Hypothyroidism in pregnancy - a review
DOI:
https://doi.org/10.12775/JEHS.2023.36.01.009Keywords
overt hypothyroidism, subclinical hypothyroidism, pregnancy, adverse fetal outcomesAbstract
Introduction: Thyroid diseases, right after diabetes, are the most common endocrine disorder in pregnant women. Hypothyroidism occurs most frequently among all of the thyroid dysfunctions. Thyroid hormones are essential for the proper course of pregnancy and correct fetal development. Even a mild deficiency carries the risk of complications for both mother and child. It is therefore important to make a swift diagnosis, implement appropriate substitution treatment and monitor the course of the disease throughout pregnancy and in the postpartum period.
Purpose of the work: The article reviews the current state of knowledge regarding maternal hypothyroidism in pregnancy. The aim of the review is to highlight the prevalence of the disease, stress the associated adverse outcomes and present the recommended management.
Materials and methods: A literature research on PubMed, Cochrane Library and Google Scholar databases was done up to May 2023 with restriction to English and Polish language articles regarding hypothyroidism and pregnancy.
Summary: It is extremely important to perform TSH screening tests in women planning pregnancy and during the first obstetric visit. Due to the prevalence of thyroid disorders in society, it is necessary to educate both patients and physicians. An uncomplicated diagnosis process, low cost of screening tests and available treatment methods are able to prevent the often tragic consequences of maternal hypothyroidism.
References
Ain KB, Mori Y, Refetoff S. Reduced clearance rate of thyroxine-binding globulin (TBG) with increased sialylation: a mechanism for estrogen-induced elevation of serum TBG concentration. J Clin Endocrinol Metab. 1987 Oct;65(4):689-96. doi: 10.1210/jcem-65-4-689.
Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med. 1994 Oct 20;331(16):1072-8. doi: 10.1056/NEJM199410203311608.
Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997 Jun;18(3):404-33. doi: 10.1210/edrv.18.3.0300.
Yazbeck CF, Sullivan SD. Thyroid disorders during pregnancy. Med Clin North Am. 2012 Mar;96(2):235-56. doi: 10.1016/j.mcna.2012.01.004.
Trofimiuk-Müldner M, Konopka J, Sokołowski G, et al. Current iodine nutrition status in Poland (2017): is the Polish model of obligatory iodine prophylaxis able to eliminate iodine deficiency in the population? Public Health Nutr. 2020; 23(14): 2467–2477. doi: 10.1017/S1368980020000403.
Zygmunt A, Adamczewski Z, Zygmunt A, et al. An assessment of the effectiveness of iodine prophylaxis in pregnant women--analysis in one of reference gynaecological-obstetric centres in Poland. Endokrynol Pol. 2015; 66(5): 404–411. doi: 10.5603/EP.2015.0050.
Hubalewska-Dydejczyk A, Trofimiuk-Müldner M, Ruchala M, Lewiński A, Bednarczuk T, Zgliczyński W, Syrenicz A, Kos-Kudla B, Jarząb B, Gietka-Czernel M, Szczepanek-Parulska E, Krajewska J, Andrysiak-Mamos E, Zygmunt A, Karbownik-Lewińska M. Thyroid diseases in pregnancy: guidelines of the Polish Society of Endocrinology [Choroby tarczycy w ciąży: zalecenia postępowania Polskiego Towarzystwa Endokrynologicznego]. Endokrynol Pol. 2021;72(5):425-488. doi: 10.5603/EP.a2021.0089.
Fuse Y. Development of the hypothalamic-pituitary-thyroid axis in humans. Reprod Fertil Dev. 1996;8(1):1-21. doi: 10.1071/rd9960001.
Morreale de Escobar G, Obregon MJ, Escobar del Rey F. Role of thyroid hormone during early brain development. Eur J Endocrinol. 2004 Nov;151 Suppl 3:U25-37. doi: 10.1530/eje.0.151u025.
