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Autoimmune Thyroid Disease in Pregnancy

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Thyroid Diseases in Pregnancy

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Abstract

Thyroid autoimmunity is regarded as one of the most prevalent autoimmune disorders with a prevalence of 10–20% in reproductive age women. Thyroid autoantibodies may adversely influence reproductive status of women and pregnancy outcomes through thyroid stimulating hormone (TSH)-dependent and TSH-independent pathways.

Despite some evidence regarding the cost-effectiveness of the screening of all pregnant women for autoimmune thyroid disease in the first trimester, universal screening of thyroid autoantibodies is not recommended. Moreover, there is no unique cutoff of values for thyroperoxidase antibodies (TPOAb) or thyroglobulin antibody (TgAb); as a result TPOAb positivity should be considered when TPOAb levels exceed more than twice the reported upper cutoff value; TgAb concentration should be measured in the presence of TSH elevation and TPOAb negativity.

Although thyroid autoimmunity is regarded as subtle disorder in thyroid function that may result in a small reduction in the thyroxin level during pregnancy, this reduction may be associated with an increase in adverse pregnancy outcomes, including infertility, miscarriage, recurrent spontaneous abortions, preterm delivery, neonatal respiratory distress syndrome, small for gestational age (SGA), low birth weight (LBW), gestational diabetes mellitus (GDM), preeclampsia, cesarean section, placental abruption, depression, and perinatal death. In women at risk for hypothyroidism, such as euthyroid women with TPOAb+ or TgAb+, an increased surveillance is recommended which includes measurement of serum TSH level approximately every 4 weeks until mid-gestation and at least once near 30 weeks gestation. Moreover, levothyroxine (LT4) therapy for TPOAb-positive women with a TSH greater than the pregnancy-specific reference range is recommended. There is not sufficient data regarding the recommendations for or against routine LT4 therapy during pregnancy in euthyroid thyroid antibody positive women in terms of prevention of adverse pregnancy outcomes; there is growing data on lack of beneficiary effect of LT4 therapy in this situation.

Since studies on the association of maternal TPOAb positivity with child neurodevelopment are scarce, further studies are required to confirm these preliminary findings and determine the effects of LT4 therapy on child adverse outcomes in these affected women. Treatment with selenium supplementation, intravenous immunoglobulin, and glucocorticoid therapy is not recommended for pregnant women with thyroid autoimmunity.

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

    Fahimeh Ramezani Tehrani

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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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Ramezani Tehrani, F. (2022). Autoimmune Thyroid Disease in Pregnancy. In: Azizi, F., Ramezani Tehrani, F. (eds) Thyroid Diseases in Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-030-98777-0_12

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