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. Guidelines for thyroid function testing in primary care. Thyroid hormones of the fetus exclusively comes from mothers in early pregnancy, indicating that maternal hypothyroidism has a closeknit relationship with fetal growth and neuropsychological development. Management of thyroid dysfunction during pregnancy and. Among the recommendations is that all pregnant women should ingest approximately 250. The prevalence of hypothyroidism during pregnancy is estimated to be 0. For example, one study found tsh values were elevated at 11 weeks gestation in 202 women with. The authors conclude that undiagnosed hypothyroidism in pregnant women may adversely affect their fetuses. Hyperthyroidism in pregnancy american thyroid association. Getting pregnant with hypothyroidism being the parent. During the first few months of pregnancy, the fetus relies on the mother for thyroid hormones. Management of thyroid dysfunction during pregnancy and postpartum. Thyroid testing in pregnancy should be performed on symptomatic women and those with a personal history of thyroid disease or medical. Hypothyroidism in pregnancy home womens healthcare.
Hypothyroidism can also interfere with the development of an embryo fertilized egg. Guidelines of the american thyroid association for the. The thyroid gland is a butterflyshaped endocrine gland that is normally located in the lower front of the neck. Diagnosis and management of subclinical hypothyroidism in. Managing thyroid disease during pregnancy, new ata guidelines. Thyroid hormones play an essential part in normal brain development. These advances relate to the optimal management of pregnant women on levothyroxine therapy, the impact of iodine deficiency on the mother and developing fetus, the adverse effect of maternal hypothyroidism on mental development in their infants, the syndrome of postpartum thyroiditis, and its relation to permanent hypothyroidism. In the united states, the most common cause of an underactive thyroid during pregnancy is a condition called hashimotos disease, or hashimotos thyroiditis. Constipation in pregnancy tina sara verghese mbbs,a, kaori futaba frcs mmedsci,b pallavi latthe md mrcog c aclinicalresearchfellow,obstetricsandgynaecology,birminghamwomensnhsfoundationtrust,edgbaston,birmingham,westmidlandsb15 2tg, uk bconsultant colorectal surgeon, department of colorectal surgery, queen elizabeth. 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. Hypothyroidism can occur during pregnancy due to the initial presentation of hashimotos thyroiditis, inadequate treatment of a woman already known to have hypothyroidism from a variety of causes, or overtreatment of a hyperthyroid woman with anti. How to manage hypothyroid disease in pregnancy mdedge obgyn.
For women with overt hypothyroidism who are planning pregnancy, guidelines recommend optimisation of tsh before conception. Hypothyroidism in pregnancy american thyroid association. Thyroid disease in pregnancy american family physician. Ppt hypothyroidism in pregnancy powerpoint presentation. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Most of these studies have assessed thyroid function during the late.
Thyroid disease in pregnancy is a common clinical problem. Subclinical hypothyroidism in the infertile female. Thyroid disorders in pregnancy and postpartum australian. International federation of gynecology and obstetrics. This brochure will help you better understand hypothyroidism and pregnancy, and how hypothyroidism can be managed. In addition to other usual causes of hyperthyroidism see hyperthyroidism brochure, very high levels of hcg, seen in severe forms of morning sickness hyperemesis gravidarum, may cause transient hyperthyroidism in early pregnancy. Hypothyroidism in pregnancy is usually caused by hashimotos disease and occurs in 2 to 3 out of every 100 pregnancies.
Untreated hypothyroidism, even a mild version, may contribute to pregnancy complications. Deprivation of the maternal thyroid hormone due to hypothyroidism can have irreversible effects on the fetus. Tsh levels and risk of miscarriage in women on longterm levothyroxine. The aim of this article was to summarize the reported results of the literature related to the management of thyroid disease during pregnancy in order to help. The aim of these guidelines is to inform clinicians, patients. A retrospective study of 150 women with hypothyroidism, 99 of whom were on treatment before conception, found that when treatment was inadequate thyrotropin. American college of obstetricians and gynecologists.
The incidence of hypothyroidism during pregnancy is estimated to be 0. When thyroid hormone levels are too low, it causes symptoms like tremors, weight loss and frequent bowel movements. Hypothyroidism in pregnancy weiping teng, zhongyan shan, komal patilsisodia, david s cooper hypothyroidism is the most common pregnancy related thyroid disorder, a. Data sources include ibm watson micromedex updated 4 may 2020, cerner multum updated 4 may. Overall, the most common cause of hypothyroidism is the autoimmune disorder known as hashimotos thyroiditis see hypothyroidism brochure. About hypothyroidism in women, the risk of developing hypothyroid ism increases with age and during pregnancy, the postpartum period, and menopause garber et al. Overt hyperthyroidism during pregnancy was not prevalent and was reported in 2 out of pregnancies 0. Subclinical hypothyroidism also needs to be detected and treated to.
