Tsh and ft4 concentrations differ over the course of pregnancy, so results should be evaluated in the context of trimesterspecific reference intervals tsri. 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. Management of thyroid dysfunction during pregnancy and postpartum. Production of thyroxine t 4 and triiodothyronine t 3 increases by 50%, along with a 50% increase in the daily iodine requirement. Maternal earlypregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy. 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 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. 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. 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. It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. 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. The american thyroid association ata has published new guidelines that cover most aspect of thyroid function and dysfunction during pregnancy and the postpartum period. This guideline covers investigating all suspected thyroid disease and managing primary thyroid disease related to the thyroid rather than the pituitary gland. It does not cover managing thyroid cancer or thyroid disease in pregnancy.
A detailed literature research on medline, cochrane library, embase, nlh, clinicaltrials. Thyroid disease and pregnancy ppt linkedin slideshare. 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. Women with thyroid disorders in pregnancy should be followed up by their gp in the postpartum period. 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. Management of thyroid dysfunction during pregnancy and.
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. Aug 01, 2018 changes in thyroid biochemistry during pregnancy lead to several challenges for both testing and interpreting the results of thyroid function tests. Thyroid disease is a group of disorders that affects the thyroid gland. In addition to other usual causes of hyperthyroidism see hyperthyroidism brochure, very high levels of hcg, seen in severe forms of morning sickness hyperemesis. Thyroid disorders in pregnancy and postpartum australian. Treatment for thyroid disease or disorders, depend on the type that caused it.
For women known to have hypothyroidism, an increase in thyroxine dose by 2040% when pregnancy is confirmed usually ensures they remain euthyroid. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. Thyroid disorders are common in pregnancy, and the most common disorder is subclinical hypothyroidism. 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.
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. Diagnose and manage complex thyroid disorders with comprehensive testing from quest thyroid disorders have many etiologies, manifestations, and potential therapies. Early and effective treatment of thyroid disorder ensures a safe pregnancy with minimal maternal and neonatal complications. 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. This medicine should not be used to treat obesity or weight problems. Obstetriciangynecologists are at the forefront of the diagnosis of all forms of thyroid disease, including hypothyroidism, hyperthyroidism, thyroid nodules, multinodular goiters, and thyroid cancer. Since the guidelines for the management of these disorders by the american thyroid association ata were. Acog practice bulletin on thyroid disease in pregnancy. Any patient discovered to have a thyroid nodule should be asked about any positive family history for the occurrence of a benignmalignant thyroid. Thyroid hormones control how your body uses energy, so they affect the way nearly every organ in your body. Notably normal thyroid test values change in pregnancy treatment for hypothyroidism is recommended when tsh levels are 2.
Thyroid disorders in pregnancy linkedin slideshare. Thyroid disorders, mostly hypothyroidism, being one of the common diseases during pregnancy, if untreated, affect the neuropsycho development of neonates. Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is thought to reduce these risks. Thyroid disorders and pregnancy childrens hospital of. South australian perinatal practice guidelines thyroid. Pregnancy hormones can cause changes in thyroid hormone levels. Physiology during pregnancy the thyroid gland undergoes hyperplasia and increased vascularity. Healthcare providers should check thyroid levels in their pregnant patients. Nov 27, 2018 luckily, thyroid disorders can be treated safely with medication during pregnancy, minimizing any risks to you or your baby.
The thyroid is a small, butterflyshaped gland in the front of your neck that makes thyroid hormones. Jan 15, 2017 these guidelines provide a superb overview on the pathophysiology and the clinical management of thyroid disorders during and after pregnancy. The thyroid enlarges slightly in healthy women during pregnancy, but usually not enough for a health care professional to feel during a physical exam. Thyroid disorders in pregnancy article pdf available in the journal of the association of physicians of india 59 supplsuppl.
South australian perinatal practice guidelines thyroid disorders in pregnancy. Sometimes the body produces too much or too little thyroid hormone. Both disorders mostly increased in size as the pregnancy progressed, returning to their pre. These conditions must be evaluated in a timely and costeffective manner. Pre pregnancy care significantly improves pregnancy outcomes especially for women with preexisting medical conditions such as diabetes and thyroid disorders. Thyroid diseases affect up to 5% of all pregnancies. The evaluation and treatment of pregnant women with thyroid disease parallel that of nonpregnant women and men but present some unique problems. Pregnancy related hormones raise the level of thyroid hormones in the blood. Thyroid disorders can range from a small, harmless goiter enlarged gland that needs no treatment to lifethreatening cancer. The thyroid diseaseshyperthyroidism and hypothyroidismare relatively common in pregnancy and important to treat. If medicine does not work, the thyroid gland may need to be removed.
If very sensitive imaging techniques ultrasound are used. A multidisciplinary approach can improve obstetric outcomes. Is there a connection between thyroid disorders and autism. A prospective study was undertaken during pregnancy in 120 euthyroid women presenting with mild thyroid abnormalities ta.
Summing up, the diagnosis and management of thyroid disorders during pregnancy differ substantially from those in general population. Oct 16, 2015 thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. The guidelines were compiled by american thyroid association guidelines taskforces selected for their expertise on the topic. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction.
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. South australian perinatal practice guidelines workgroup at. 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. Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery.
