Interventions for preventing and treating hyperthyroidism in pregnancy

Earl, Rachel; Crowther, Caroline A; Middleton, Philippa

doi:10.1002/14651858.cd008633

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…Mestman et al [ 91 , 92 ] underscores the importance of pre-pregnancy counseling for hyperthyroid women and the use of contraception until achievement of a euthyroid status before conceiving. Earl et al [ 93 ] found no interventions for the prevention and treatment of hyperthyroidism during pregnancy. Their result for usage of antithyroid drugs (ATD) was inconclusive due to the small potential risk of adverse fetal effects of methimazole and maternal effects of propylthiouracil.…”

Section: Addressing Thyroid Disorders Preconceptionalymentioning

confidence: 99%

Preconception care: screening and management of chronic disease and promoting psychological health

et al. 2014

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IntroductionA large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women.MethodsA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for preventing and managing chronic diseases and promoting psychological health on maternal, newborn and child health outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsMaternal prepregnancy diabetic care is a significant intervention that reduces the occurrence of congenital malformations by 70% (95% Confidence Interval (CI): 59-78%) and perinatal mortality by 69% (95% CI: 47-81%). Furthermore, preconception management of epilepsy and phenylketonuria are essential and can optimize maternal, fetal and neonatal outcomes if given before conception. Ideally changes in antiepileptic drug therapy should be made at least 6 months before planned conception. Interventions specifically targeting women of reproductive age suffering from a psychiatric condition show that group-counseling and interventions leading to empowerment of women have reported non-significant reduction in depression (economic skill building: Mean Difference (MD) -7.53; 95% CI: -17.24, 2.18; counseling: MD-2.92; 95% CI: -13.17, 7.33).ConclusionWhile prevention and management of the chronic diseases like diabetes and hypertension, through counseling, and other dietary and pharmacological intervention, is important, delivering solutions to prevent and respond to women’s psychological health problems are urgently needed to combat this leading cause of morbidity.

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Section: Addressing Thyroid Disorders Preconceptionalymentioning

confidence: 99%

Preconception care: screening and management of chronic disease and promoting psychological health

et al. 2014

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“…The treatment of hyperthyroidism in pregnancy is imperative due to its important negative effects on pregnancy outcome and both mother and foetus health (83,102,103). Thus no randomized controlled trials have been conducted in pregnant hyperthyroid women comparing ATD interventions with no interventions (111).…”

Section: Treatment Of Pathological Hyperthyroidismmentioning

confidence: 99%

“…To reduce unnecessary exposure to ATD in early pregnancy ideally all potentially fertile women should be given written instructions to (I) perform a pregnancy test within a few days after the 1st day of a missed (or atypical week) menstrual period, if pregnancy is a possibility; (II) if the pregnancy test is positive promptly contact physician/ specialist nurse and do not take further ATD until advice given. Considering the risks of hyperthyroidism on one side, and those derived from ATD interventions to the other, some authors suggest that fertile women affected with hyperthyroidism and seeking pregnancy should plan thyroid surgery or radioactive iodine before the plan to become pregnant (111,118).…”

Section: Box 1 Management Of Hypothyroidism In Pregnancymentioning

confidence: 99%

“…Transient gestational thyrotoxicosis usually occurs during the first trimester of pregnancy, and spontaneously resolves when hCG levels decrease, therefore ATD interventions are not indicated, while beta-blockers may be considered in symptomatic cases (111,121). Similarly, no ATD treatment is required for women with hyperemesis gravidarum; however, they need careful electrolyte monitoring and may require intravenous fluids, especially in severe forms.…”

Section: Treatment Of Transient Gestational Thyrotoxicosis and Schypermentioning

confidence: 99%

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Thyroid Function in Pregnancy

