Chapter 14
Thyroid Regulation and Dysfunction in the Pregnant Patient
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 main ‘take home’ messages
PRIMARY HYPOTHYROIDISM
Clinical epidemiology and causal factors.
Clinical and diagnostic features.
Microchimerism.
Repercussions of hypothyroidism on pregnancy outcome.
Screening for hypothyroidism during pregnancy.
Therapeutic considerations.
Fetal-neonatal consequences of maternal hypothyroidism.
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
FINAL CONCLUSIONS
