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[Thyroid dysfunction in pregnant women: clinical dilemmas]
Rosa Vissenberg1, Mariëtte Goddijn, Ben Willem Mol
1Academisch Medisch Centrum, Afd. Gynaecologie en Obstetrie, Amsterdam, the Netherlands. r.vissenberg@amc.uva.nl
Nederlands Tijdschrift Voor Geneeskunde
|December 11, 2012
Summary
Thyroid dysfunction during pregnancy, including hypothyroidism and hyperthyroidism, can lead to complications. Treatment options like levothyroxine, propylthiouracil, or thiamazole are discussed, alongside reference TSH values for pregnant Dutch women.
Area of Science:
- Endocrinology
- Obstetrics
- Perinatology
Context:
- Thyroid disorders, such as hypothyroidism and hyperthyroidism, are recognized as significant factors influencing pregnancy outcomes.
- Maternal and neonatal complications are frequently associated with both overt and subclinical thyroid dysfunction during gestation.
- Thyroid auto-immunity in pregnancy also presents risks for maternal and neonatal health.
Purpose:
- To review the management of thyroid dysfunction in pregnancy, including treatment modalities for hypothyroidism and hyperthyroidism.
- To discuss the current evidence regarding the efficacy of levothyroxine treatment for subclinical hypothyroidism and thyroid auto-immunity in preventing pregnancy complications.
- To provide reference values for thyroid-stimulating hormone (TSH) levels during pregnancy for the Dutch population.
Summary:
- Overt hypothyroidism necessitates treatment with levothyroxine, while hyperthyroidism is managed with propylthiouracil or thiamazole.
- The effectiveness of levothyroxine in mitigating pregnancy complications associated with subclinical hypothyroidism and thyroid auto-immunity remains unproven.
- Recommended TSH reference ranges for the Dutch population are 0.01-4.00 mU/l for the first and second trimesters, with similar values likely applicable to the third trimester.
Impact:
- This information aids clinicians in optimizing thyroid management during pregnancy, thereby potentially reducing maternal and neonatal morbidity.
- Establishing clear reference ranges aids in the accurate diagnosis and timely intervention for thyroid disorders in pregnant individuals.
- Further research is needed to clarify the benefits of treating subclinical thyroid dysfunction and auto-immunity during pregnancy.
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