The task force consisted of international experts in the field of thyroid disease and pregnancy, and included representatives from the ata, asia and oceania thyroid association, latin american thyroid society, american college of obstetricians and gynecologists, and the midwives alliance of north america. These guidelines cover diagnostic and therapeutic aspects of thyroid nodular disease but not thyroid cancer management. Thyroid uk pregnancy and thyroid disorders guideline documents. Correspondingly, there is concern about the effect of overt ie, symptomatic maternal thyroid disease and even subclinical maternal thyroid disease on fetal development. Other authorities suggest screening in a wider group including age 30 years, from an area of known moderate to severe iodine insufficiency, or have a family history of thyroid disease. Reference ranges for thyroid hormones are different in pregnancy especially in the third trimester,when there is a move towards the hypothyroid end of the spectrum.
Feb 15, 2014 thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental. The first edition was published in april 2001 under the same title numbered greentop guideline no. Understanding these change are important to interpreting, identifying and managing of thyroid disease in pregnancy. A normal pregnancy results in a number of important reversible physiological and hormonal changes that alter thyroid structure and more importantly function. For women known to have hypothyroidism, an increase in thyroxine dose by 2040% when pregnancy is confirmed usually ensures they remain euthyroid. However, there is a lack of evidencebased guidelines to assist in planning the management of affected pregnancies.
Jan 15, 2017 home american thyroid association guidelines for diagnosis and management of thyroid disease during pregnancy published in thyroid journal. Aug 01, 2019 thyroid illness may follow an infection of the thyroid or an autoimmune condition, such as hashimotos disease, or it could result from surgical removal of part, or all, of the thyroid. Thyroid function testing with serum tsh should be performed in early pregnancy for women with symptoms of thyroid disease or a personal history of thyroid disease. S1s47, 22007 abstract management of thyroid dysfunction during pregnancy and postpar tum 1. Symptomatic treatment is recommended for the former. The most common thyroid diseases during pregnancy are hyper and hypothyroidism and their variants including isolated hypothyroxinemia hypot 4, autoimmune thyroid disease ait d and different types of goiter. The role of these antibodies in reproductive health has received increasing attention over recent years. Acute management this is the third edition of this guideline. Thyroid dysfunction and reproductive health jefferys 2015. Jan 23, 2015 thyroid disease is classically divided into hyperthyroidism and hypothyroidism, and the causes of thyroid disease are numerous table 1. International federation of gynecology and obstetrics.
Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery. Thyroid diseases affect up to 5% of all pregnancies. Oct 16, 2015 graves disease, the most common cause of thyrotoxicosis in pregnancy, is an autoimmune condition characterized by production of thyroid stimulating immunoglobulin tsi and thyroid stimulating hormone binding inhibitory immunoglobulin tbii these two antibodies facilitate the thyroid stimulating hormone tsh receptor in the mediation of thyroid stimulation and inhibition, respectively. Hence thyroid function test becomes essential to know the thyroid status in pregnancy and also to detect the subclinical disease. Thromboembolic disease in pregnancy and the puerperium. Management of thyroid dysfunction during pregnancy and. Thyroid disease is a group of disorders that affects the thyroid gland. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. Thyroid disease in pregnancy uncontrolled thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. Among the recommendations is that all pregnant women should ingest approximately 250 micrograms of iodine daily. Thyroidstimulating hormone tsh is secreted by the anterior pituitary, which stimulates the thyroid to synthesise t4 and t3, which in turn inhibits tsh synthesis. Guidelines american association of clinical endocrinologists.
Changes in thyroid hormone concentrations that are characteristic of hyperthyroidism must be distinguished from physiological changes in thyroid hormone economy that occur in pregnancy, especially in the first trimester. There is also a subset of patients who are euthyroid and have positive thyroid autoantibodies. Enlarge thyroid dysfunction is the second most common endocrine disorder in pregnancy, affecting 23% of women. Postpartum thyroiditis is the most common form of postpartum thyroid dysfunction and may present as hyper or hypothyroidism. Thyroid disease is the second most common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of miscarriage, placental. Thyroid hormones control how your body uses energy, so they affect the way nearly every organ in your body workseven the way your heart beats. Pregnancy may affect the course of these thyroid disorders and, conversely, thyroid diseases may affect the course of pregnancy. Thyroid conditions raise the risk of pregnancy complications. Purpose cardiac disease is a leading cause of maternal death in pregnancy in many developed countries, including the uk. Thyroid disorders are prevalent in women of childbearing age and for this reason commonly present as an intercurrent disease in pregnancy and the puerperium. Four key changes in the new guidelines are highlighted. Testing for hypothyroidism during pregnancy with serum tsh.
