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… 

Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy.

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.

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

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

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

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

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

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”

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
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

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.

Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism

It is not possible to unequivocally advocate for thyroxine replacement in pregnant women with subclinical and overt hypothyroidism until large scale randomized controlled trials are performed, and there was no association between raised thyroid antibodies and adverse pregnancy outcomes in either group.
...

References

SHOWING 1-10 OF 127 REFERENCES

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

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.

Subclinical Hypothyroidism and Pregnancy Outcomes

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.

Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders.

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.

Subclinical Thyroid Disease and the Incidence of Hypertension in Pregnancy

Women with subclinical hypothyroidism identified during pregnancy have an increased risk for severe preeclampsia when compared with euthyroid women, and this is a secondary analysis of a prospective prenatal population-based study.

Pregnant women on thyroxine substitution are often dysregulated in early pregnancy.

Thyroxine dose should be increased as needed early in pregnancy to avoid hypothyroidism andfetal loss was significantly greater in pregnant women with abnormal T SH values compared to those with normal TSH values.

National status of testing for hypothyroidism during pregnancy and postpartum.

Gestational hypothyroidism is more common than generally acknowledged and testing is not common, and test selection is variable, and there is a low rate of postpartum follow-up.

Hypothyroidism in pregnancy: pre‐pregnancy thyroid status influences gestational thyroxine requirements

  • A. KothariJ. Girling
  • Medicine, Biology
    BJOG : an international journal of obstetrics and gynaecology
  • 2008
None of the women who had stable doses of thyroxine during pregnancy had required recent pre‐pregnancy changes in dose or needed postnatal changes, suggesting a long‐term need for more Thyroxine rather than a transient gestational effect.

Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.

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

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

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.
...