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Thyroid (dys-)function in normal and disturbed pregnancy

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

During pregnancy, physiologic changes in maternal thyroid function take place especially due to hormonal as well as metabolic processes. Human chorionic gonadotropin activates the maternal thyroid gland leading to increased thyroid hormone production. A sufficient availability of maternal thyroid hormones is essential for fetal development, especially during the first trimester of pregnancy, when the fetal thyroid gland is not yet functional.

Materials and Methods

Current knowledge of thyroid dysfunction including thyroid autoimmunity, hypothyroidism or hyperthyroidism is summarized with special focus on miscarriage and pregnancy disorders. Therefore, a Medline research as well as an analysis of current guidelines on thyroid function and pregnancy was performed.

Results

A study focusing on TSH levels in normal and disturbed pregnancies, the risk of miscarriage in association with thyroid autoantibodies, and (subclinical) hypothyroidism in infertile and fertile women were included.

Conclusion

Maternal thyroid dysfunction negatively affects pregnancy outcome. Besides a routine iodine supplementation in pregnant women and treatment of hypo as well as hyperthyroidism, TSH levels should routinely be measured in women during childbearing years and adjusted to concentrations <2.5 mIU/l in order to optimize maternal health and fetal development.

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References

  1. Glinoer D et al (1990) Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab 71(2):276–287

    Article  PubMed  CAS  Google Scholar 

  2. Ballabio M, Poshychinda M, Ekins RP (1991) Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. J Clin Endocrinol Metab 73(4):824–831

    Article  PubMed  CAS  Google Scholar 

  3. de Escobar GM et al (2008) The changing role of maternal thyroid hormone in fetal brain development. Semin Perinatol 32(6):380–386

    Article  PubMed  Google Scholar 

  4. Dhingra S et al (2008) Resistance to thyroid hormone in pregnancy. Obstet Gynecol 112(2 Pt 2):501–503

    Article  PubMed  Google Scholar 

  5. Mori M et al (1988) Morning sickness and thyroid function in normal pregnancy. Obstet Gynecol 72(3 Pt 1):355–359

    PubMed  CAS  Google Scholar 

  6. Glinoer D (1999) What happens to the normal thyroid during pregnancy? Thyroid 9(7):631–635

    Article  PubMed  CAS  Google Scholar 

  7. Glinoer D (2007) The importance of iodine nutrition during pregnancy. Public Health Nutr 10(12A):1542–1546

    Article  PubMed  Google Scholar 

  8. De Geyter C et al (2009) Pattern of thyroid function during early pregnancy in women diagnosed with subclinical hypothyroidism and treated with l-thyroxine is similar to that in euthyroid controls. Thyroid 19(1):53–59

    Article  PubMed  Google Scholar 

  9. Pearce EN et al (2008) Association of first-trimester thyroid function test values with thyroperoxidase antibody status, smoking, and multivitamin use. Endocr Pract 14(1):33–39

    PubMed  Google Scholar 

  10. Rashid M, Rashid MH (2007) Obstetric management of thyroid disease. Obstet Gynecol Surv 62(10):680–688 quiz 691

    Article  PubMed  Google Scholar 

  11. Loh JA et al (2009) The magnitude of increased levothyroxine requirements in hypothyroid pregnant women depends upon the etiology of the hypothyroidism. Thyroid 19(3):269–275

    Article  PubMed  CAS  Google Scholar 

  12. Shields B et al (2009) Cigarette smoking during pregnancy is associated with alterations in maternal and fetal thyroid function. J Clin Endocrinol Metab 94(2):570–574

    Article  PubMed  CAS  Google Scholar 

  13. Smallridge RC et al (2005) Thyroid function inside and outside of pregnancy: what do we know and what don’t we know? Thyroid 15(1):54–59

    Article  PubMed  Google Scholar 

  14. Kothari A, Girling J (2008) Hypothyroidism in pregnancy: pre-pregnancy thyroid status influences gestational thyroxine requirements. BJOG 115(13):1704–1708

    Article  PubMed  CAS  Google Scholar 

  15. Glinoer D (1998) The systematic screening and management of hypothyroidism and hyperthyroidism during pregnancy. Trends Endocrinol Metab 9(10):403–411

    Article  PubMed  CAS  Google Scholar 

  16. Krassas GE et al (1999) Disturbances of menstruation in hypothyroidism. Clin Endocrinol 50(5):655–659

    Article  CAS  Google Scholar 

  17. Poppe K, Velkeniers B, Glinoer D (2008) The role of thyroid autoimmunity in fertility and pregnancy. Nat Clin Pract Endocrinol Metab 4(7):394–405

