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Maternal Clinical Hypothyroidism

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Thyroid Diseases in Pregnancy

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Abstract

Overt hypothyroidism is a common endocrine disorder affecting 1–2% of women of reproductive age. The most common cause of hypothyroidism in iodine-sufficient areas is chronic autoimmune thyroiditis (known as Hashimoto’s disease). Overt hypothyroidism may occur with highly non-specific symptoms and signs, challenging the identification of women at risk of thyroid function abnormalities. The current guidelines advocate for a case-finding strategy in which all pregnant women should be verbally screened at the initial prenatal visit for any risk factor for thyroid dysfunction.

Overt maternal hypothyroidism has consistently been shown to be associated with an increased risk of adverse pregnancy complications: miscarriage, anaemia in pregnancy, arterial hypertension and pre-eclampsia, abruption placentae, preterm delivery, post-partum haemorrhage, maternal cardiac insufficiency, stillbirth, congenital malformations, low birthweight, and neonatal respiratory distress. Additionally, untreated maternal hypothyroidism in pregnancy has been associated with delayed offspring psychomotor development, language and attention disorders, and a decrease of approximately seven points in the intellectual quotient of the offspring.

Treatment of overt hypothyroidism is recommended from preconception or at early stages of pregnancy in order to prevent significant negative harm to both the mother and the foetus. Oral levothyroxine is the most effective and safe drug to rapidly restore euthyroidism in pregnant women. Levothyroxine dosage should be titrated to rapidly reach, and thereafter maintain, serum TSH concentrations to trimester-specific normal TSH ranges, with TSH measurements approximately every 4 weeks until mid-gestation and at least once near 30 weeks gestation. After giving birth, maternal levothyroxine dosing should be reduced to pre-pregnancy levels.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, España

    Inés Velasco

  2. Diabetes Department, Prince Charles Hospital, Merthyr Tydfil, UK

    Onyebuchi E. Okosieme

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  1. Inés Velasco
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  2. Onyebuchi E. Okosieme
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  1. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fereidoun Azizi

  2. Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Fahimeh Ramezani Tehrani

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Velasco, I., Okosieme, O.E. (2022). Maternal Clinical Hypothyroidism. In: Azizi, F., Ramezani Tehrani, F. (eds) Thyroid Diseases in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-030-98777-0_6

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