Skip to main content
SpringerLink
Log in

Thyroid Disease During Pregnancy: An Overview for the Primary Care Physician

  • Chapter
  • First Online:
Medical Problems During Pregnancy

  • 1392 Accesses

Abstract

Thyroid disease in pregnancy encompasses a wide spectrum of disorders including hypothyroidism, hyperthyroidism, and benign and malignant thyroid nodules. Thyroid function tests change during normal pregnancy which can make diagnosis of abnormal thyroid function difficult. Uncontrolled hypothyroidism in pregnancy is associated with both maternal and fetal adverse effects, and universal screening has been proposed although not currently recommended in low-risk patients. Similarly, uncontrolled hyperthyroidism is associated with adverse pregnancy outcomes. Antithyroid drugs have a low absolute risk but an increased relative risk of fetal effects. Thyroid nodules in pregnancy are evaluated based on ultrasound findings, and fine needle aspiration may be warranted. Pregnancy is not thought to impact the prognosis of thyroid carcinoma, and surgery may be generally deferred until postpartum.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Glinoer D, de Nayer P, Bourdoux P, Lemone M, Robyn C, van Steirteghem A, Kinthaert J, Lejeune B. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab. 1990;71(2):276–7.

    Article  CAS  PubMed  Google Scholar 

  2. Glinoer D, Spencer CA. Serum TSH determinations in pregnancy: how, when and why? Nat Rev Endocrinol. 2010;6(9):526–9.

    Article  CAS  PubMed  Google Scholar 

  3. Mandel SJ, Spencer CA, Hollowell JG. Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid. 2005;15(1):44–53.

    Article  PubMed  Google Scholar 

  4. Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005;105(2):239–45.

    Article  PubMed  Google Scholar 

  5. Cotzias C, Wong SJ, Taylor E, Seed P, Girling J. A study to establish gestation-specific reference intervals for thyroid function test in normal singleton pregnancy. Eur J Obstet Gynecol Reprod Biol. 2008;137(1):61–6.

    Article  PubMed  Google Scholar 

  6. Panesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem. 2001;38(Pt 4):329–32.

    Article  CAS  PubMed  Google Scholar 

  7. Dashe JS, Casey BM, Wells CE, McIntire DD, Byrd EW, Leveno KJ, Cunningham FG. Thyroid-stimulating hormone in singleton and twin pregnancy: importance of gestational age-specific reference ranges. Obstet Gynecol. 2005;106(4):753–7.

    Article  CAS  PubMed  Google Scholar 

  8. Costeira MJ, Oliveira P, Ares S, Roque S, de Escobar GM, Palha JA. Parameters of thyroid function throughout and after pregnancy in an iodine-deficient population. Thyroid. 2010;20(9):995–1001.

    Article  PubMed  Google Scholar 

  9. Stagnaro-Green A, Abalovich MD, Alexander E, Azizi F, Mestman J, Negro R, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21(10):1081–125.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, et al. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;3:127–30.

    Article  Google Scholar 

  11. Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM, et al. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. J Clin Endocrinol Metab. 2013;98(11):4382–90.

    Article  CAS  PubMed  Google Scholar 

  12. LaFranchi SH, Haddow JE, Hollowell JG. Is thyroid inadequacy during gestation a risk factor for adverse pregnancy and developmental outcomes? Thyroid. 2005;15(1):16–71.

    Article  Google Scholar 

  13. Kooistra L, Kuppens SM, Hasaart TH, Vader HL, Wijnen HA, Oei SG, et al. High thyrotropin levels at end term increase the risk of breech presentation. Clin Endocrinol (Oxf). 2010;73(5):661–5.

    Article  CAS  Google Scholar 

  14. Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, et al. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011;96(10):3234–41.

    Article  CAS  PubMed  Google Scholar 

  15. de Escobar GM, Ares S, Berbel P, Obregon MJ, del Rey FE. The changing role of maternal thyroid hormone in fetal brain development. Semin Perinatol. 2088;32(6):380–6.

    Article  Google Scholar 

  16. Man EB, Jones WS, Holden RH, Mellits ED. Thyroid function in human pregnancy. 8. Retardation of progeny aged 7 years; relationship to maternal age and maternal thyroid function. Am J Obstet Gynecol. 1971;111(7):905–16.

    Article  CAS  PubMed  Google Scholar 

  17. Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;34(8):549–55.

