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Thyroid Disorders

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Perinatology

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Abstract

This chapter was elaborated to provide evidence-based information with practical applicability in helping for the care of pregnant and postpartum women. The thyroid disorders here discussed were divided into three major groups: subclinical hypothyroidism, glandular hypofunction or hyperfunction, and nodular pathologies (excluding neoplasia).

Subclinical hypothyroidism consists in thyroid-stimulating hormone (TSH) levels above the established range for a particular gestational age associated with normal circulating levels of thyroxine (T4) in the absence of clinical symptoms. Its main cause is autoimmune thyroid disease but it may also be secondary to iodine deficiency. Treatment with thyroxine administration should always be considered since negative obstetric, fetal, and neonatal outcomes in untreated patients have been described. Patients undergoing assisted reproduction, in particular, should aim at TSH levels <2.5 mU/L through administration or L-thyroxine. Women who are antiperoxidase (anti-TPO) positive and present TSH levels below this limit, with normal free thyroxine (FT4) levels, should not be treated.

Clinical pathologies secondary to either suppression or hyperstimulation of pituitary secretion of TSH present as hyperthyroidism and hypothyroidism, respectively. Pregnant patients with TSH values >2.5 mU/L should be tested for the presence of anti-TPO, circulating levels of FT4, and ideally have an ultrasound scan of the thyroid gland. Clinical and family history should be evaluated along with these laboratory findings in order to determine whether or not to implement treatment with oral administration of L-thyroxine. Nontreatment can result in gestational loss, obstetric complications, and fetal neurological damage.

As for hypersecretion syndromes the most common cause of hyperthyroidism is Graves’ disease (GD), with a prevalence of 0.2% in all gestations, followed by toxic multinodular goiter (Plummer’s disease) and thyroid adenoma. Diagnosis is determined by low levels of TSH associated to hyperthyroxinemia. Initial treatment consists of clinical support; administration of beta-blockers may be considered, and for patients at risk of thyrotoxicosis, the use of antithyroid drugs might be the treatment of choice.

Thyroid nodular disease, which is prevalent in the general population, is of special interest in this group because when present may demand surgical intervention. Family history of cancer, history of exposure to radiation of the cervical area, and ultrasound findings are useful tools for better understanding the nature of the disease. Nodules >1 cm should be carefully evaluated, and investigation with fine needle aspiration (FNA) should be considered for cytologic diagnostic.

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Authors and Affiliations

  1. Perinatal/Rede D’or, Rio de Janeiro, RJ, Brazil

    Luciana C. Cima & Mariane T. Tauile

  2. Instituto Fernandes Figueira / Fiocruz, Rio de Janeiro, RJ, Brazil

    Viviane P. Monteiro

  3. Pontifícia Universidade Católica (PUC), Rio de Janeiro, RJ, Brazil

    Isabela Bussade

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  1. Maternal and Child Department, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil

    Renato Augusto Moreira de Sá

  2. Federal University of Paraíba, João Pessoa, Paraíba, Brazil

    Eduardo Borges da Fonseca

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Cima, L.C., Tauile, M.T., Monteiro, V.P., Bussade, I. (2022). Thyroid Disorders. In: Moreira de Sá, R.A., Fonseca, E.B.d. (eds) Perinatology. Springer, Cham. https://doi.org/10.1007/978-3-030-83434-0_27

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