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. Guidelines of the american thyroid association for the diagnosis. Thyroid disease is common, affecting 1% to 2% of pregnant women. South australian perinatal practice guidelines thyroid. Thyroid disorders are among the common endocrine disorders in pregnant women. The american thyroid association ata has published new guidelines that cover most aspect of thyroid function and dysfunction during pregnancy and the postpartum period. There is an association between thyroid dysfunction and adverse pregnancy and fetal outcomes. As you know, accurately diagnosingand ascertaining the causeof the disease is vital to determining appropriate treatment, ensuring effective disease management, and avoiding complications.
In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. Summing up, the diagnosis and management of thyroid disorders during pregnancy differ substantially from those in general population. This guideline covers investigating all suspected thyroid disease and managing primary thyroid disease related to the thyroid rather than the pituitary gland. The evaluation and treatment of pregnant women with thyroid disease parallel that of nonpregnant women and men but present some unique problems. International federation of gynecology and obstetrics working group on good clinical practice in maternal fetal medicine. Due to the complex hormonal changes during pregnancy, it is important to remember that. The international federation of gynecology and obstetrics figo is a unique organization, being the only international. Atd propylthiouracil is of choice than methimazole may. 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. Thyroid disease in pregnancy is a common clinical problem.
Since the guidelines for the management of these disorders by the american thyroid association ata were. Another separate issue relates to screening for thyroid dysfunction before and during pregnancy. An overview of thyroid physiology and disease during pregnancy is presented here. Managing thyroid disease during pregnancy, new ata guidelines. Management of antenatal subclinical hypothyroidism and subclinical hyperthyroidism. Almost 50% of women with antithyroid peroxidase antibodies in early pregnancy will develop postpartum thyroiditis, therefore it is the most useful marker identifying those at risk. Learning objectives to gain an overview of the effect of thyroid disorders on reproductive health. An endocrine society clinical practice guideline clinical guidelines the endocrine societys the endocrine society 8401 connecticut avenue, suite 900 chevy chase. Overview of thyroid disease and pregnancy uptodate. Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction.
Pregnancy related hormones raise the level of thyroid hormones in the blood. Uncorrected thyroid dysfunction in pregnancy has adverse effects on fetal and maternal wellbeing. In cases of frank hyperthyroidism due to graves disease or. Treating for two is a program that aims to improve the health of women and babies by identifying the safest treatment options for common conditions before, during, and after pregnancy. South australian perinatal practice guidelines workgroup at. Thyroid physiology and common diseases in pregnancy. Thyroid disease during pregnancy the thyroid is a large gland located in the neck that is responsible for hormone growth and regulation, which means that any thyroid disorder can throw a lot of things in your body out of whack. Diagnosis and management of thyroid disease in pregnancy. Consequently, obstetric providers must be familiar with thyroid physiology and management of thyroid diseases in pregnancy. Pdf adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Thyroid disorders are among the common endocrine disorders in pregnant women after diabetes mellitus. New guidelines for thyroid disease during pregnancy. Overall, the most common cause of hyperthyroidism in women of.
Our aim was to know the prevalence of thyroid dysfunction in pregnancy and its impact on obstetric outcome in indian population. Both disorders mostly increased in size as the pregnancy progressed, returning to their pre. Pregnancy may modify the course of thyroid disease, and pregnancy outcomes can depend on optimal management of thyroid disorders. This is especially true if you have a thyroid disease, such as hyperthyroidism or hypothyroidism, when pregnant. After the first trimester, tsh levels return to baseline values. Symptomatic treatment is recommended for the former. Guidelines for the diagnosis and management of thyroid disease during pregnancy and the postpartum 2017 2017 guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and. These guidelines cover diagnostic and therapeutic aspects of thyroid nodular disease but not thyroid cancer management.
Since it has been estimated that around 1 in 6 pregnant women in an iodine sufficient population are affected by thyroid disease,6 this is a substantial health. Thyroid disease and pregnancy american thyroid association. Hyperthyroidism in pregnancy american thyroid association. According to current guidelines, universal screening is recommended in individuals at high risk for thyroid illness. Guidelines of the american thyroid association for the diagnosis and management of thyroid disease during pregnancy and postpartum.
Guidelines of the american thyroid association for the. Some medicines may cause birth defects, pregnancy loss, prematurity, infant death, or developmental disabilities. Thyroid disorders in pregnancy and postpartum australian. Any patient discovered to have a thyroid nodule should be asked about any positive family history for the occurrence of a benignmalignant thyroid. Treatment guidelines during pregnancy treating for two.