    Article  Google Scholar 

  18. Henrichs J, Bongers-Schokking JJ, Schenk JJ, Ghassabian A, Schmidt HG, Visser TJ, et al. Maternal thyroid function during early pregnancy and cognitive functioning in early childhood: the generation R study. J Clin Endocrinol Metab. 2010;95(9):4227–34.

    Article  CAS  PubMed  Google Scholar 

  19. Li Y, Shan Z, Teng W, Yu X, Li Y, Fan C, et al. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol (Oxf). 2010;72(6):825–9.

    Article  CAS  Google Scholar 

  20. Pakkila F, Mannisto T, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, et al. The impact of gestational thyroid hormone concentrations on ADHD symptoms of the child. J Clin Endocrinol Metab. 2014;99(1):E1–8.

    Article  PubMed  Google Scholar 

  21. Negro R, Mangieri T, Coppola L, Presicce G, Casavola EC, Gismondi R, et al. Levothyroxine treatment in thyroid peroxidase antibody-positive women undergoing assisted reproduction technologies: a prospective study. Hum Reprod. 2005;20(6):1529–33.

    Article  CAS  PubMed  Google Scholar 

  22. Negro R, Formoso G, Mangieri T, Pezzarossa A, Dazzi D, Hassan H. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006;91(7):2587–91.

    Article  CAS  PubMed  Google Scholar 

  23. Vaidya B, Anthony S, Bilous M, Shields B, Drury J, Hutchison S, et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab. 2007;92(1):203–7.

    Article  CAS  PubMed  Google Scholar 

  24. Negro R, Schwartz A, Gismondi R, Tinelli A, Mangieri T, Stagnaro-Green A. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95(4):1699–707.

    Article  CAS  PubMed  Google Scholar 

  25. Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012;366(6):493–501.

    Article  CAS  PubMed  Google Scholar 

  26. Mandel SJ, Larsen PR, Seely EW, Brent GA. Increased need for thyroxine during pregnancy in women with primary hypothyroidism. N Engl J Med. 1990;323(2):91–6.

    Article  CAS  PubMed  Google Scholar 

  27. Hallengren B, Lantz M, Andreasson B, Grennert L. Pregnant women on thyroxine substitution are often dysregulated in early pregnancy. Thyroid. 2009;19(4):391–4.

    Article  CAS  PubMed  Google Scholar 

  28. Taylor PN, Minassian C, Rehman A, Igbal A, Draman MS, Hamilton W, et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. J Clin Endocrinol Metab. 2014;99(10):3895–902.

    Article  CAS  PubMed  Google Scholar 

  29. Abalovich M, Alcaraz G, Kleiman-Rubinsztein J, Pavlove MM, Cornelio C, Levalle O, et al. The relationship of preconception thyrotropin levels to requirements for increasing the levothyroxine dose during pregnancy in women with primary hypothyroidism. Thyroid. 2010;20(10):1175–8.

    Article  CAS  PubMed  Google Scholar 

  30. Rotondi M, Mazziotti G, Sorvillo F, Piscopo M, Cioffi M, Amato G, et al. Effects of increased thyroxine dosage pre-conception on thyroid function during early pregnancy. Eur J Endocrinol. 2004;151(6):695–700.

    Article  CAS  PubMed  Google Scholar 

  31. Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. N Engl J Med. 2004;351(3):241–9.

    Article  CAS  PubMed  Google Scholar 

  32. Lazarus J, Okosieme OE. Hyperthyroidism in pregnancy. In: Endotext LJ, De Groot, et al., editors. mdtext.com, inc. South Dartmouth; 2000.

    Google Scholar 

  33. Marchant B, Brownlie BE, Hart DM, Horton PW, Alexander WD. The placental transfer of prophylthiouracil, methimazole and carbimazole. J Clin Endocrinol Metab. 1977;45(6):1187–93.

    Article  CAS  PubMed  Google Scholar 

  34. Mandel SJ, Brent GA, Larsen PR. Review of antithyroid drug use during pregnancy and a report of a case of aplasia cutis. Thyroid. 1994;4(1):129–33.

    Article  CAS  PubMed  Google Scholar 

  35. Gardner DF, Cruikshank DP, Hays PM, Cooper DS. Pharmacology of propylthiouracil (PTU) in pregnant hyperthyroid women: correlation of maternal PTU concentrations with cord serum thyroid function tests. J Clin Endocrinol Metab. 1986;62(1):217–20.

