References

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 https://doi.org/https://doi.org/10.1056/NEJMoa040079

Alexander EK, Pearce EN, Brent GA 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017; 27:(3)315-89 https://doi.org/https://doi.org/10.1089/thy.2016.0457

Association for Clinical Biochemistry, British Thyroid Association, British Thyroid Foundation. UK guidelines for the use of thyroid function tests. 2006. http://www.btf-thyroid.org/images/documents/tft_guideline_final_version_july_2006.pdf (accessed 18 May 2018)

Barbesino G, Tomer Y. Clinical review: clinical utility of TSH receptor antibodies. J Clin Endocrinol Metab.. 2013; 98:(6)2247-55 https://doi.org/https://doi.org/10.1210/jc.2012-4309

British Thyroid Foundation. Psychological symptoms and thyroid disorders. 2015a. http://www.btf-thyroid.org/information/leaflets/37-psychological-symptoms-guide (accessed 18 May 2018)

British Thyroid Foundation. Pregnancy and Fertility in thyroid disorders. 2015b. http://www.btf-thyroid.org/information/leaflets/38-pregnancy-and-fertility-guide (accessed 25 May 2018)

British Thyroid Foundation. Iodine FAQ. 2018a. http://www.btf-thyroid.org/projects/iodine/249-iodine-faq (accessed 18 May 2018)

British Thyroid Foundation. Thyroid in Pregnancy–Information. 2018b. http://www.btf-thyroid.org/projects/pregnancy/202-thyroid-in-pregnancy-information (accessed 18 May 2018)

Brown RS. Minireview: developmental regulation of thyrotropin receptor gene expression in the fetal and newborn thyroid. Endocrinology. 2004; 145:(9)4058-61 https://doi.org/https://doi.org/10.1210/en.2004-0458

Bucci I, Giuliani C, Napolitano G. Thyroid-stimulating hormone receptor antibodies in pregnancy: Clinical relevance. Front Endocrinol. 2017; 8 https://doi.org/https://doi.org/10.3389/fendo.2017.00137

Post-partum thyroiditis. 2018. https://www.uptodate.com/contents/thyroiddisordersinpregnancy (accessed 18 May 2018)

Randomised Controlled Trial of the Efficacy and Mechanism of Levothyroxine Treatment on Pregnancy and Neonatal Outcomes in Women with Thyroid Antibodies. (TABLET). 2018. https://www.birmingham.ac.uk/research/activity/mds/trials/bctu/trials/womens/tablet/index.aspx

De Groot L, Abalovich M, Alexander EK Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.. 2012; 97:(8)2543-65 https://doi.org/https://doi.org/10.1210/jc.2011-2803

Hyer S, Pratt B, Newbold K, Hamer C. Outcome of pregnancy after exposure to radioiodine in utero. Endocr Pract.. 2011; 17:(aop)1-10 https://doi.org/https://doi.org/10.4158/EP10237.RA

Iuliano SL, Laws ER. The diagnosis and management of lymphocytic hypophysitis. Expert Rev Endocrinol Metab.. 2011; 6:(6)777-83 https://doi.org/https://doi.org/10.1586/eem.11.74

Karras S, Krassas GE. Breastfeeding and antithyroid drugs: a view from within. Eur Thyroid J.. 2012; 1:(1)30-3 https://doi.org/https://doi.org/10.1159/000336595

Labadzhyan A, Brent GA, Hershman JM, Leung AM. Thyrotoxicosis of pregnancy. J Clin Transl Endocrinol.. 2014; 1:(4)140-4 https://doi.org/https://doi.org/10.1016/j.jcte.2014.07.008

Lazarus JH. Thyroid function in pregnancy. Br Med Bull. 2011; 97:(1)137-48 https://doi.org/https://doi.org/10.1093/bmb/ldq039

Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J.. 2014; 3:(2)76-94 https://doi.org/https://doi.org/10.1159/000362597

Le Donne M, Mento C, Settineri S, Antonelli A, Benvenga S. Postpartum mood disorders and thyroid autoimmunity. Front Endocrinol.. 2017; 8 https://doi.org/https://doi.org/10.3389/fendo.2017.00091

Léger J. Management of fetal and neonatal Graves' disease. Horm Res Paediatr.. 2017; 87:(1)1-6 https://doi.org/https://doi.org/10.1159/000453065

Maraka S, Singh Ospina NM, O'Keeffe DT Effects of increasing levothyroxine on pregnancy outcomes in women with uncontrolled hypothyroidism. Horumon To Rinsho.. 2017; 86:(1)150-5 https://doi.org/https://doi.org/10.1111/cen.13168