Thyroid disease in pregnancy can affect the health of the mother as well as the child before and after delivery. Thyroid disorders are prevalent in women of childbearing age and for this reason commonly present as an intercurrent disease in pregnancy and the puerperium. January 2018 dr hayley willacy draws your attention to the american thyroid associations 2017 guidelines for managing thyroid disease around pregnancy. Thyroid disorders have many etiologies, manifestations, and potential therapies. Sometimes the body produces too much or too little thyroid hormone. Since the guidelines for the management of these disorders by the american thyroid association ata were first published in 2011, significant clinical and scientific advances have occurred in the field. South australian perinatal practice guidelines thyroid disorders in pregnancy. Studies published during the past decade have enabled researchers to gain new insights into the diagnosis, physiology and treatment of thyroid disease during pregnancy. Thyroid disorders are common in pregnancy and related to maternal and fetal complications. Managing thyroid disease during pregnancy, new ata guidelines the 2017 guidelines, issued after 6 years of new evidence and experience, offer more targeted recommendations for clinical management of women who have thyroid disease once.
The thyroid is a small, butterflyshaped gland in the front of your neck that makes thyroid hormones. Management of thyroid dysfunction during pregnancy and postpartum. Thyroid disease is a group of disorders that affects the thyroid gland. Since it has been estimated that around 1 in 6 pregnant women in an iodinesufficient population are affected by thyroid disease,6 this is a substantial health. Prevalence of thyroid disorder in pregnancy and pregnancy. Prevalence of thyroid disorder in pregnancy and pregnancy outcome. Additionally, women with active graves disease during pregnancy are at higher risk of developing very severe hyperthyroidism known as thyroid storm. Thank you for referring your patient with an abnormal thyroid stimulating hormone tsh measurement, to the maternity outpatients department of the royal brisbane and womens hospital rbwh. Acog practice bulletin on thyroid disease in pregnancy. But there are a couple other things im pretty close to expert status at after years of navigating them.
Pregnancy has a considerable effect on maternal thyroid function. Thyroid disease is a disorder that affects the thyroid gland. Routine thyroid screening in pregnancy is not recommended thyroid testing in pregnancy should be conducted for women at risk, including known thyroid disease, symptoms of overt thyroid disease, suspected goiter, autoimmune medical disorders such as type 1 diabetes mellitus. An overview of thyroid physiology and disease during pregnancy is presented. Thyroid hormones are necessary for the babys brain development while in the womb. Whereas about 23% of pregnant women are hypothyroid, of whom 0.
Thyroid disorders are common in pregnancy and the most common disorder is subclinical hypothyroidism. Evidence suggests that treating thyroid disorders and keeping thyroid stimulating hormone levels at the lower end of normal in euthyroid women may improve conception rates in subfertile women and reduce early pregnancy loss. Disorders of thyroid hormone production can affect fertility, fetal growth and development. As a result, diagnosing both hypo and hyperthyroidism can be challenging. It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. Management of thyroid dysfunction during pregnancy and. It does not cover managing thyroid cancer or thyroid disease in pregnancy. Thyroid dysfunction involves either over or under activity of the thyroid gland. Guidelines american association of clinical endocrinologists. Hypothyroxinaemia, which is common in the preterm infant, and thyrotoxicosis, which is rare, are important neonatal thyroid disorders. 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. Thyroid dysfunction australian government department of.
As per who guidelines, the recommended total dietary intake of iodine is 250. Ppt thyroid disease in pregnancy powerpoint presentation. Postpartum thyroiditis is the most common form of postpartum thyroid dysfunction and may present as hyper or hypothyroidism. It aims to improve quality of life by making recommendations on diagnosis, treatment, longterm care and support. This chapter focuses on identifying and treating women at high risk of the condition. Thyroid hormones are important for energy metabolism, the metabolism of nutrients and inorganic ions, thermogenesis, and for stimulation of growth and development of. 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. Graves disease often improves during the third trimester of pregnancy and may worsen during the post partum period. Ata professional guidelines american thyroid association. Current guidelines recommend targeted screening of women at high risk, including those with a history of thyroid disease, type 1 diabetes. International federation of gynecology and obstetrics. 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. With about 5 combined years of pregnancy and almost that many since my thyroid diagnosis, ive learned the hard way how to navigate them both especially together. Among the recommendations is that all pregnant women should ingest approximately 250.
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