Study of Thyroid Disease in Pregnancy: A Review

Marefa Tuz Zohora Lima; Tanvir Ahmed Tamim; Fatema Tuz Zohora Toma

Abstract

Pregnancy-related thyroid conditions, the second most prevalent endocrine disorders following diabetes, demand effective management to mitigate adverse consequences for both mother and fetus. Thyroid disease is associated with obstetric and child development complications, necessitating consideration from clinical and scientific viewpoints. This review consolidates current knowledge on thyroid disease in pregnancy, encompassing management, physiological changes, pathological functions, diagnosis, and treatment. Physiological alterations include thyroid stimulation by hCG, placental expression of deiodinases, and increased thyroid vascularity. Hypothyroidism, occurring in 0.6% of pregnancies, poses risks if untreated. Hyperthyroidism, affecting 0.2%, demands careful diagnosis due to TSH suppression in early pregnancy. Adverse outcomes include preterm labor, low birth weight, and impaired neurodevelopment. Post-delivery, monitoring and adjusting levothyroxine are essential, and anti-thyroid drug risks must be considered. Fetal and neonatal outcomes, influenced by maternal TRAb levels, require vigilance. Iodine's role in pregnancy, especially deficiency implications, underscores the importance of monitoring and supplementation. Postpartum care includes thyroid function tests and addressing postpartum thyroiditis, impacting 8% of women. Breastfeeding with antithyroid drugs requires cautious consideration, ensuring minimal impact on neonatal thyroid function. Screening for thyroid disorders during pregnancy remains debated, with case-finding limitations. Thyroid antibodies in euthyroid pregnant women correlate with adverse outcomes, necessitating careful monitoring. Recent research reveals a prevalence of thyroid peroxidase antibody (TPO Ab) in women of childbearing age, emphasizing the need for meticulous monitoring due to the elevated risk of hypothyroidism during pregnancy. Despite inconclusive evidence, levothyroxine supplementation may be considered for TPO Ab-positive euthyroid pregnant women with a history of miscarriage. Effective management, early diagnosis, and tailored care contribute to improved maternal and fetal health, emphasizing the need for continued research and evidence-based guidelines.

Abstract

Keywords