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The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
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Thyroid in pregnancy: From physiology to screening.

Drahomira Springer1, Jan Jiskra2, Zdenka Limanova2

  • 1a Institute of Medical Biochemistry and Laboratory Medicine, 1st Faculty of Medicine, Charles University and General University Hospital , Prague , Czech Republic.

Critical Reviews in Clinical Laboratory Sciences
|January 20, 2017
PubMed
Summary

Maternal thyroid hormones are vital for fetal development. Early detection and treatment of thyroid dysfunction in pregnancy, through universal screening, are crucial to prevent irreversible fetal harm.

Keywords:
Autoimmune thyroid diseaseanti-thyroperoxidase antibodiespregnancypregnancy lossscreeningthyroid-stimulating hormone

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Area of Science:

  • Endocrinology
  • Reproductive Medicine
  • Maternal-Fetal Medicine

Background:

  • Maternal thyroid hormones are essential for fetal growth, particularly brain and skeletal development, during early pregnancy.
  • Maternal hypothyroidism can lead to irreversible fetal developmental issues after the 14th gestational week.
  • Thyroid dysfunction prevalence in pregnancy ranges from subclinical hypothyroidism (4-17%) to overt hypothyroidism (0.3-0.5%) and hyperthyroidism (0.1-1%).

Purpose of the Study:

  • To review the physiology of thyroid hormones during pregnancy.
  • To discuss the causes and effects of maternal thyroid dysfunction on pregnancy and fetal development.
  • To evaluate case-finding versus universal screening strategies for thyroid disorders in pregnancy.

Main Methods:

  • Review of current literature on thyroid physiology and dysfunction in pregnancy.
  • Analysis of diagnostic approaches including TSH and TPOAb assessment.
  • Discussion of screening strategies and cost-effectiveness.

Main Results:

  • Thyroid function ontogeny is nearly complete by 12-14 weeks; early levothyroxine substitution is critical for hypothyroidism.
  • Thyroid peroxidase antibodies (TPOAb) positivity is common and linked to increased risk of hypothyroidism and adverse pregnancy outcomes.
  • Trimester-specific TSH reference intervals are recommended; universal screening may be more cost-effective than case-finding.

Conclusions:

  • Universal screening for thyroid disorders in pregnancy, including TSH and TPOAb assessment, is supported by evidence for improved cost-effectiveness and detection rates.
  • Timely diagnosis and management of maternal thyroid dysfunction are critical for optimal fetal neurodevelopment and pregnancy outcomes.
  • Further research and implementation of universal screening protocols are recommended.