Thyroid disorders and pregnancy childrens hospital of. Overt hypothyroidism should be treated before conception with levothyroxine as the first choice with a goal of tsh less than 2. During pregnancy, there is a gradual increase in the requirements of t4 from four to six weeks to 1620 weeks of gestation. Other causes include radioiodine ablation of thyroid while treating hyperthyroidism or thyroid cancer, surgery of. Subclinical hypothyroidism is more common than is overt hypothyroidism, and is usually defined as a serum thyroidstimulating hormone tsh concentration greater than the pregnancyspecific reference range for each laboratory value, or by serum tsh concentrations. Women with preexisting hypothyroidism need to increase their thyroxine dose by approximately 30% in pregnancy this is best achieved by taking two additional doses per week in most cases increasing from seven to nine doses per week on suspicion or confirmation of pregnancy. January 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy.
Hypothyroidism and pregnancy overt untrea ted hypothyroidism is associated with fetal loss, gestational hypertension, placental abruption, poor perinatal outcome and severe neurodevelopmental delay. Clinical practice guidelines for hypothyroidism in adults. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 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. Jessica gray msiv april, 2011 casey and leveno fig. The american thyroid association taskforce on thyroid disease during pregnancy and postpartum alex stagnarogreen chair, 1 marcos abalovich, 2 erik alexander, 3 fereidoun azizi, 4 jorge mestman, 5 roberto negro, 6 angelita nixon, 7 elizabeth n. Iodine deficiency is the most common cause of hypothyroidism worldwide vanderpump, 2011. Treatment with sufficient amounts of thyroid hormone replacement significantly reduces the risk for developing pregnancy complications associated with hypothyroidism, such as premature birth, preeclampsia, miscarriage, postpartum hemorrhage, anemia and. 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. Autoimmune thyroiditis is the commonest cause of hypothyroidism during pregnancy. Subclinical hypothyroidism is defined as elevated tsh with normal ft 4 and ft 3 in an asymptomatic patient. Also, if you are pregnant and your hypothyroidism is not treated, your baby may be born prematurely before the predicted due date, weigh less than normal, and have lowered mental capacity. Primary, prevention of hypothyroidism is by a healthy diet and iodised fortified salt especially in iodine deficient areas.
The prevalence of hypothyroidism in pregnancy is around 2. Hypothyroidism is one of the most common endocrinopathies during pregnancy with an estimated prevalence of 35% among pregnant women. There is an increased risk of complications in pregnancy if hypothyroidism is not carefully treated. Hypothyroidism in pregnancy tehrani annals of thyroid. Hypothyroidism is usually caused when thyroid gland either fails to work normally or is not being stimulated properly by pituitary gland or hypothalamus. Cosponsored by the american association of clinical endocrinologists and the american thyroid association jeffrey r. Other symptoms of hypothyroidism, such as constipation and muscle cramps, are also often chalked up to common pregnancy aches and pains. You can use this information to have a more meaningful conversation with your doctor. In hashimotos disease, the immune system makes antibodies that attack the thyroid, causing inflammation and damage that make it less able to make thyroid hormones. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body.
Hypothyroidism in pregnancy weiping teng, zhongyan shan, komal patilsisodia, david s cooper hypothyroidism is the most common pregnancyrelated thyroid disorder, a. Treatment of hypothyroidism during pregnancy is handled by an endocrinologist together with an obstetrician. Undiagnosed or inadequately treated hypothyroidism during pregnancy can have devastating consequences on the developing fetus. Hypothyroidism and isolated hypothyroxinemia in pregnancy. Subclinical hypothyroidism is defined by a normal free thyroxine in the presence of an elevated thyroidstimulating hormone tsh. A free powerpoint ppt presentation displayed as a flash slide show on. Pregnancy with hypothyroidism requires constant monitoring of the doctor and the application of treatment. The developing fetal brain requires optimal thyroxine levels from early in the first trimester of p regnancy. If the patient has a thyroid nodule she should be evaluated and treated during pregnancy. Level changes characteristic of normal pregnancy, overt hypothyroidism, and subclinical hypothyroidism are given. Overt hypothyroidism is diagnosed in a symptomatic patient by elevated tsh level and low levels of ft 4 and free t 3 ft 3. Diagnosis and treatment of hypothyroidism in pregnancy. Severe, untreated hypothyroidism during pregnancy may cause complications that affect the baby and.