scholarly journals The Treatment of Hypothyroidism in Pregnancy

2017 ◽  
Vol 24 (2) ◽  
pp. 155-160
Author(s):  
Rucsandra Dănciulescu Miulescu ◽  
Andrada Doina Mihai
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Hormone Deficiency ◽  
Specific Reference ◽  
Overt Hypothyroidism ◽  
American Thyroid Association ◽  
Diagnosis And Management ◽  
Pregnancy And Postpartum ◽  
In Pregnancy

Abstract Hypothyroidism is a pathologic condition generated by the thyroid hormone deficiency. The American Thyroid Association advises for the screening of hypothyroidism beginning at 35 years and thereafter every 5 years in people at high risk for this condition: females older than 60 years, pregnant women, patients with other autoimmune disease or patients with a history of neck irradiation. In pregnant women, hypothyroidism can been associated with adverse effect for both mother and child. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ recommends the treatment of maternal overt hypothyroidism: females with a thyrotropin (TSH) level higher than the trimester-specific reference interval and decreased free thyroxine (FT4), and females for which TSH level is higher than 10.0 mIU/L, irrespective of the FT4 value, with administration of oral levothyroxine. The goal of treatment of maternal overt hypothyroidism is to bring back the serum TSH values to the reference range specific for the pregnancy trimester. The Guidelines of the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ recommends treatment of pregnancy associated subclinical hypothyroidism with the following levothyroxine doses: „1.20 μg/kg/day for TSH≤4.2 mU/l, 1.42 μg/kg/day for TSH >4.2-10 and 2.33 μg/kg/day for overt hypothyroidism“. The „Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum“ and the „European Thyroid Association for the Management of Subclinical Hypothyroidism in Pregnancy and in Children“ do not recommend the treatment of isolated hypothyroxinemia in pregnancy.

scholarly journals Thyroid screening in pregnancy - a compulsory preventive activity

2015 ◽  
Vol 21 (3) ◽  
pp. 151-156
Author(s):  
Olesea Scrinic ◽  
E. Circo
Keyword(s):  
Pregnant Women ◽  
Thyroid Dysfunction ◽  
Reference Range ◽  
The Black Sea ◽  
Specific Reference ◽  
Overt Hypothyroidism ◽  
American Thyroid Association ◽  
Thyroid Disorder ◽  
Entire Study ◽  
In Pregnancy

ABSTRACT Obiectives: To assess the prevalence of thyroid dysfunction in a group of pregnant women, originating from Dobrogea region of southeastern Romania, considered to be an area without iodine deficiency, including the Black Sea area. Materials and methods: We enrolled 324 pregnant women in different trimesters of pregnancy. Each case was reviewed by a detailed madical history, clinical examination and by serum dosage of thyroid hormones: TSH, FT4, and the antithyroidperoxidase. They were evaluated by comparison with trimester -specific reference range for TSH recommended by American Thyroid Association, then the results were compared with those obtained using the manufacturers reference range. Abortion rate was also analysed. Results: The prevalence of thyroid dysfunction was different in all the 3 trimesters: subclinical hypothyroidism being the most frequently approx. 24% of all cases; 7% of pregnant women had overt hypothyroidism. Incidence of thyrotoxicosis in entire study cases was approx. 5.5%. The most frecvent thyroid autoimune disorders were Hashimoto thyroiditis: 42 % - I trimester, 26,6% in II trimester and about 12,5 % in III-trimester; Graves disease have an incidence of only 0,9 % (n=3).The difference between reference methods eluded a lower number of cases using manufactures reference range for TSH (P< 0,001), but higher for recommended trimester - specific TSH value, confirming the undervalueted hypothesis. The risk of misclassifying the hypothyroidism is between 3 %-8 %. Conclusion: Necessity for thyroid hormone dosage periodic/trimesterly/ in pregnancy is a preventive measure. The reference values for hormonal dosage requires trimester-specific assessment. The possibility of hormonal disorders during pregnancy is common. The need for specific therapy at diagnosis depends on the nature of hormonal disorder. Further precautions are needed in pregnant women with known autoimmune thyroid disorder or newly diagnosed

scholarly journals Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome

2015 ◽  
Vol 40 (2) ◽  
pp. 52-57 ◽  
Author(s):  
M Sharmeen ◽  
PA Shamsunnahar ◽  
TR Laita ◽  
SB Chowdhury
Keyword(s):  
Adverse Effects ◽  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Perinatal Outcomes ◽  
Fetal Outcome ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Adequate Treatment ◽  
In Pregnancy

Objectives: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome.Methods: We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted.Results: Overt hypothyroidism was significantly (p<0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p<0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P=0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p<0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.Bangladesh Med Res Counc Bull 2014; 40 (2): 52-57

scholarly journals Prevalence of thyroid disorders in pregnancy

2018 ◽  
Vol 7 (9) ◽  
pp. 3493
Author(s):  
Sangeeta Pahwa ◽  
Sabia Mangat
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Fetal Outcome ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Subclinical Hyperthyroidism ◽  
Thyroid Screening ◽  
In Pregnancy

