Thyroid Diseases in Pregnancy

Preface
Contents
Contributors
Thyroid Function in Pregnancy
	Normal Thyroid, Anatomy, Physiology
	Thyroid Physiology and Function in Pregnancy
		Iodine Metabolism
	Thyroid Function Tests
	Assessment of Thyroid Function in Pregnancy: Gestation-Specific Reference Intervals for Thyroid Function Tests in Pregnancy
	Fetal Thyroid Gland (Embryology; Anatomy, Physiology)
	Placental Transfer and Metabolism of Thyroid Hormones
	Summary
	References
Iodine Deficiency/Excess and Pregnancy Outcomes
	Iodine Metabolism
	World Status of Iodine Deficiency
	Impact of Iodine Deficiency on Pregnancy Outcomes
	Iodine Supplementation
	Impact of Iodine Excess on Pregnancy Outcomes
	Summary
	References
Iodine Requirements in Pregnancy
	Introduction
	Sources of Iodine
	Role of Iodine
	Iodine Physiology During Pregnancy and Lactation
	Studies of Iodine Status in Pregnancy
	Studies Assessing the Effects of Maternal Iodine Status in Pregnancy
	Prospective Studies of Maternal Iodine Supplementation in Pregnancy
	Recommendations for Iodine Nutrition in Pregnancy and Lactation
	Conclusion
	References
Screening of Thyroid Function in Pregnancy
	Introduction
	Methods
	Findings
		The Condition Should Be an Important Health Problem
		There Should Be an Accepted Treatment
		Availability of Facilities for Diagnosis and Treatment
		Recognizable Latent or Early Symptomatic Stage
		Suitable Test or Examination
		Acceptability of the Screening Test
		Natural History of the Condition
		Agreed Policy on Whom to Treat as Patients
		Economical Reasoning of Screening
		Continuity of Screening Program
	Thyroid Autoimmunity and Pregnancy
	Pregnancy Outcomes in Subclinical Hypothyroidism
	Subclinical Hypothyroidism and Fetal-Offspring Outcomes
	What Would Be Missed During Targeted Screening?
	Cost-Effectiveness of Various Screening Methods
	Summary
	References
Preconception Counseling
	Introduction
	Preconception Counseling Regarding Iodine Status
	Preconception Counseling Regarding Hypothyroidism and Autoimmune Thyroid Disease
	Preconception Counseling Regarding Hyperthyroidism
	Preconception Counseling Regarding Thyroid Nodules and Cancer
	Summary
	References
Maternal Clinical Hypothyroidism
	Definition
	Prevalence
	Aetiology
	Clinical Features
	Diagnosis
	Adverse Outcomes (Maternal, Foetal and Child Risks)
		Preconception
		During Pregnancy
		Effects on Child Development
	Treatment (Dosage, Goal, Outcomes)
		Preconception Management
		During Pregnancy
			Overt Hypothyroidism Newly Diagnosed in Pregnancy
			Overt Hypothyroidism Known Before Pregnancy
				Hypothyroid Patients Adequately Treated Before Pregnancy
				Hypothyroid Patients Inadequately Treated Before and In Early Pregnancy
		At Post-partum
	Monitoring
		Preconception
		During Pregnancy
		After Delivery
	Summary
	References
Gestational Subclinical Hypothyroidism
	Introduction
	Definition of SCH
	Reference Ranges for Serum TSH for Diagnosis of SCH
	Measurement of FT4 and Thyroid Autoantibodies in the Diagnosis of SCH
	Aetiology of Gestational SCH
	Prevalence and Progression of Gestational SCH
	Practical Approach to Management of SCH: Re-analysis of Our Data
	Adverse Outcomes of SCH
	Treatment Monitoring and Screening
	Screening for Hypothyroidism in Pregnancy
	Summary
	References
Isolated Hypothyroxinemia During Pregnancy
	Definition
	Prevalence
	Etiology
		Iodine Deficiency
		Iron Deficiency
		Placental Angiogenic Factors
		High BMI
		hCG Levels
		Older Age
		Multiparity
		Lower Level of Education
		Thyroid Peroxidase Antibodies and Autoimmunity
		Exposure to Environmental Contaminants
		Hypertension
		Smoking
		Anxiety
		Twin Pregnancy
	Clinical Features
	Diagnosis
	Adverse Outcomes
	Treatment
	Monitoring
	Summary
	References
Maternal Hyperthyroidism
	Definition
	Prevalence and Aetiology
	Foetal-Maternal Relationships
	Clinical Presentation
	Diagnosis