    Article  CAS  PubMed  Google Scholar 

  36. Clementi M, Di Gianantonio E, Cassina M, Leoncini E, Botto LD, Mastroiacovo P, et al. Treatment of hyperthyroidism in pregnancy and birth defects. J Clin Endocrinol Metab. 2010;95(11):E337–41.

    Article  PubMed  Google Scholar 

  37. Yoshihara A, Noh J, Yamaguchi T, Ohye H, Sato S, Sekiya K, et al. Treatment of graves’ disease with antithyroid drugs in the first trimester of pregnancy and the prevalence of congenital malformation. J Clin Endocrinol Metab. 2012;97(7):2396–403.

    Article  CAS  PubMed  Google Scholar 

  38. Anderson SL, Olsen J, Wu CS, Laurberg P. Birth defects after early pregnancy use of antithyroid drugs: a Danish nationwide study. J Clin Endocrinol Metab. 2013;98(11):4373–81.

    Article  Google Scholar 

  39. Anderson SL, Olsen J, Wu CS, Laurberg P. Severity of birth defects after propylthiouracil exposure in early pregnancy. Thyroid. 2014;24:1533–40.

    Article  Google Scholar 

  40. Rivkees SA. Propylthiouracil versus methimazole during pregnancy: an evolving tale of difficult choices. J Clin Endocrinol Metab. 2013;98(11):4332–5.

    Article  CAS  PubMed  Google Scholar 

  41. Glinoer D, Soto MF, Bourdoux P, Lejeune B, Delange F, Lemone M, et al. Pregnancy in patients with mild thyroid abnormalities: maternal and neonatal repercussions. J Clin Endocrinol Metab. 1991;73(2):421–7.

    Article  CAS  PubMed  Google Scholar 

  42. Struve CW, Haupt S, Ohlen S. Influence of frequency of previous pregnancies on the prevalence of thyroid nodules in women without clinical evidence of thyroid disease. Thyroid. 1993;3(1):7–9.

    Article  CAS  PubMed  Google Scholar 

  43. Kung AW, Chau MT, Lao TT, Tam SC, Low LC. The effect of pregnancy on thyroid nodule formation. J Clin Endocrinol Metab. 2002;87(3):102–4.

    Article  Google Scholar 

  44. Marley EF, Oertel YC. Fine-needle aspiration of thyroid lesions in 57 pregnant and postpartum women. Diagn Cytopathol. 1997;16(2):122–5.

    Article  CAS  PubMed  Google Scholar 

  45. Tan GH, Gharib H, Goellner JR, van Heerden JA, Bahn RS. Management of thyroid nodules in pregnancy. Arch Intern Med. 1996;156(2):2317–20.

    Article  CAS  PubMed  Google Scholar 

  46. Rosen IB, Walfish PG, Nikore V. Pregnancy and surgical thyroid disease. Surgery. 1985;98(6):1135–40.

    CAS  PubMed  Google Scholar 

  47. Smith LH, Danielson B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol. 2003;189(4):1128–35.

    Article  PubMed  Google Scholar 

  48. Brander A, Viikinkoski P, Tuuhea J, Voutilainen L, Kivisaari L. Clinical versus ultrasound examination of the thyroid gland in common clinical practice. J Clin Ultrasound. 1992;20(1):37–42.

    Article  CAS  PubMed  Google Scholar 

  49. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002;87(5):1941–6.

    Article  CAS  PubMed  Google Scholar 

  50. Herzon FS, Morris DM, Segal MN, Rauch G, Parnell T. Coexistent thyroid cancer and pregnancy. Arch Otolaryngol Head Neck Surg. 1994;120(11):1191–3.

    Article  CAS  PubMed  Google Scholar 

  51. Moosa M, Mazzaferri EL. Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab. 1997;82(9):2862–6.

    Article  CAS  PubMed  Google Scholar 

  52. Monroy-Lozano BE, Hurtado-Lopez LM, Zaldivar-Ramirez FR, Basurto-Kuba E. Clinical behavior of thyroid papillary cancer in pregnancy: optimal time for its treatment. Ginecol Obstet Mex. 2001;69:359–62.

    CAS  PubMed  Google Scholar 

  53. Yasmeen S, Cress R, Romano PS, Xing G, Berger-Chen S, Danielson B, et al. Thyroid cancer in pregnancy. Int J Gynaecol Obstet. 2005;91(1):15–20.