Managing thyroid problems during pregnancy or before reduces the risk of autism in children. Thyroid disease in pregnancy american family physician. Pregnancy impacts the functioning of the thyroid gland profoundly and is. There are a variety of thyroid disorders, that can cause a variety of symptoms such as dry skin, constipation, depression, nervousness, fatigue, intolerance to heat or cold, weight loss, weight gain, increased sweating, and heart palpitations. Thyroid disorders in pregnancy metro north hospital and. 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. Hyperthyroidism in pregnancy american thyroid association. According to current guidelines, universal screening is recommended in individuals at high risk for thyroid illness. Ask to see the results and make sure the doctor is using the most up to date references. The thyroid gland can increase in size during pregnancy enlarged thyroid goiter. Anyone who even suspects thyroid disease should get tested, preferably before pregnancy or as soon as possible. Pdf adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Among the recommendations is that all pregnant women should ingest approximately 250.
Obstetricians, endocrinologists, and perinatologists are often called upon to interact in the management of complex thyroid problems. Thyroid disorders are prevalent in women of childbearing age and for this reason commonly present as an intercurrent disease in pregnancy and the puerperium. Most of these conditions are treatable, and may affect mother and fetus adversely if they are not evaluated and managed appropriately. Some medicines may cause birth defects, pregnancy loss, prematurity, infant death, or developmental disabilities. Treatment guidelines during pregnancy treating for two. Graves disease represents the most common cause of maternal hyperthyroidism during pregnancy only 0.
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. But theres another side of pregnancy that can be heartbreaking and devastatingand that is infertility and loss. Overall, the most common cause of hyperthyroidism in women of childbearing age is graves disease see graves disease brochure, which occurs in 0. Almost every pregnant woman will face a decision about taking medicines before and during pregnancy. During gestation, women with hyperthyroidism should have their thyroid function checked every 34 weeks. 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 are encountered frequently during pregnancy and the postpartum period. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. Another separate issue relates to screening for thyroid dysfunction before and during pregnancy. Thyroid function and thyroid disorders during pregnancy. P regnancy has a profound impact on the thyroid gland and thyroid function. Endocrine disorders in pregnancy pdf free download. You may not be able to use desiccated thyroid if you.
Potential problems include preeclampsia, prematurity and congenital abnormality. May 02, 2019 desiccated thyroid treats hypothyroidism low thyroid hormone. 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 disease is a disorder that affects the thyroid gland. January 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy. Pregnancy provides an opportunity for ongoing health promotion in women with endocrine disorders such as diabetes. Management of antenatal subclinical hypothyroidism and subclinical hyperthyroidism. 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.
Thyroid dysfunction in pregnancy has consequences for mother and baby. Learning objectives to gain an overview of the effect of thyroid disorders on reproductive health. As per who guidelines, the recommended total dietary intake of iodine is 250. 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. Pregnancy may affect the course of these thyroid disorders and, conversely, thyroid diseases may affect the course of pregnancy. A severe, lifethreatening form of hyperthyroidism, called thyroid storm, may complicate pregnancy.
An overview of thyroid physiology and disease during pregnancy is presented here. The gland increases 10% in size during pregnancy in iodinereplete countries and by 20%40% in areas of iodine deficiency. 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. Antenatal, antithyroid drug, hyperthyroidism, hypothyroidism, thyroid cancer, thyroid nodules. Kebebew and modified from the article by brito and colleagues patterns of use, efficacy, and safety of treatment options for patients with graves disease.
Thyroid disease in pregnancy is a common clinical problem. Your doctor will check your thyroid hormone levels every 6 to 8 weeks during pregnancy and 4 weeks after a change in dose. Thyroid disorders in pregnancy dr ajay sdhawle associateprofessor,obgy jnmcsawangi 2. Thyroid hormone deficiencies are known to be detrimental for.
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. Moreover, thyroid disorders and their management may affect both the pregnant woman and the developing fetus. In addition, they also define areas where additional research is needed. Ata professional guidelines american thyroid association. Thyroid storm a lifethreatening condition, requiring early recognition and aggressive therapy in an intensive care unit setting. 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. Guidelines of the american thyroid association for the.
However, not all medicines are safe to take during pregnancy. As a result, diagnosing both hypo and hyperthyroidism can be challenging. It aims to improve quality of life by making recommendations on diagnosis, treatment, longterm care and support. Thyroid disease is the second most common endocrine condition encountered in women of childbearing age after diabetes. Current guidelines recommend targeted screening of women at high risk, including those with a history of thyroid disease, type 1 diabetes.
Thyroid disease isnt something to mess around with, especially before and during pregnancy. Managing thyroid disease during pregnancy, new ata guidelines. Pregnancy can be such a wonderful and joyful time, even though it has its struggles. However, pregnancyassociated goiters occur much more frequently in iodinedeficient areas of the world. Treating for two is a program that aims to improve the health of women and babies by. 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. 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.
Guidelines for diagnosis and management of thyroid disease. Stimulation of thyroid function by hcg during pregnancy. New guidelines for thyroid disease during pregnancy. Key issues remain regarding the clinical usefulness of diagnosis and treatment of thyroid disorders during pregnancy that should be addressed in future studies. Postpartum thyroiditis may present months after delivery. Since the guidelines for the man agement of these disorders by the american thyroid. Jul 08, 2019 a growing body of evidence confirms that thyroid disorders are strongly associated with autism risk. Thyroid hormones are necessary for the babys brain development while in the womb. A nationwide populationbased study representing the three treatment options for graves disease with different failure rates and associated complication. Pregnancy has a considerable effect on maternal thyroid function. Maternal early pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy. The most common cause of hyperthyroidism in pregnancy is graves disease, which accounts for 8590% of all cases. According to recent american thyroid association ata guidelines, the recommended reference ranges for tsh are 0. Thyroid disorders are among the common endocrine disorders in pregnant women after diabetes mellitus.