Background: Thyroid disorders are among the common endocrine problems in pregnant women. Often overlooked in pregnancy due to nonspecific symptoms and hyper-metabolic state of pregnancy. Western literature shows prevalence of hypothyroidism in pregnancy as 2.5% and hypothyroidism as 0.1-0.4%. There is paucity of data on prevalence of thyroid disorders in India pregnant population. This study was carried out to know prevalence of thyroid disorders in pregnant women in Indian population.Methods: One hundred pregnant women attending antenatal clinic in first trimester were registered. Detailed history and examination was done. Apart from routine basic and obstetrical investigations, TSH, FT3 and FT4 level estimation was done.Results: Prevalence of thyroid dysfunction was high in this study in first trimester pregnant women, with subclinical hypothyroidism in 6%, overt hypothyroidism in 2%, subclinical hyperthyroidism 2 % and overt hyperthyroidism 0%.Conclusions: Prevalence of thyroid disorders, especially subclinical hypothyroidism (6%), overt hypothyroidism (2%) and subclinical hyperthyroidism (2%) was high. To prevent adverse effects on maternal and fetal outcome, we are emphasizing the importance of routine antenatal thyroid screening.

scholarly journals Practice Variation in the Care of Subclinical Hypothyroidism During Pregnancy: A National Survey of Physicians in the United States

2019 ◽  
Vol 3 (10) ◽  
pp. 1892-1906 ◽  
Author(s):  
Freddy J K Toloza ◽  
Naykky M Singh Ospina ◽  
Rene Rodriguez-Gutierrez ◽  
Derek T O’Keeffe ◽  
Juan P Brito ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Online Survey ◽  
The United States ◽  
American Thyroid Association ◽  
Clinical Practices ◽  
Endocrine Society ◽  
Clinical Scenarios ◽  
In Pregnancy ◽  
Current Practices

Abstract Evidence regarding the effects of subclinical hypothyroidism (SCH) on adverse pregnancy outcomes and the ability of levothyroxine (LT4) treatment to prevent them is unclear. Available recommendations for the management of SCH during pregnancy are inconsistent. We conducted a nationwide survey among physicians assessing their knowledge of and current practices in the care of SCH in pregnancy and compared these with the most recent American Thyroid Association (ATA) recommendations. In this cross-sectional study, an online survey was sent to active US members of the Endocrine Society. This survey included questions about current practices and clinical scenarios aimed at assessing diagnostic evaluation, initiation of therapy, and follow-up in pregnant women with SCH. In total, 162 physicians completed the survey. ATA guidelines were reviewed by 76%, of whom 53% indicated that these guidelines actually changed their practice. Universal screening was the preferred screening approach (54%), followed by targeted screening (30%). For SCH diagnosis, most respondents (52%) endorsed a TSH level >2.5 mIU/L as a cutoff, whereas 5% endorsed a population-based cutoff as recommended by the ATA. The decision to initiate treatment varied depending on the specific clinical scenario; however, when LT4 was initiated, respondents expected a small/very small reduction in maternofetal complications. In conclusion, despite recently updated guidelines, there is still wide variation in clinical practices regarding the care of women with SCH in pregnancy. Highly reliable randomized trials are required to evaluate the effectiveness of the most uncertain treatment practices on the care of pregnant women with SCH.

scholarly journals Review of American Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum

2018 ◽  
Vol 14 (3) ◽  
pp. 128-139
Author(s):  
Valentin V. Fadeyev
Keyword(s):  
Thyroid Disease ◽  
Critical Appraisal ◽  
Clinical Decision Making ◽  
Task Force ◽  
Synthesis Methods ◽  
American Thyroid Association ◽  
Thyroid Function Tests ◽  
Diagnosis And Management ◽  
Published Evidence ◽  
In Pregnancy

Thyroid disease in pregnancy is a common clinical problem. 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. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid disease in women during pregnancy, preconception, and the postpartum period. The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations. The guideline task force had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. 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, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy, and directions for future research. We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid disease in pregnant and postpartum women. While all care must be individualized, such recommendations provide, in our opinion, optimal care paradigms for patients with these disorders.

scholarly journals Mild Anemia May Affect Thyroid Function in Pregnant Chinese Women During the First Trimester

2021 ◽  
Vol 12 ◽  
Author(s):  
Guan-ying Nie ◽  
Rui Wang ◽  
Peng Liu ◽  
Ming Li ◽  
Dian-jun Sun
Keyword(s):  
Pregnant Women ◽  
Thyroid Function ◽  
Normal Control ◽  
Subclinical Hypothyroidism ◽  
First Trimester ◽  
Specific Reference ◽  
American Thyroid Association ◽  
Mild Anemia ◽  
Upper Limit ◽  
Tsh Levels

