Thyroid disease in relation to pregnancy: a decade of change

Inspection of the references cited in this review indicates that much work has occurred in the area of thyroid and pregnancy during the last decade. Significant advances in our understanding of the immunology of pregnancy and the effect of thyroid disease on this process have taken place. The role of hCG in the physiology of pregnancy and its relevance to thyroid function has been an emerging theme. There is still no clear explanation for the association between thyroid antibodies and infertility or miscarriage. During the last decade a general concensus has developed in relation to the management of hyperthyroidism in pregnancy although there are still variations in antithyroid drug use at this time. The aetiological classification of congenital hyper- and hypothyroidism utilizing new technologies has opened up a new perspective on these disorders. Attention has been drawn to the importance of treating maternal hypothyroidism with adequate thyroid replacement therapy and to the possibility of impaired child neuropsychological development consequent on low maternal thyroid hormone concentration in early gestation in non iodine deficient areas. Significant advances have been made during the last decade in the description of the clinical features and in our understanding of the pathogenesis of postpartum thyroid disease. The importance of long-term follow up of selected patient groups has also been emphasized.