    Article  PubMed  CAS  Google Scholar 

  18. Verga U et al (2009) Adjustment of L-T4 substitutive therapy in pregnant women with subclinical, overt or post-ablative hypothyroidism. Clin Endocrinol 70(5):798–802

    Article  CAS  Google Scholar 

  19. Alvarez-Pedrerol M et al (2009) Iodine levels and thyroid hormones in healthy pregnant women and birth weight of their offspring. Eur J Endocrinol 160(3):423–429

    Article  PubMed  CAS  Google Scholar 

  20. Abalovich M et al (2007) Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 92(8 Suppl):1–47

    Article  Google Scholar 

  21. Cleary-Goldman J et al (2008) Maternal thyroid hypofunction and pregnancy outcome. Obstet Gynecol 112(1):85–92

    Article  PubMed  Google Scholar 

  22. Zimmerman D (1999) Fetal and neonatal hyperthyroidism. Thyroid 9(7):727–733

    Article  PubMed  CAS  Google Scholar 

  23. Rivkees SA, Mandel SJ (2011) Thyroid disease in pregnancy. Horm Res Paediatr 76(Suppl 1):91–96

    Article  PubMed  CAS  Google Scholar 

  24. Weetman AP (2000) Graves’ disease. N Engl J Med 343(17):1236–1248

    Article  PubMed  CAS  Google Scholar 

  25. Muller AF et al (2008) Thyroid function disorders—Guidelines of the Netherlands Association of Internal Medicine. Neth J Med 66(3):134–142

    PubMed  CAS  Google Scholar 

  26. Davis LE et al (1989) Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 160(1):63–70

    PubMed  CAS  Google Scholar 

  27. Drury MI (1986) Hyperthyroidism in pregnancy. J R Soc Med 79(6):317–318

    PubMed  CAS  Google Scholar 

  28. Mestman JH (1997) Hyperthyroidism in pregnancy. Clin Obstet Gynecol 40(1):45–64

    Article  PubMed  CAS  Google Scholar 

  29. Laurberg P et al (2009) Management of Graves’ hyperthyroidism in pregnancy: focus on both maternal and foetal thyroid function, and caution against surgical thyroidectomy in pregnancy. Eur J Endocrinol 160(1):1–8

    Article  PubMed  CAS  Google Scholar 

  30. Anselmo J et al (2004) Fetal loss associated with excess thyroid hormone exposure. JAMA 292(6):691–695

    Article  PubMed  CAS  Google Scholar 

  31. Todorova K, Genova M, Konova E (2008) Frequency of miscarriages among pregnant women with autoimmune thyroid disorders. Akush Ginekol 47(2):16–20

    CAS  Google Scholar 

  32. Stagnaro-Green A et al (1990) Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA 264(11):1422–1425

    Article  PubMed  CAS  Google Scholar 

  33. Glinoer D et al (1991) Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab 73(2):421–427

    Article  PubMed  CAS  Google Scholar 

  34. Lejeune B et al (1993) Antithyroid antibodies underlying thyroid abnormalities and miscarriage or pregnancy induced hypertension. Br J Obstet Gynaecol 100(7):669–672

    Article  PubMed  CAS  Google Scholar 

  35. Bussen S, Steck T (1995) Thyroid autoantibodies in euthyroid non-pregnant women with recurrent spontaneous abortions. Hum Reprod 10(11):2938–2940

    PubMed  CAS  Google Scholar 

  36. Reznikoff-Etievant MF et al (1999) Habitual abortions in 678 healthy patients: investigation and prevention. Hum Reprod 14(8):2106–2109

    Article  PubMed  CAS  Google Scholar 

  37. Gartner R, Reincke M (2008) Substitution of thyroid hormones. Internist 49(5):538, 540–4

    Google Scholar 

  38. Alexander EK et al (2004) Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med 351(3):241–249

    Article  PubMed  CAS  Google Scholar 

  39. El Baba KA, Azar ST (2012) Thyroid dysfunction in pregnancy. Int J Gen Med 5:227–230

    PubMed  Google Scholar 

  40. Negro R et al (2006) Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab 91(7):2587–2591

    Article  PubMed  CAS  Google Scholar 

  41. Luton D et al (2005) Management of Graves’ disease during pregnancy: the key role of fetal thyroid gland monitoring. J Clin Endocrinol Metab 90(11):6093–6098

