Diagnosis and management of subclinical hypothyroidism in pregnancy

@article{Negro2014DiagnosisAM,
  title={Diagnosis and management of subclinical hypothyroidism in pregnancy},
  author={R. Negro and A. 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… Expand
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. Expand
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. Expand
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. Expand
An enumeration of the prevalence of hypothyroidism during pregnancy in central India
TLDR
The present data on the prevalence of hypothyroidism in pregnant women strongly recommend the inclusion of routine thyroid screening in a central Indian population. Expand
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. Expand
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. Expand
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. Expand
“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. Expand
Management for women with subclinical hypothyroidism in pregnancy
  • K. Wiles
  • Medicine
  • 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. Expand
Beneficial Effects on Pregnancy Outcomes of Thyroid Hormone Replacement for Subclinical Hypothyroidism
TLDR
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. Expand
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References

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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. Expand
Subclinical Hypothyroidism and Pregnancy Outcomes
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. Expand
Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders.
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. Expand
Maternal Use of Thyroid Hormones in Pregnancy and Neonatal Outcome
TLDR
Compared to women in a reference population, those who used thyroxine while pregnant had increased rates of preeclampsia, preexisting or gestational diabetes, cesarean section, and induction of labor, and the risk of preterm birth in women taking thyroid hormones was increased, but only marginally. Expand
Subclinical Thyroid Disease and the Incidence of Hypertension in Pregnancy
TLDR
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. Expand
Pregnant women on thyroxine substitution are often dysregulated in early pregnancy.
TLDR
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. Expand
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TLDR
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. Expand
Hypothyroidism in pregnancy: pre‐pregnancy thyroid status influences gestational thyroxine requirements
TLDR
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. Expand
Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.
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. Expand
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. Expand
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