Correspondingly, there is concern about the effect of overt ie, symptomatic maternal thyroid disease and even subclinical maternal. Pregnancy complicationstherapy thyroid crisisdiagnosis. Thyroid dysfunction in pregnancy has consequences for mother and baby. For women known to have hypothyroidism, an increase in thyroxine dose by 2040% when pregnancy is confirmed usually ensures they remain euthyroid. Guidelines centers for disease control and prevention. Hypothyroidism is the most common form of thyroid dysfunction during pregnancy. Aug 01, 2018 in addition to women with preexisting thyroid disease e. Thyroid disorders in pregnancy and postpartum australian. Potential problems include preeclampsia, prematurity and congenital abnormality. These conditions must be evaluated in a timely and costeffective manner.
May 15, 2002 the committee on practice bulletinsobstetrics of the american college of obstetricians and gynecologists acog has developed a practice guideline on thyroid disease in pregnancy. The thyroid is a small, butterflyshaped gland in the front of your neck that makes thyroid hormones. The gland increases 10% in size during pregnancy in iodinereplete countries and by 20%40% in areas of iodine deficiency. In 2015 there are now 7 level a recommendations by.
Diagnosis and treatment of hypothyroidism in pregnancy. During gestation, women with hyperthyroidism should have their thyroid function checked every 34 weeks. Although some symptoms of hyperthyroidism are similar to normal symptoms of pregnancy or some nonthyroidassociated diseases, the results of serum thyroid. Thyroid screening in pregnancy international journal of. Despite being the majority of thyroid sufferers, women rarely know that thyroid problems increase their risk of pregnancy complications, including infertility, preeclampsia, miscarriage, premature delivery, and low birth weight. Thyroid disease in pregnancy background thyroid disorders are common in young women and may first come to attention when the patient presents for pregnancy care. An overview of thyroid physiology and disease during pregnancy is presented here. Production of thyroxine t 4 and triiodothyronine t 3 increases by 50%, along with a 50% increase in the daily iodine requirement. P regnancy has a profound impact on the thyroid gland and thyroid function. Anyone who even suspects thyroid disease should get tested, preferably before pregnancy or as soon as possible. Thyroid disease in pregnancy american family physician.
American college of obstetricians and gynecologists. Acog clinical is designed for easy and convenient access to the latest clinical guidance for patient care. How to manage hypothyroid disease in pregnancy mdedge obgyn. Thyroid stimulating antibodies risk of immunemediated fetal hypothyroidism and hyperthyroidism thyroid stimulating immunoglobulins tsi stimulate fetal thyroid 15% of neonates have hyperthyroidism or neonatal graves disease tshbinding inhibitory immunoglobulins inhibit fetal thyroid decreased occurrence with maternal treatment during pregnancy. Alexander ek, pearce en, brent ga et al 2017 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid. The thyroid and pregnancy even before conception, thyroid conditions that have lingered untreated can hinder a womans ability to become pregnant or can lead to miscarriage. Thyroid dysfunction australian government department of health. Graves or hashimotos diseases or family history of thyroid disease, women with clinical signs andor symptoms of thyroid disease should also be screened. For women with overt hypothyroidism who are planning pregnancy, guidelines recommend optimisation of tsh before conception. Various physiologic changes during pregnancy make evaluation of thyroid function during gestation different from that in nongravid women see figure 1 and table 1.
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 evaluation and treatment of pregnant women with thyroid disease parallel that of nonpregnant women and men but present some unique problems. Opioid use and opioid use disorder in pregnancy obstet gynecol. Committee on practice bulletinsobstetrics acog practice bulletin number 148. Approximately 18% of all women are categorized in the highestrisk group for overt hypothyroidism in pregnancy. Clinical management guidelines for obstetriciangynecologists. Hypothyroidism during pregnancy should be treated with levothyroxine, with a serum tsh. Pregnancy has a profound effect on thyroid gland function, and thyroid disease is common in pregnancy. Jul 11, 2019 research grant to study the action of tregulatory cells in thyroid antibodypositive pregnant women awarded to stephanie behringermassera, md, by the american thyroid association by ata 2018 news releases, basic science research, news releases, thyroid disease and pregnancy, thyroid research grants. Thyroid disease and pregnancy american thyroid association. Effect of treatment of maternal subclinical hypothyroidism or hypothyroxinemia on iq in offspring. Thyroid dysfunction australian government department of. Thyroid disease and pregnancy ppt linkedin slideshare. We do not recommend the use of armour thyroid for treatment of hypothyroidism.
Research grant to study the action of tregulatory cells in thyroidantibodypositive pregnant women awarded to stephanie behringermassera, md, by the american thyroid association by ata 2018 news releases, basic science research, news releases, thyroid disease and pregnancy, thyroid research grants. Many studies have examined maternal and fetal complication rates in treated and untreated overt and subclinical hypothyroidism to clarify whether all pregnant women should be screened for thyroid disease, and whether they should be treated if they have subclinical hypothyroidism, isolated hypothyroxinaemia, or are. Acog guidelines at a glance thyroid disease in pregnancy. Ask to see the results and make sure the doctor is using the most up to date references. Antithyroid drug therapy for graves disease during pregnancy. The aim is to study the fetomaternal outcome of pregnant women. Management of hypothyroidism in pregnancy with armour. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery. Hence thyroid function test becomes essential to know the thyroid status in pregnancy and also to detect the subclinical disease.
