Table of Contents

INTRODUCTION

MATERNAL THYROID PHYSIOLOGY

Regulation of the thyroid in normal pregnancy

Effects of human chorionic gonadotropin on thyroid function

Hyperemesis gravidarum

Changes in circulating thyroid hormone binding proteins

Increased plasma volume

Thyroxine production rate

Thyroid function parameters in normal pregnancy

Placental metabolism of thyroid hormones

Main “take home” messages

PREGNANCY AND IODINE DEFICIENCY

Iodine nutrition status before pregnancy, during pregnancy and lactation: the new recommendations

Epidemiology of iodine deficiency during pregnancy

Metabolism of iodine during normal pregnancy

The concept of excessive thyroidal stimulation

Goiter formation in mother and progeny is the hallmark of iodine deficiency during pregnancy

Monitoring the adequacy of iodine intake and implementing iodine nutrition fortification during pregnancy

Prevention of pregnancy-related goitrogenesis

The case of pregnancy in severe iodine deficiency

Recommendations and ‘take home’ messages

AUTOIMMUNE THYROID DISEASE AND PREGNANCY

Effects of pregnancy on immune function

Thyroid autoimmunity and disorders of female reproduction

Effects of pregnancy on thyroid function in women with thyroid auto-antibodies

Recommendations and ‘take home’ messages

PRIMARY HYPOTHYROIDISM

Clinical epidemiology and causal factors

Clinical and diagnostic features

Microchimerism

Repercussions of hypothyroidism on pregnancy outcome

Management and therapy of gestational hypothyroidism

Fetal-neonatal consequences of maternal hypothyroidism

Screening for hypothyroidism during pregnancy

Recommendations and ‘take home’ messages

THYROTOXICOSIS

Clinical diagnosis of hyperthyroidism in pregnancy

Laboratory diagnosis

Clinical aspects of the management of Graves’ disease in pregnancy

Therapeutic considerations

Fetal & neonatal adverse effects of maternal hyperthyroidism

Hyperthyroidism in the early postpartum period

Recommendations and ‘take home’ messages

Gestational non autoimmune hyperthyroidism

Recommendations and ‘take home’ messages

NODULAR THYROID DISEASE

Thyroid nodule growth during pregnancy

Diagnostic evaluation of a thyroid nodule in pregnancy

Management

Recommendations and ‘take home’ messages

SCREENING FOR THYROID DISORDERS ASSOCIATED WITH PREGNANCY

Prerequisites for screening in primary prevention

Policy considerations for systematic screening during pregnancy

Present situation concerning screening

FINAL CONCLUSIONS