Thyroid dysfunction during pregnancy
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roghayeh Marandi, M.D.
Synonyms and keywords:
Overview
Even mild maternal thyroid hormone deficiency may lead to neurodevelopment complications in the fetus. Hence, it is important to prevent adverse maternal and fetal outcomes by timely treating thyroid disease during pregnancy. Thyroid abnormalities are not easily recognized without specific screening programs, and they are very often subclinical in nature. Serum thyroid-stimulating hormone ( TSH) and free thyroxine levels ( T4 ) are the main diagnostic indicators of thyroid disease. There are four Changes in thyroid functions that occur during pregnancy: Increase in estrogen causes increased TBG, decreased Free T4, HCG has Structural similarity with TSH and rise during pregnancy, so there is an increase in T4/ T3, decrease in TSH. Also, there is increased peripheral metabolism of thyroid hormone and a decline in iodide availability related to increased renal clearance and overall losses to the fetus and placenta.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Thyroid storm due to infection, surgery, preeclampsia, and delivery
Common Causes
- Increase in Estrogen: increased TBG, decreased Free T4
- HCG rise: Structural similarity with TSH: increase in T4/ T3, decrease in TSH
- Increased peripheral metabolism of thyroid hormones: Placenta: type II /III deiodinases Fetus dependent on Type II for T4 T3
- Decline in the availability of iodide related to increased renal clearance and overall losses to the fetus and placenta
Diagnosis
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Treatment
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Do's
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Don'ts
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