BackgroundPregnant women are often susceptible to anemia, which can damage the thyroid gland. However, compared with moderate and severe anemia, less attention has been paid to mild anemia. The purpose of this study was to evaluate the effect of mild anemia on the thyroid function in pregnant women during the first trimester.MethodsA total of 1,761 women in the first trimester of their pregnancy were enrolled from Shenyang, China, and divided into mild anemia and normal control groups based on their hemoglobin levels. Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) levels were compared between the two groups.ResultsThe TSH levels of pregnant women with mild anemia were higher than those of pregnant women without mild anemia (p &lt; 0.05). Normal control women were selected to set new reference intervals for TSH, FT3, and FT4 levels during the first trimester, which were 0.11–4.13 mIU/l, 3.45–5.47 pmol/l, and 7.96–16.54 pmol/l, respectively. The upper limit of TSH 4.13 mU/l is close to the upper limit 4.0 mU/l recommended in the 2017 American Thyroid Association (ATA) guidelines, indicating that exclusion of mild anemia may reduce the difference in reference values from different regions. Mild anemia was related to 4.40 times odds of abnormally TSH levels (95% CI: 2.84, 6.76) and 5.87 increased odds of abnormal FT3 (95% CI: 3.89, 8.85). The proportion of hypothyroidism and subclinical hypothyroidism in patients with mild anemia was higher than that in those without anemia (0.6% vs. 0, p = 0.009; 12.1% vs. 1.9%, p &lt; 0.001). Mild anemia was related to 7.61 times increased odds of subclinical hypothyroidism (95% CI: 4.53, 12.90).ConclusionsMild anemia may affect thyroid function during the first trimester, which highlights the importance of excluding mild anemia confounding when establishing a locally derived specific reference interval for early pregnancy.

scholarly journals Subclinical Hypothyroidism in Pregnancy - A Case Series

2017 ◽  
Vol 16 (1) ◽  
pp. 53-60
Author(s):  
Samir Sahu ◽  
Praruti Dash ◽  
Subhasree Ray
Keyword(s):  
Pregnant Women ◽  
Subclinical Hypothyroidism ◽  
Large Population ◽  
Medical Science ◽  
Treatment Protocol ◽  
Case Series ◽  
Overt Hypothyroidism ◽  
Foetal Development ◽  
Beneficial Effects ◽  
In Pregnancy

Background: Effects of overt hypothyroidism on pregnancy outcomes and foetal development are well established and treatment protocol is reputable.Method and material: The prevalence and effects of subclinical hypothyroidism (SCH) on pregnancy are not yet clear. Hence, universal screening of all pregnant women is still debatable and treatment of detected sub clinical hypothyroidism is yet to have general consensus as data regarding beneficial effects of treatment to mother and foetus in SCH cases is inadequate.Result: Odisha is a known endemic area of Iodine deficiency and reports of occurrences of SCH in Odisha are very limited. This study is a case series, done to detect the prevalence of SCH in pregnancy in the ante-natal unit of a medical college and hospital catering to a large population of Odisha.Conclusion: This prospective study included screening of the pregnant women for thyroid function and follow – up of the cases with SCH till confinement to record any adverse effects of the thyroid dysfunction on obstetric outcome.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.53-60

scholarly journals Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum

Thyroid ◽  
2011 ◽  
Vol 21 (10) ◽  
pp. 1081-1125 ◽  
Author(s):  
Alex Stagnaro-Green ◽  
Marcos Abalovich ◽  
Erik Alexander ◽  
Fereidoun Azizi ◽  
Jorge Mestman ◽  
...  
Keyword(s):  
Thyroid Disease ◽  
American Thyroid Association ◽  
Diagnosis And Management ◽  
Pregnancy And Postpartum

Thyroid disease during pregnancy

2011 ◽  
pp. 547-552 ◽  
Author(s):  
John H. Lazarus ◽  
L.D. Kuvera ◽  
E. Premawardhana
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Overt Hypothyroidism ◽  
Thyroid Disorders ◽  
Childbearing Age ◽  
Thyroid Function Testing ◽  
Appropriate Therapy ◽  
Function Testing ◽  
In Pregnancy

Thyroid disorders are common. The prevalence of hyperthyroidism is around 5/1000 in women and overt hypothyroidism about 3/1000 in women. Subclinical hypothyroidism has a prevalence in women of childbearing age in iodine-sufficient areas of between 4% and 8%. As these conditions are generally much more common in females, it is to be expected that they will appear during pregnancy. Developments in our understanding of thyroid physiology (1) and immunology (2) in pregnancy, as well as improvements in thyroid function testing (3), have highlighted the importance of recognizing and providing appropriate therapy to women with gestational thyroid disorders. Before considering the clinical entities occurring during and after pregnancy it is useful to briefly review thyroid physiology and immunology in relation to pregnancy.

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