    Article  PubMed  CAS  Google Scholar 

  42. Rao VR, Lakshmi A, Sadhnani MD (2008) Prevalence of hypothyroidism in recurrent pregnancy loss in first trimester. Indian J Med Sci 62(9):357–361

    Article  PubMed  Google Scholar 

  43. Wilson C (2011) Thyroid function: new guidance for the diagnosis and management of thyroid diseases in pregnancy. Nat Rev Endocrinol 7(10):559

    Article  PubMed  Google Scholar 

  44. Moleti M et al (2009) Gestational thyroid function abnormalities in conditions of mild iodine deficiency: early screening versus continuous monitoring of maternal thyroid status. Eur J Endocrinol 160(4):611–617

    Article  PubMed  CAS  Google Scholar 

  45. Orito Y et al (2009) Thyroid function in early pregnancy in Japanese healthy women: relation to urinary iodine excretion, emesis and fetal and child development. J Clin Endocrinol Metab 94(5):1683–1688

    Google Scholar 

  46. Teng W et al (2006) Effect of iodine intake on thyroid diseases in China. N Engl J Med 354(26):2783–2793

    Article  PubMed  CAS  Google Scholar 

  47. Utiger RD (2006) Iodine nutrition—more is better. N Engl J Med 354(26):2819–2821

    Article  PubMed  CAS  Google Scholar 

  48. Vaidya B et al (2012) Treatment and screening of hypothyroidism in pregnancy: results of a European survey. Eur J Endocrinol 166(1):49–54

    Article  PubMed  CAS  Google Scholar 

  49. Arojoki M et al (2000) Hypothyroidism among infertile women in Finland. Gynecol Endocrinol 14(2):127–131

    Article  PubMed  CAS  Google Scholar 

  50. Grassi G et al (2001) Thyroid autoimmunity and infertility. Gynecol Endocrinol 15(5):389–396

    PubMed  CAS  Google Scholar 

  51. Poppe K et al (2002) Thyroid dysfunction and autoimmunity in infertile women. Thyroid 12(11):997–1001

    Article  PubMed  Google Scholar 

  52. Raber W et al (2003) Thyroxine treatment modified in infertile women according to thyroxine-releasing hormone testing: 5 year follow-up of 283 women referred after exclusion of absolute causes of infertility. Hum Reprod 18(4):707–714

    Article  PubMed  CAS  Google Scholar 

  53. Abalovich M et al (2007) Subclinical hypothyroidism and thyroid autoimmunity in women with infertility. Gynecol Endocrinol 23(5):279–283

    Article  PubMed  CAS  Google Scholar 

  54. Iijima T et al (1997) Effects of autoantibodies on the course of pregnancy and fetal growth. Obstet Gynecol 90(3):364–369

    Article  PubMed  CAS  Google Scholar 

  55. Kutteh WH et al (1999) Increased prevalence of antithyroid antibodies identified in women with recurrent pregnancy loss but not in women undergoing assisted reproduction. Fertil Steril 71(5):843–848

    Article  PubMed  CAS  Google Scholar 

  56. Bagis T, Gokcel A, Saygili ES (2001) Autoimmune thyroid disease in pregnancy and the postpartum period: relationship to spontaneous abortion. Thyroid 11(11):1049–1053

    Article  PubMed  CAS  Google Scholar 

  57. Poppe K et al (2003) Assisted reproduction and thyroid autoimmunity: an unfortunate combination? J Clin Endocrinol Metab 88(9):4149–4152

    Article  PubMed  CAS  Google Scholar 

  58. Negro R et al (2005) Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study. Hum Reprod 20(6):1529–1533

    Article  PubMed  CAS  Google Scholar 

  59. Negro R et al (2007) Euthyroid women with autoimmune disease undergoing assisted reproduction technologies: the role of autoimmunity and thyroid function. J Endocrinol Invest 30(1):3–8

    PubMed  CAS  Google Scholar 

  60. Negro R et al (2010) Increased pregnancy loss rate in thyroid antibody negative women with TSH levels between 2.5 and 5.0 in the first trimester of pregnancy. J Clin Endocrinol Metab 95(9):E44–E48

    Article  PubMed  Google Scholar 

  61. De Groot L et al (2012) Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 97(8):2543–2565

    Article  PubMed  Google Scholar 

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Correspondence to Bettina Toth.

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Budenhofer, B.K., Ditsch, N., Jeschke, U. et al. Thyroid (dys-)function in normal and disturbed pregnancy. Arch Gynecol Obstet 287, 1–7 (2013). https://doi.org/10.1007/s00404-012-2592-z

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  • DOI: https://doi.org/10.1007/s00404-012-2592-z

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