	Management
	Management Goals and Monitoring
		Clinical Scenarios
			Autoimmune Disease (Graves’ Disease)
			Other Non-autoimmune Clinical Scenarios
		Importance of TRAbs Assessment During Pregnancy
		Foetal Ultrasonography
		Umbilical Cord Sampling
	Maternal and Foetal Aspects, Pregnancy Outcomes
		Maternal Aspects of Uncontrolled Thyrotoxicosis
		Foetal Aspects and Pregnancy Outcomes
	Conclusions
	Summary
	References
Gestational Transient Hyperthyroidism
	Introduction
	Definition
	Prevalence
	Pathophysiology
	Clinical Features
	Clinical, Laboratory, and Imaging Diagnosis
	Management
	Pregnancy and Neonatal Outcomes
	Summary
	References
Thyroid Storm and Neonatal Hyperthyroidism
	Introduction
	Signs and Symptoms, Differential Diagnosis
		Diagnosis
		Treatment
	Neonatal Hyperthyroidism
	The Value of TRAb and Pathogenesis of Neonatal Hyperthyroidism
	Clinical Manifestation of Neonatal Hyperthyroidism
		Diagnosis
		Umbilical Cord Blood Sampling, Cordocentesis in Diagnosis of Neonatal Hyperthyroidism
		Treatment
	Summary
	References
Autoimmune Thyroid Disease in Pregnancy
	Prevalence
	Etiology and Influencing Factors
	Maternal Adaptations During Pregnancy
	How Thyroid Autoantibodies Negatively Effect on Reproduction and Pregnancy?
		TSH-Dependent Pathological Mechanisms
		TSH-Independent Pathological Mechanisms
	Changes of Thyroid Autoantibodies During Pregnancy
	Factors that Could Be Associated with the Development of Antibodies
	Factors Reducing the Levels of Thyroid Autoantibodies [3]
	Reference Interval and Cutoff Value for Thyroid Autoantibodies
	Do Pregnant Women Need to Be Universally Screened for Thyroid Autoimmunity?
	What Are the Adverse Fertility and Pregnancy Outcomes of Thyroid Antibodies?
	How Should TPOAb+ Women Be Monitored During Pregnancy?
	Does Levothyroxine Reduce the Risk of Adverse Pregnancy Outcomes in Euthyroid Women Who Are Thyroid Autoantibody Positive?
	Does Levothyroxine Reduce the Risk of Adverse Pregnancy Outcomes in Subclinical Hypothyroid Women Who Are Thyroid Autoantibody Positive?
	Is Thyroid Autoimmunity Associated with Adverse Neurodevelopmental Outcomes? And Does Levothyroxine Reduce These Adverse Outcomes?
	What Is the Role of Selenium in Treatment of Women with Thyroid Autoimmunity?
	What Is the Role of Intravenous Immunoglobulin Therapy or Corticosteroid Therapy in Treatment of Women with Thyroid Autoimmunity?
	Should Euthyroid/Subclinical Hypothyroid TPOAb- Positive Women Be Monitored After Pregnancy?
	Does Maternal Thyroid Autoimmunity Induce Thyroid Autoimmunity in Offsprings?
	Summary
	References
Thyroid Nodules and Thyroid Cancer in the Pregnant Woman
	Introduction
	Thyroid Nodules During Pregnancy
	Evaluation and Diagnosis
	Evaluation and Management of Thyroid Cancer During Pregnancy
		Incidence
		Prognosis
		Surgical Treatment During Pregnancy
	Management of Preexisting Thyroid Cancer During Pregnancy
	Pregnancy and Radioactive Iodine
	Summary
	References
Postpartum Thyroiditis: Diagnosis and Management
	Definition
	Epidemiology
	Etiology
	Clinical Presentation
	PPT and Postpartum Depression
	Thyroid Dysfunction and Breastfeeding
	Laboratory Studies
	Ultrasound
	Differential Diagnosis
	Permanent Hypothyroidism
	Treatment
	Risk Factors
	Prevention
	Conclusion
	Summary
	References
Postpartum Thyrotoxicosis
	Introduction
	Postpartum Alterations of Thyroid Antibodies
	Clinical Presentation
	Laboratory Findings
	Etiology
	Management
	Management of Breast-Feeding Women
	Monitoring and follow-Up
	Summary
	References
Thyroid and Infertility
	Introduction
	Hypothyroidism and Infertility
	Hyperthyroidism and Infertility
	Thyroid Autoimmunity and Infertility
	Summary
	References
Thyroid Disorders and Hormonal Contraceptives
	Introduction
	Physiological Consideration
	Guide for Clinical Practice
	Hypothyroidism
	Hyperthyroidism
	Autoimmunity
	Summary
	References