Meidahl Petersen K, Jimenez-Solem E, Andersen JT b-Blocker treatment during pregnancy and adverse pregnancy outcomes: a nationwide population-based cohort study. BMJ Open. 2012; 2:(4) https://doi.org/https://doi.org/10.1136/bmjopen-2012-001185

Muller AF, Drexhage HA, Berghout A. Postpartum thyroiditis and autoimmune thyroiditis in women of childbearing age: recent insights and consequences for antenatal and postnatal care. Endocr Rev.. 2001; 22:(5)605-30 https://doi.org/https://doi.org/10.1210/edrv.22.5.0441

National Institute for Health and Care Excellence. Hypothyroidism. 2016. https://cks.nice.org.uk/hypothyroidism#!scenario (accessed 18 May 2018)

National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies [CG190]. 2017. https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#place-of-birth (accessed 18 May 2018)

Okosieme O, Gilbert J, Abraham P Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee. Clin Endocrinol (Oxf). 2015; 84:(6)799-808 https://doi.org/https://doi.org/10.1111/cen.12824

Persani L. Clinical review: Central hypothyroidism: pathogenic, diagnostic, and therapeutic challenges. J Clin Endocrinol Metab.. 2012; 97:(9)3068-78 https://doi.org/https://doi.org/10.1210/jc.2012-1616

Puig-Domingo M, Vila L. The implications of iodine and its supplementation during pregnancy in fetal brain development. Curr Clin Pharmacol.. 2013; 8:(2)97-109 https://doi.org/https://doi.org/10.2174/1574884711308020002

Hyperthyroidism, hypothyroidism during pregnancy: Clinical manifestations, diagnosis, and causes. 2018. https://www.uptodate.com/contents/thyroiddisordersinpregnancy

Skeaff S. Iodine deficiency in pregnancy: the effect on neurodevelopment in the child. Nutrients. 2011; 3:(2)265-73 https://doi.org/https://doi.org/10.3390/nu3020265

Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab.. 2012; 97:(2)334-42 https://doi.org/https://doi.org/10.1210/jc.2011-2576

Taylor PN, Vaidya B. Side effects of anti-thyroid drugs and their impact on the choice of treatment for thyrotoxicosis in pregnancy. Eur Thyroid J.. 2012; 1:(3)176-185 https://doi.org/https://doi.org/10.1159/000342920

Tingi E, Syed AA, Kyriacou A, Mastorakos G, Kyriacou A. Benign thyroid disease in pregnancy: A state of the art review. J Clin Transl Endocrinol.. 2016; 6:37-49 https://doi.org/https://doi.org/10.1016/j.jcte.2016.11.001

Virmani S, Srinivas SB, Bhat R, Rao R, Kudva R. Transient thyrotoxicosis in molar pregnancy. J Clin Diagn Res.. 2017; 11:(7)QD01-2 https://doi.org/https://doi.org/10.7860/JCDR/2017/28561.10133

Caring for women with thyroid disorders in pregnancy

02 July 2018
12 min read
Volume 26 · Issue 7

Abstract

Thyroid hormone levels within the normal range are essential to support a healthy pregnancy. Since thyroid disorders are prevalent in women of childbearing age, midwives need to be fully aware of the implications of these conditions for the mother and fetus to ensure the best possible pregnancy outcomes. With increasing understanding about the interaction between the thyroid function of the mother and her offspring, this article is focused on the practical aspects of caring for women based on updated guidelines. This review considers the risks of maternal hypothyroidism and hyperthyroidism to the pregnant woman and her baby during and after pregnancy.

Thyroid disorders are prevalent in women of childbearing age and may therefore present during pregnancy. Awareness of the implications of thyroid disorders in pregnancy is therefore essential to ensure optimal outcomes for women and neonates (Lazarus, 2011). The key to good management of thyroid disease in pregnancy is close liaison between the GP, the midwife (in the community and in hospital), the endocrinologist and the obstetrician. This review will focus on the practical aspects of managing women with either hypothyroidism or hyperthyroidism in pregnancy and in the postpartum period.

Thyroid function is defined by levels of circulating thyroid hormones. When all thyroid parameters, namely free thyroxine (fT4), free triiodothyronine (fT3), and thyroid stimulating hormone (TSH), are abnormal, thyroid function is classified as either ‘overt hypothyroidism’ (thyroid deficiency) or ‘overt hyperthyroidism’ (thyroid hormone excess). If only TSH levels are abnormal but levels of fT4 and fT3 are normal, the disorder is termed ‘subclinical’; either subclinical hypothyroidism (TSH high) or subclinical hyperthyroidism (TSH low). The risks of both overt or subclinical thyroid disease will be discussed below.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month