Diagnosis and management of subclinical hypothyroidism in pregnancy

@article{Negro2014DiagnosisAM,
  title={Diagnosis and management of subclinical hypothyroidism in pregnancy},
  author={Roberto Negro and Alex S Stagnaro-Green},
  journal={BMJ : British Medical Journal},
  year={2014},
  volume={349}
}
In prospective studies, the prevalence of undiagnosed subclinical hypothyroidism in pregnant women ranges from 3% to 15%. Subclinical hypothyroidism is associated with multiple adverse outcomes in the mother and fetus, including spontaneous abortion, pre-eclampsia, gestational hypertension, gestational diabetes, preterm delivery, and decreased IQ in the offspring. Only two prospective studies have evaluated the impact of levothyroxine therapy in pregnant women with subclinical hypothyroidism… 
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105 Citations
Highly Influential Citations
3
Background Citations
33
Methods Citations
1
Results Citations
1

105 Citations

Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy.

TLDR
High-risk screening is not useful in predicting which women are at risk of thyroid disease in early pregnancy since ∼10% of women with SCH or hypothyroidism could not be diagnosed in this way.

Subclinical hypothyroidism in pregnancy; is there a need for pharmacological intervention?

TLDR
The observed complication rates were much similar, in fact, lesser with gestational diabetes, pregnancy hypertension, IUGR, LBW compared to global and Indian prevalence rates, indicating that the cut-off for diagnosing subclinical hypothyroidism should be derived from TSH assays from the local geographic population.

Women with Subclinical Hypothyroidism Are at Low Risk of Poor Pregnancy Outcome in Japan.

TLDR
Estate of elevated thyroid-stimulating hormone (TSH) is not associated with overall adverse pregnancy outcomes in Japanese women without known medical complications.

An enumeration of the prevalence of hypothyroidism during pregnancy in central India

Individualized Follow-up of Pregnant Women with Asymptomatic Autoimmune Thyroid Disease

TLDR
There was no significant difference regarding the gestational week, weight, or length at birth between the interventional group and controls, when TSH values were in the optimal range, during the whole pregnancy.

Hypothyroidism screening during first trimester of pregnancy

TLDR
The aim of this research was to determine the optimal thyroid-stimulating hormone cut-off point to screen for subclinical hypothyroidism in the first trimester of gestation in a population of a clinical area and to determined the diagnostic value of this screening test for detecting anti-thyroid peroxidase antibodies.

Second trimester levothyroxine treatment for subclinical hypothyroidism or hypothyroxinaemia of pregnancy does not improve cognitive outcomes of children

TLDR
The impact of subclinical hypothyroidism (SCH) on pregnancy outcomes is complex and Observational and retrospective studies have shown a correlation with adverse maternal and fetal events.

“Hypothyroidism screening during first trimester of pregnancy”

TLDR
The optimal thyroid-stimulating hormone cut-off point to screen for subclinical hypothyroidism in the first trimester of gestation in a population of clinical area is determined and the diagnostic value of this screening test for detecting anti-thyroid peroxidase antibodies is determined.

Management for women with subclinical hypothyroidism in pregnancy

  • K. Wiles
  • Medicine, Biology
    Drug and Therapeutics Bulletin
  • 2019
TLDR
Pregnancy outcomes in SCH are discussed and the evidence for thyroxine replacement is detailed and reference intervals for thyroid function are outlined including the new upper limit for TSH defined by the American Thyroid Association in 2017.

Pregnancy outcomes and thyroid dysfunction: preterm birth risk assessment

TLDR
A universal approach to determining the threshold values of TSH for the diagnosis of subclinical hypothyroidism in pregnant women, to the need and tactics of its treatment has not been developed.
...

References

SHOWING 1-10 OF 127 REFERENCES

Five-Year Follow-Up for Women With Subclinical Hypothyroidism in Pregnancy

TLDR
The majority of cases of subclinical hypothyroidism in pregnancy are transient, so treatment with l-thyroxine in these patients should be reviewed because it may not be warranted after pregnancy.

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TLDR
It is speculated that the previously reported reduction in intelligence quotient of offspring of women with subclinical hypothyroidism may be related to the effects of prematurity.

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TLDR
In conclusion, women with asymptomatic AITD who are euthyroid in early pregnancy carry a significant risk of developing hypothyroidism progressively during gestation, despite a marked reduction in antibody titers.

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TLDR
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TLDR
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TLDR
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TLDR
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TLDR
Pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency, and postpartum thyroiditis inWomen with underlying Hashimoto’s disease who were euthyroid prior to conception.

Overt and subclinical thyroid dysfunction among Indian pregnant women and its effect on maternal and fetal outcome

TLDR
Prevalence of thyroid disorders, especially overt and subclinical hypothyroidism (6.47%) was high in this study, and significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.

Maternal thyroid deficiency and pregnancy complications: implications for population screening

TLDR
From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death, which would be another reason to consider population screening.
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