In your healthy pregnancy with thyroid disease, they team up to give readers the answers they need. Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is. Thyroid disease in pregnancy obstetrics and gynecology. New evidencebased recommendations from the american thyroid association ata provide guidance to clinicians in diagnosing and managing thyroid disease during pregnancy and the postpartum period. Managing thyroid disease during pregnancy, new ata guidelines. Guidelines for diagnosis and management of thyroid disease. This document was prepared as a collaborative effort between the american association of clinical endocrinologists aace, american college of endocrinology ace and associazione medici endocrinologi ame. New guidelines for thyroid disease during pregnancy. An awareness of the gestational changes to thyroid physiology and the impact of uncontrolled thyroid disease on pregnancy and infant outcome is essential for the successful management of hypothyroidism and hyperthyroidism. Adverse pregnancy and neonatal outcomes are increased by maternal thyroid disease and adequate treatment is thought to reduce these risks. August, 2012 the endocrine societys clinical practice guideline for the management of thyroid disease during pregnancy and after birth has been updated from its 2007 version.
Thyroid dysfunction in pregnancy has consequences for mother and baby. May 29, 20 thyroid conditions raise the risk of pregnancy complications. Potential problems include preeclampsia, prematurity and congenital abnormality. Ait d represents the main cause of hypothyroidism during preg nancy ranging in prevalence between 5 and 20% with an average of 7. Guidelines of the american thyroid association for the. Thyroid disease in pregnancy american family physician. The thyroid is a small, butterflyshaped gland in the front of your neck that makes thyroid hormones. The nhmrc recommends that all women who are pregnant, breastfeeding or considering pregnancy, take an iodine supplement of. Jul 11, 2019 research grant to study the action of tregulatory cells in thyroid antibodypositive pregnant women awarded to stephanie behringermassera, md, by the american thyroid association by ata 2018 news releases, basic science research, news releases, thyroid disease and pregnancy, thyroid research grants. Thyroid management in pregnancy thyroid management in pregnancy by mater mothers hospital alignment is licensed under a creative commons attributionsharealike 4. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. Acog guidelines at a glance thyroid disease in pregnancy. Pregnancy and fetal development guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum the american thyroid association taskforce on thyroid disease during pregnancy and postpartum alex stagnarogreen chair,1 marcos abalovich,2 erik alexander,3 fereidoun azizi,4 jorge.
Screening for thyroid function is recommended in the first trimester particularly in countries with a deficient iodine diet and in symptomatic patients tsh is the superior method for screening. Approximately one to two cases of gestational hyperthyroidism occur per pregnancies. The aim is to study the fetomaternal outcome of pregnant women. Founder of dana trentini and thyroid health advocate and bestselling author mary shomon have both endured challenges with pregnancies due to thyroid disorders. Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Uncorrected thyroid dysfunction in pregnancy has adverse effects on fetal. Treatment for hypothyroidism during pregnancy consists of daily taking a daily synthetic thyroid hormone, and continuing to take it throughout pregnancy. Jun 24, 2016 january 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy. Thyroid dysfunction affects 23% of pregnant women and one in 10 women of childbearing age with normal thyroid function have underlying thyroid autoimmunity, which may indicate reduced functional reserve. The evaluation and treatment of pregnant women with thyroid disease parallel that of nonpregnant women and men but present some unique problems. Comparison of two guidelines on management of thyroid nodules and thyroid cancer during pregnancy 2014 bmj.
With personal stories and cuttingedge medical advice from leading. Identification of hyperthyroidism in a pregnant woman is important because adverse. Moreover, thyroid disorders and their management may affect both the pregnant woman and the developing fetus. The endocrine society clinical practice guideline management of thyroid dysfunction during pregnancy and postpartum 2007 american thyroid association taskforce pregnancy and post partum 2011 lothian guidance for diagnosis and management of thyroid function in pregnancy undated. Management of thyroid dysfunction during pregnancy and postpartum. Figo is dedicated to the improvement of womens health and. Thyroid hormones control how your body uses energy, so they affect the way nearly every organ in your body. Thyroid disorders in pregnancy and postpartum australian. The international federation of gynecology and obstetrics figo is a unique organization, being the only international professional body that brings together obstetrical and gynecological associations from all over the world. An overview of thyroid physiology and disease during pregnancy is presented here.