Dec 05, 2018 fetal thyroid disease, infection, anemia, hearing loss. Alexander ek, pearce en, brent ga et al 2017 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Uncorrected thyroid dysfunction in pregnancy has adverse effects on fetal and maternal wellbeing. The committee on practice bulletinsobstetrics of the american college of obstetricians and gynecologists acog has developed a practice guideline on thyroid disease in pregnancy. Several studies, mostly retrospective, have shown an association between overt hypothyroidism and adverse fetal and obstetric outcomes e. A 33 year old lady was referred to our joint antenatalendocrine clinic at 18 weeks gestation. Universal screening for thyroid disease during pregnancy. Jan 15, 2017 pregnancy has a profound effect on thyroid gland function, and thyroid disease is common in pregnancy.
Diagnosis and management of thyroid disease in pregnancy. Thyroid illness may follow an infection of the thyroid or an autoimmune condition, such as hashimotos disease, or it could result from surgical removal of part, or all, of the thyroid. Thyroid diseases affect up to 5% of all pregnancies. Acog practice bulletin on thyroid disease in pregnancy. Do not do universal screening for thyroid disease in pregnancy. Thyroid hormones control how your body uses energy, so they affect the way nearly every organ in your body. Diagnosis and treatment of hyperthyroidism in pregnancy. Many studies have examined maternal and fetal complication rates in treated and untreated overt and subclinical hypothyroidism to clarify whether all pregnant women should be screened for thyroid disease, and whether they should be treated if they have subclinical hypothyroidism, isolated hypothyroxinaemia, or. In this disease, the immune systemyour bodys natural defense against diseasemistakes cells in the thyroid gland for harmful invaders. Correspondingly, there is concern about the effect of overt ie, symptomatic maternal thyroid disease and even subclinical maternal thyroid disease on fetal development. Thyroid disease is the second most common endocrine disorder affecting women of. Iodine requirements uplasma iodide levels decrease during pregnancy due to fetal theft of iodide and increased renal clearance uassociated with noticeable increase in thyroid gland size in 15% of women that returns to normal after birth uacog recommends 220 mcg of iodine daily during pregnancy uis only some a minority of prenatal vitamins uother sources of iodine include vegetables, fruits. Given the rapidity of advances in this field, it is not surprising that controversy surrounds optimal detection and management of thyroid disease in the pregnant woman.
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. The 2015 acog practice bulletin points out that methimazole has been associated with fetal esophageal or. The most common type of thyroiditis is called hashimoto disease. South australian perinatal practice guidelines workgroup at.
Jul 30, 2019 thyroid disease isnt something to mess around with, especially before and during pregnancy. Universal screening for thyroid disease in pregnancy can identify patients with thyroid disease requiring treatment, and ultimately decrease rates of complications. Thyroid disease is a group of disorders that affects the thyroid gland. Universal screening is costeffective compared to the currently accepted practice of targeted screening and may even be costsaving in some healthcare systems. In addition to women with preexisting thyroid disease e. A normal pregnancy results in a number of important reversible physiological and hormonal changes that alter thyroid structure and more importantly function. South australian perinatal practice guidelines thyroid. Understanding these change are important to interpreting, identifying and managing of thyroid disease in pregnancy.
Management of thyroid dysfunction during pregnancy and postpartum. Thyroid disorders are prevalent in women of childbearing age and for this reason commonly present as an intercurrent disease in pregnancy and the puerperium. Developed with members, physicians, and womens health care professionals needs in mind, userfriendly features include. The guidelines are divided into the following nine areas. Optimal care of the pregnant woman with thyroid disease. Thyroid disease during pregnancy has certain characteristics that make writing guidelines more complicated than for some other fields. Graves disease represents the most common cause of maternal hyperthyroidism during pregnancy only 0. Hypothyroxinemia and tpoantibody positivity are risk factors for premature delivery. Since the guidelines for the management of these disorders by the. Subscribe now to access exclusive acog clinical content, including. The most common cause of hypothyroidism is a disorder known as thyroiditisan inflammation of the thyroid gland.
Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is. 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. Management of thyroid dysfunction during pregnancy and. Oct 16, 2015 thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. Thyroid disease in pregnancy uncontrolled thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. Thyroid dysfunction in pregnancy is clinically important as insufficient thyroxine is associated with an increased risk of premature birth, low birth weight and miscarriage. Treatment for hypothyroidism during pregnancy consists of daily taking a daily synthetic thyroid hormone, and continuing to take it throughout pregnancy. Obstetriciangynecologists are at the forefront of the diagnosis of all forms of thyroid disease, including hypothyroidism, hyperthyroidism, thyroid nodules, multinodular goiters, and thyroid cancer.
Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is thought to reduce these risks. Reference ranges for thyroid hormones are different in pregnancy especially in the third trimester,when there is a move towards the hypothyroid end of the spectrum. Hashimotos is an autoimmune disorder and has an association with other autoimmune diseases such as type 1 diabetes mellitus. 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. Fortunately, most thyroid problems that affect pregnancy are easily treated. Guidelines for diagnosis and management of thyroid disease. Guidelines of the american thyroid association for the. 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. Thyroid disease in pregnancy is a common clinical problem. Thyroid testing in pregnancy should be performed on symptomatic women and those with a personal history of thyroid disease or medical conditions associated with. Subclinical hypothyroidism and hypothyroidism in pregnancy cobs 46 4 3.
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