Thyroid disease in pregnancy and childhood

Area of Science:

• Endocrinology
• Obstetrics
• Perinatology

Background:

• Pregnancy significantly alters thyroid function, with specific hormonal changes and a critical role for maternal thyroxine (T4) in fetal brain development.
• Iodine deficiency in pregnant populations, particularly in Europe, raises concerns about adequate fetal T4 supply.
• Thyroid autoimmunity is increasingly linked to adverse pregnancy outcomes, including fetal loss, though mechanisms and treatments require further investigation.

Purpose of the Study:

• To review current understanding of thyroid disease in pregnancy, focusing on diagnosis, management, and impact on maternal and fetal health.
• To highlight the importance of maternal thyroid hormone levels for fetal neurodevelopment and the potential consequences of dysfunction.
• To discuss the role of thyroid autoimmunity and screening in predicting and managing thyroid dysfunction during and after pregnancy.

Main Methods:

• Literature review of studies on thyroid function, thyroid disease, and pregnancy outcomes.
• Analysis of data regarding maternal thyroid hormone levels, iodine status, and fetal development.
• Examination of evidence for the impact of thyroid autoimmunity and screening on pregnancy complications.

Main Results:

• Maternal hypothyroidism or subclinical hypothyroidism, indicated by low T4 or high TSH, can negatively affect child IQ.
• Thyroid autoimmunity, detected by TPO antibodies, predicts subclinical hypothyroidism and postpartum thyroid dysfunction.
• Propylthiouracil is recommended for hyperthyroidism, with dose adjustments for thyroxine therapy in hypothyroidism.

Conclusions:

• Screening for thyroid function and antibodies in early pregnancy is recommended, alongside considering levothyroxine therapy for subclinical hypothyroidism.
• Maternal thyroid health is crucial for fetal neurodevelopment, necessitating attention to iodine sufficiency and management of thyroid disorders.
• Further research is needed to clarify the etiology of congenital hypothyroidism and optimize management strategies for thyroid dysfunction in pregnancy.