    Article  CAS  PubMed  Google Scholar 

  54. Nam KH, Yoon JH, Chang HS, Park CS. Optimal timing of surgery in well-differentiated thyroid carcinoma detected during pregnancy. J Surg Oncol. 2005;91(3):199–203.

    Article  PubMed  Google Scholar 

  55. Vannucchi G, Perrino M, Rossi S, Colombo C, Vicentini L, Dazzi D, et al. Clinical and molecular features of differentiated thyroid cancer during pregnancy. Eur J Endocrinol. 2010;162(1):145–51.

    Article  CAS  PubMed  Google Scholar 

  56. Gharib H, Papini E, Valcalvi R, Baskin HJ, Crescenzi A, Dottorini ME, et al. American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2006;12(1):63–102.

    Article  PubMed  Google Scholar 

  57. Rosen IB, Walfish PG. Pregnancy as a predisposing factor in thyroid neoplasia. Arch Surg. 1986;121(11):1287–90.

    Article  CAS  PubMed  Google Scholar 

  58. Doherty CM, Shindo ML, Rice DH, Montero M, Mestman JH. Management of thyroid nodules during pregnancy. Laryngoscope. 1995;105(3 Pt 1):251–5.

    Article  CAS  PubMed  Google Scholar 

  59. Chong KM, Tsai YL, Chuang J, Hwang JL, Chen KT. Thyroid cancer in pregnancy: a report of 3 cases. J Reprod Med. 2007;52(5):416–8.

    PubMed  Google Scholar 

  60. Kuy S, Roman SA, Desai R, Sosa JA. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg. 2009;144(5):399–406.

    Article  PubMed  Google Scholar 

  61. Loh JA, Wartofsky L, Jonklass J, Burman KD. The magnitude of increased levothyroxine requirements in hypothyroid pregnant women depends on the etiology of the hypothyroidism. Thyroid. 2009;19(3):269–75.

    Article  CAS  PubMed  Google Scholar 

  62. Sawka AM, Lakra DC, Lea J, Alshehri B, Tsang RW, Brierly JD, et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol (Oxf). 2008;69(3):479–90.

    Article  Google Scholar 

  63. Garsi JP, Schlumberger M, Rubino C, Ricard M, Labbé M, Ceccarelli C, et al. Therapeutic administration of 131I for differentiated thyroid cancer: radiation dose to ovaries and outcome of pregnancies. J Nucl Med. 2008;49(5):845–52.

    Article  PubMed  Google Scholar 

  64. Roswoll RV, Winship T. Thyroid carcinoma in pregnancy. Surg Gynecol Obstet. 1965;121(5):1039–42.

    Google Scholar 

  65. Hill CS, Clark RL, Wolf M. The effect of subsequent pregnancy on patients with thyroid carcinoma. Surg Gynecol Obstet. 1966;122(6):1219–22.

    PubMed  Google Scholar 

  66. Rosário PW, Barroso AL, Purisch S. The effect of subsequent pregnancy on patients with thyroid carcinoma apparently free of the disease. Thyroid. 2007;17(11):1175–6.

    Article  PubMed  Google Scholar 

  67. Leboeuf R, Emerick LE, Martorella AJ, Tuttle RM. Impact of pregnancy on serum thyroglobulin and detection of recurrent disease shortly after delivery in thyroid cancer survivors. Thyroid. 2007;17(6):543–7.

    Article  CAS  PubMed  Google Scholar 

  68. Hirsch D, Levy S, Tsvetov G, Weinstein R, Lifshitz A, Singer J, et al. Impact of pregnancy on outcome and prognosis of survivors of papillary thyroid cancer. Thyroid. 2010;10:1179–85.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Bethany M. Mulla MD

  2. Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Christopher M. Mulla MD & James V. Hennessey MD

Authors
  1. Bethany M. Mulla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher M. Mulla MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James V. Hennessey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bethany M. Mulla MD .

Editor information

Editors and Affiliations

  1. Department of Neurology, Brigham and Womens Hospital, Boston, Massachusetts, USA

    Carolyn Bernstein

  2. Boston Maternal Fetal Medicine, Brookline, Massachusetts, USA

    Tamara C. Takoudes

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Mulla, B.M., Mulla, C.M., Hennessey, J.V. (2017). Thyroid Disease During Pregnancy: An Overview for the Primary Care Physician. In: Bernstein, C., Takoudes, T. (eds) Medical Problems During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-39328-5_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-39328-5_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-39326-1

  • Online ISBN: 978-3-319-39328-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation