be evaluated in the context of trimesterspecific reference intervals tsri. With personal stories and cuttingedge medical advice from leading. We do not recommend the use of armour thyroid for treatment of hypothyroidism. Care requires coordination among several healthcare professionals. There is an increased risk of complications in pregnancy if hypothyroidism is not carefully treated. Carney, do, naval hospital pensacola family medicine residency program, pensacola, florida jeff d. Furthermore, up to 18% of all pregnant women are thyroid peroxidase. There is an association between thyroid dysfunction and adverse pregnancy and fetal outcomes. May 06, 2016 management of thyroid dysfunction during pregnancy and postpartum. A 33 year old lady was referred to our joint antenatalendocrine clinic at 18 weeks gestation.
Different factors of maternal thyroid function occur during pregnancy. Thyroid disease in pregnancy american family physician. The thyroid gland can increase in size during pregnancy enlarged thyroid goiter. Oct 16, 2015 thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. British thyroid association, patient information statement on hypothyroidism and the press 2007. Thyroid dysfunction australian government department of. Subclinical hypothyroidism is more common than is overt hypothyroidism, and is usually defined as a serum thyroid stimulating hormone tsh concentration greater than the pregnancy specific reference range for each laboratory value, or by serum tsh concentrations greater than 25 miu.
Thyroid disorders and pregnancy childrens hospital of. Desiccated thyroid is not expected to be harmful to an unborn baby, but your dose needs may be different during pregnancy. Management of hypothyroidism in pregnancy with armour thyroid. Pregnancy impacts the functioning of the thyroid gland profoundly and is. Management of thyroid diseases during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on the pregnancy and the fetus. Outline treatment of hyperthyroidism during pregnancy. For the first 1820 weeks of pregnancy, the baby is completely dependent on the mother for the production of thyroid hormone. Thyroid diseases are common in women of childbearing age. In most cases surgery can be safely delayed until after delivery and with adequate management and outcome of pregnancy in women with thyroid. 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. Thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. An estimated 300,000 pregnancies annually in the u.
Thyroid disorders are prevalent in women of childbearing age and for this reason commonly present in pregnancy. It is five to tentimes more common in women than in. The thyroid is functioning normally if the tsh and free t4 remain in the trimesterspecific normal ranges throughout pregnancy. Thyroid function tests should be re checked after approximately 2 weeks to ensur e that a satisfactory ft4 level has been achieved free t4 16 21pmoll with ideally tsh of less than 2 mul. Thyroid function in pregnancy british medical bulletin. Selenoproteins protect thyroid tissue pregnancy, thyroid and selenium increased risk of thyroid disorders during pregnancy thyroid disorders have farreaching consequences for mother and child negative impact of hypothyroidism on the brain development of the baby risk screening identified only 20 percent of those affected. 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. Armour thyroid and combined thyroxinetriiodothyronine as thyroid hormone replacement. 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. The importance of trimesterspecific reference ranges for thyroid function tests in pregnancy has been established 5, 6. Aitd carries a risk for impaired fertility and is the main cause of hypothyroidism in pregnant women, with the prevalence of its overt form being 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. Among the recommendations is that all pregnant women should ingest approximately 250 micrograms of iodine daily. January 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy. This chapter focuses on identifying and treating women at high risk of the condition. Guideline title 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Pregnancy can be such a wonderful and joyful time, even though it has its struggles. Small amounts of thyroid can pass into breast milk, but this is not expected to harm a nursing baby. Guidelines for tshreceptor antibody measurements in pregnancy. Subclinical hypothyroidism and hypothyroidism in pregnancy cobs 46 4 3. Founder of dana trentini and thyroid health advocate and bestselling author mary shomon have both endured challenges with pregnancies due to thyroid disorders.
Management of thyroid dysfunction during pregnancy and. Subclinical hypothyroidism is defined by a normal free thyroxine in the presence of an elevated thyroid stimulating hormone tsh. Thyroid function tests change during pregnancy due to the influence of two main hormones. Guidelines of the american thyroid association for the. The american thyroid association ata has published new guidelines that cover most aspect of thyroid function and dysfunction during pregnancy and the postpartum period. Management of thyroid cancer during pregnancy poses distinct challenges due to concerns regarding maternal and fetal wellbeing. Developer american thyroid association ata funding source ata.
A statement from the british thyroid association executive committee, february 2007 3. Several studies, mostly retrospective, have shown an association between overt hypothyroidism and adverse fetal and obstetric outcomes e. Ata thyroid disease in pregnancy guidelines were pre viously published in 2011 1. The thyroid enlarges slightly in healthy women during pregnancy, but usually not enough for a health care professional to feel during a physical exam. We have developed evidencebased recommendations to. Guidelines for thyroid function testing in primary care. The difficulty lies in recognizing a thyroid problem during a time when some of the chief complaints fatigue, constipation and heat intolerance can be either the normal side effects of pregnancy or signals that something is wrong with the thyroid. The thyroid gland is a butterflyshaped endocrine gland that is normally located in the lower. 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. The revised guidelines for the management of thyroid disease in pregnancy include recommendations regarding the interpretation of thyroid function tests in pregnancy, iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxi. Production of thyroxine t 4 and triiodothyronine t 3 increases by 50%, along with a 50% increase in the daily iodine requirement.