Delitala

Maioli

Dessole

et al. 2022

Thyroid Diseases in Pregnancy

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Thyroid hormones are essential for pregnancy maintenance and correct foetal development; even a mild thyroid disturbance can cause potential adverse consequences on obstetric outcomes and foetal wellbeing. Pregnancy also places substantial demands on the thyroid axis, with consequent increase of thyroid hormone requirements. Thus, it is critical to maintain appropriate levels of iodine and thyroid hormones during pregnancy. Thyroid disorders are relatively common in pregnancy, and a prompt diagnosis of thyroid dysfunction requiring medical intervention is needed. Data from large population cohorts and randomised clinical trials demonstrated that it is challenging to establish precise cut-offs of thyroid dysfunction in pregnancy, and therefore diagnose milder forms of thyroid dysfunction. There is now a growing awareness of the need for greater clarity with regard to gestational thyroid reference ranges which should not only be trimester specific, but also population and laboratory method specific. Sub-optimal thyroid function might also be exacerbated by the presence of thyroid autoantibodies, especially anti-thyroid peroxidase antibodies; such evidence led to a change in the most recent American Thyroid Association guidelines. Overt thyroid dysfunction is associated with adverse outcomes, particularly foetal loss, and early gestational age at delivery; there is universal agreement about the absolute necessity to treat such conditions. On the other hand it is unclear whether marginal thyroid abnormalities, such as subclinical hypothyroidism (ScHypo) and isolated hypothyroxinemia (IH), have sufficient impact to justify widespread screening for thyroid disease in pregnancy. This has led to substantial discrepancies between societal guidelines. More recently concern has also been raised regarding over-treatment of hypothyroidism which may result in adverse neurocognitive outcomes. There is a pressing need for evidence-based studies to determine whether universal thyroid screening in pregnancy is appropriate. Iodine deficiency and endocrine disruptors are also likely to have similar deleterious impacts as thyroid insufficiency and greater clarity is also needed here.

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“…Detection of thyroid disorders preconception is essential due to the adverse effects thyroid abnormalities have on conception and pregnancy. It is well established that both uncontrolled thyrotoxicosis and overt hypothyroidism are associated with adverse pregnancy outcomes such as reduced fertility, miscarriage, pre-eclampsia and pre-term birth [1][2][3] . Subclinical hyperthyroidism and subclinical hypothyroidism (SCH) are biochemical diagnoses defined by an abnormal serum thyroid stimulating hormone (TSH)…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Thyroid Dysfunction and Autoimmunity in Women With History of Miscarriage or Subfertility

Dhillon-Smith

Tobías

Smith

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

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Objective To describe the prevalence of and factors associated with different thyroid dysfunction phenotypes in women who are asymptomatic preconception. Design Observational cohort study. Setting A total of 49 hospitals across the United Kingdom between 2011 and 2016. Participants Women aged 16 to 41years with history of miscarriage or subfertility trying for a pregnancy. Methods Prevalences and 95% confidence intervals (CIs) were estimated using the binomial exact method. Multivariate logistic regression analyses were conducted to identify risk factors for thyroid disease. Intervention None. Main Outcome Measure Rates of thyroid dysfunction. Results Thyroid function and thyroid peroxidase antibody (TPOAb) data were available for 19213 and 19237 women, respectively. The prevalence of abnormal thyroid function was 4.8% (95% CI, 4.5-5.1); euthyroidism was defined as levels of thyroid-stimulating hormone (TSH) of 0.44 to 4.50 mIU/L and free thyroxine (fT4) of 10 to 21 pmol/L. Overt hypothyroidism (TSH > 4.50 mIU/L, fT4 < 10 pmol/L) was present in 0.2% of women (95% CI, 0.1-0.3) and overt hyperthyroidism (TSH < 0.44 mIU/L, fT4 > 21 pmol/L) was present in 0.3% (95% CI, 0.2-0.3). The prevalence of subclinical hypothyroidism (SCH) using an upper TSH concentration of 4.50 mIU/L was 2.4% (95% CI, 2.1-2.6). Lowering the upper TSH to 2.50 mIU/L resulted in higher rates of SCH, 19.9% (95% CI, 19.3-20.5). Multiple regression analyses showed increased odds of SCH (TSH > 4.50 mIU/L) with body mass index (BMI) ≥ 35.0 kg/m2 (adjusted odds ratio [aOR] 1.71; 95% CI, 1.13-2.57; P = 0.01) and Asian ethnicity (aOR 1.76; 95% CI, 1.31-2.37; P < 0.001), and increased odds of SCH (TSH ≥ 2.50 mIU/L) with subfertility (aOR 1.16; 95% CI, 1.04-1.29; P = 0.008). TPOAb positivity was prevalent in 9.5% of women (95% CI, 9.1-9.9). Conclusions The prevalence of undiagnosed overt thyroid disease is low. SCH and TPOAb are common, particularly in women with higher BMI or of Asian ethnicity. A TSH cutoff of 2.50 mIU/L to define SCH results in a significant proportion of women potentially requiring levothyroxine treatment.

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Interventions for preventing and treating hyperthyroidism in pregnancy

Cited by 3 publications

References 19 publications

Preconception care: screening and management of chronic disease and promoting psychological health

Preconception care: screening and management of chronic disease and promoting psychological health

Thyroid Function in Pregnancy

The Prevalence of Thyroid Dysfunction and Autoimmunity in Women With History of Miscarriage or Subfertility

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