Ausó E, Lavado-Autric R, Cuevas E, Del Rey FE, Morreale De Escobar G, Berbel P. A moderate and transient deficiency of maternal thyroid function at the beginning of fetal neocorticogenesis alters neuronal migration. Endocrinology. 2004 Sep;145(9):4037-47. doi: 10.1210/en.2004-0274.
Dentice M, Marsili A, Zavacki A, Larsen PR, Salvatore D. The deiodinases and the control of intracellular thyroid hormone signaling during cellular differentiation. Biochim Biophys Acta. 2013 Jul;1830(7):3937-45. doi: 10.1016/j.bbagen.2012.05.007.
Degrelle SA, Guibourdenche J, Galland F, Bidart JM, Fournier T, Evain-Brion D. Iodide transporters expression in early human invasive trophoblast. Placenta. 2013 Jan;34(1):29-34. doi: 10.1016/j.placenta.2012.11.002.
Sahay RK, Nagesh VS. Hypothyroidism in pregnancy. Indian J Endocrinol Metab. 2012 May;16(3):364-70. doi: 10.4103/2230-8210.95667.
Thilly CH, Delange F, Lagasse R, Bourdoux P, Ramioul L, Berquist H, Ermans AM. Fetal hypothyroidism and maternal thyroid status in severe endemic goiter. J Clin Endocrinol Metab. 1978 Aug;47(2):354-60. doi: 10.1210/jcem-47-2-354.
Vermiglio F, Lo Presti VP, Moleti M, Sidoti M, Tortorella G, Scaffidi G, Castagna MG, Mattina F, Violi MA, Crisà A, Artemisia A, Trimarchi F. Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab. 2004 Dec;89(12):6054-60. doi: 10.1210/jc.2004-0571.
Berbel P, Mestre JL, Santamaría A, Palazón I, Franco A, Graells M, González-Torga A, de Escobar GM. Delayed neurobehavioral development in children born to pregnant women with mild hypothyroxinemia during the first month of gestation: the importance of early iodine supplementation. Thyroid. 2009 May;19(5):511-9. doi: 10.1089/thy.2008.0341.
De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Aug;97(8):2543-65. doi: 10.1210/jc.2011-2803. Erratum in: J Clin Endocrinol Metab. 2021 May 13;106(6):e2461.
Klein RZ, Haddow JE, Faix JD, Brown RS, Hermos RJ, Pulkkinen A, Mitchell ML. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf). 1991 Jul;35(1):41-6. doi: 10.1111/j.1365-2265.1991.tb03494.x.
Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012 Mar 24;379(9821):1142-54. doi: 10.1016/S0140-6736(11)60276-6.
Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, Grobman WA, Laurberg P, Lazarus JH, Mandel SJ, Peeters RP, Sullivan S. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Mar;27(3):315-389. doi: 10.1089/thy.2016.0457. Erratum in: Thyroid. 2017 Sep;27(9):1212.
Kostecka-Matyja M, Fedorowicz A, Bar-Andziak E, Bednarczuk T, Buziak-Bereza M, Dumnicka P, Górska M, Krasnodębska M, Niedźwiedzka B, Pach D, Ruchała M, Siewko K, Solnica B, Sowiński J, Szelachowska M, Trofimiuk-Müldner M, Wachowiak-Ochmańska K, Hubalewska-Dydejczyk A. Reference Values for TSH and Free Thyroid Hormones in Healthy Pregnant Women in Poland: A Prospective, Multicenter Study. Eur Thyroid J. 2017 Apr;6(2):82-88. doi: 10.1159/000453061.
Allan WC, Haddow JE, Palomaki GE, Williams JR, Mitchell ML, Hermos RJ, Faix JD, Klein RZ. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen. 2000;7(3):127-30. doi: 10.1136/jms.7.3.127.
Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, Xu YH, Tao FB. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. J Clin Endocrinol Metab. 2011 Oct;96(10):3234-41. doi: 10.1210/jc.2011-0274.
Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002 Jan;12(1):63-8. doi: 10.1089/105072502753451986..
Davis LE, Leveno KJ, Cunningham FG. Hypothyroidism complicating pregnancy. Obstet Gynecol. 1988 Jul;72(1):108-12.
Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol. 1993 Mar;81(3):349-53.
Karakosta P, Alegakis D, Georgiou V, Roumeliotaki T, Fthenou E, Vassilaki M, Boumpas D, Castanas E, Kogevinas M, Chatzi L. Thyroid dysfunction and autoantibodies in early pregnancy are associated with increased risk of gestational diabetes and adverse birth outcomes. J Clin Endocrinol Metab. 2012 Dec;97(12):4464-72. doi: 10.1210/jc.2012-2540.
Gietka-Czernel M. Ciąża a choroby tarczycy. Ginekologia po Dyplomie. 2013;15(2): 46-58.
Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005 Feb;105(2):239-45. doi: 10.1097/01.AOG.0000152345.99421.22.
Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, Bonsel GJ. Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. Eur J Endocrinol. 2009 Jun;160(6):985-91. doi: 10.1530/EJE-08-0953.
Wang S, Teng WP, Li JX, Wang WW, Shan ZY. Effects of maternal subclinical hypothyroidism on obstetrical outcomes during early pregnancy. J Endocrinol Invest. 2012 Mar;35(3):322-5. doi: 10.3275/7772.
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, O'Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, Faix JD, Klein RZ. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999 Aug 19;341(8):549-55. doi: 10.1056/NEJM199908193410801.
Haddow JE, McClain MR, Lambert-Messerlian G, Palomaki GE, Canick JA, Cleary-Goldman J, Malone FD, Porter TF, Nyberg DA, Bernstein P, D'Alton ME; First and Second Trimester Evaluation of Risk for Fetal Aneuploidy Research Consortium. Variability in thyroid-stimulating hormone suppression by human chorionic [corrected] gonadotropin during early pregnancy. J Clin Endocrinol Metab. 2008 Sep;93(9):3341-7. doi: 10.1210/jc.2008-0568. Epub 2008 Jun 10. Erratum in: J Clin Endocrinol Metab. 2008 Nov;93(11):4552.
Mohan V, Sinha RA, Pathak A, Rastogi L, Kumar P, Pal A, Godbole MM. Maternal thyroid hormone deficiency affects the fetal neocorticogenesis by reducing the proliferating pool, rate of neurogenesis and indirect neurogenesis. Exp Neurol. 2012 Oct;237(2):477-88. doi: 10.1016/j.expneurol.2012.07.019.
Li Y, Shan Z, Teng W, Yu X, Li Y, Fan C, Teng X, Guo R, Wang H, Li J, Chen Y, Wang W, Chawinga M, Zhang L, Yang L, Zhao Y, Hua T. Abnormalities of maternal thyroid function during pregnancy affect neuropsychological development of their children at 25-30 months. Clin Endocrinol (Oxf). 2010 Jun;72(6):825-9. doi: 10.1111/j.1365-2265.2009.03743.x.
Modesto T, Tiemeier H, Peeters RP, Jaddoe VW, Hofman A, Verhulst FC, Ghassabian A. Maternal Mild Thyroid Hormone Insufficiency in Early Pregnancy and Attention-Deficit/Hyperactivity Disorder Symptoms in Children. JAMA Pediatr. 2015 Sep;169(9):838-45. doi: 10.1001/jamapediatrics.2015.0498.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Anna Gadomska, Justyna Kurek, Rafał Gorzyński, Michał Garstka, Hanna Dominik, Zuzanna Czudy, Wojciech Pawęska, Justyna Molczyk-Sieńczak, Jan Radwański, Marika Polatowska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 444
Number of citations: 0