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. In your healthy pregnancy with thyroid disease, they team up to give readers the answers they need. Thyroid disorders in pregnancy article pdf available in the journal of the association of physicians of india 59 supplsuppl. During gestation, women with hyperthyroidism should have their thyroid function checked every 34 weeks.
Pregnancy outcome can depend on optimal management of thyroid disorders. Management of differentiated thyroid cancer in pregnancy. 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. 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. Hashimotos is an autoimmune disorder and has an association with other autoimmune diseases such as type 1 diabetes mellitus. The gland increases 10% in size during pregnancy in iodinereplete countries and by 20%40% in areas of iodine deficiency.
Thyroid dysfunction in pregnancy pubmed central pmc. Pregnancy, thyroid, and the potential use of selenium. By mid pregnancy, the babys thyroid begins to produce thyroid hormone on its own. Diagnosis and management of thyroid disease during pregnancy. As per who guidelines, the recommended total dietary intake of. Management of antenatal subclinical hypothyroidism and subclinical hyperthyroidism. Thyroid disease and pregnancy ppt linkedin slideshare.
But theres another side of pregnancy that can be heartbreaking and devastatingand that is infertility and loss. 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. 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. Target population women with thyroid disease before, during, and. Sch is the commonest form of hypothyroidism in pregnancy and is usually due to progressive thyroid destruction due to autoimmune thyroid disease. Hypothyroidism, thyroid autoimmunity, and hyperthyroidism are common in pregnancy. Current international guidelines recommend the use of ptu in the first. Jun 24, 2016 january 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy.
During the last 20 years, it has been appreciated that thyroid physiology changes significantly during gestation. Tell your doctor if you become pregnant while taking this medicine. The himalayan goiter belt words largest belt from kashmir to naga hills. Hypothyroidism is one of several thyroid diseases in which the thyroid gland doesnt make enough thyroid hormone so levels of the hormone levels become low. Quinlan, md, uniformed services university of the health. Information you can trust from the leading experts in womens health care. When thyroid hormone levels are too low, it causes symptoms like tremors, weight loss and frequent bowel movements. Concerning thyroid disorders in pregnant women, thyroid dysfunctions, i. Pdf adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Any requirement for thyroid hormones before this time is solely supplied by the mother.
Hypothyroidism in pregnancy brochure pdf american thyroid. Lazarus j, brown rs, daumerie c, hubalewskadydejczyk a, negro r, vaidya b. Thyroid dysfunction involves either over or under activity of the thyroid gland. Hyperthyroidism in pregnancy brochure pdf american thyroid. In young women, differentiated thyroid cancer is the second most common malignancy diagnosed around the time of pregnancy. Severe, untreated hypothyroidism during pregnancy may cause complications that affect the baby and lead to delayed development. Diagnosis and treatment of hypothyroidism in pregnancy. P regnancy has a profound impact on the thyroid gland and thyroid function. Management of thyroid dysfunction during pregnancy and postpartum.
You can use this information to have a more meaningful conversation with your doctor. New guidelines for thyroid disease during pregnancy. Severe, untreated hypothyroidism during pregnancy may cause complications that affect the baby and lead to delayed. May 10, 2020 thyroid autoimmunity tai is the most common autoimmune disorder in women of reproductive age, with a prevalence varying between 5 and 15%. Thyroid hyperstimulation, caused by human chorionic gonadotrophin hcg at the end of the first trimester, is another physiological change during pregnancy. Hypothyroidism is the most common pregnancy related thyroid disorder, affecting 35% of all pregnant women. Hyperthyroidism in pregnancy american thyroid association. Management of hypothyroidism in pregnancy with armour. Thyroid disorders in pregnancy and postpartum australian. Thus, hyperthyroidism in pregnant women should be carefully. Graves disease represents the most common cause of maternal hyperthyroidism during pregnancy only 0. Subclinical hypothyroidism and hypothyroidism in pregnancy.
Thyroid disorders are prevalent in women of childbearing age and for this reason. Ideally, your thyroid blood tests should be checked before you start trying for a baby, so that your thyroxine dose can be adjusted if necessary. Because of the rapid growth of the literature relating to this topic, plans for. However, pregnancy associated goiters occur much more frequently in iodinedeficient areas of the world. Pelvic organ prolapse pev001 zika virus and pregnancy pev002 english spev002 spanish patient education infographics. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. A severe, lifethreatening form of hyperthyroidism, called thyroid storm, may complicate pregnancy. Thyroid dysfunction during pregnancy thyroid research. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. 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. This brochure will help you better understand hypothyroidism and pregnancy, and how hypothyroidism can be managed. By midpregnancy, the babys thyroid begins to produce thyroid hormone on its own.
Among the recommendations is that all pregnant women should ingest approximately 250 micrograms of. It is during the first trimester of pregnancy that the thyroid hormones are most important to fetal brain development. Managing thyroid disease during pregnancy, new ata guidelines. It has also been convincingly shown that most hypothyroid women need an increased. Pregnancy impacts the functioning of the thyroid gland profoundly and is associated with a 10%40% increase in the size of the gland iodine. Pdf to provide an overview of the pathophysiology of thyroid diseases in pregnancy and the various treatment methods currently available in its. Diagnosis and treatment of hyperthyroidism in pregnancy. A further increase in t4 dose may be required to achieve this ideal thyroid.
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