Regulation of Thyroid Hormone: An Important Aspect During Pregnancy

Article ID: e080923220812 Pages: 8

  • * (Excluding Mailing and Handling)

Abstract

This paper provides a synopsis of maternal and fetal thyroid hormone stimulation during pregnancy. Treatment of thyroid illness during pregnancy is critical for avoiding negative maternal and fetal outcomes. Thyroid disorders are frequently asymptomatic and difficult to detect without specialized monitoring programs. Even mild maternal thyroid hormone insufficiency can result in fetal neurodevelopment difficulties. The thyroid is over-stimulated during pregnancy, resulting in alterations in thyroid hormone concentrations. Accurate thyroid function testing during pregnancy is crucial for both initiating thyroid hormone therapy and adjusting thyroid hormone dose in people who are already on thyroid hormone. Trimester-specific intervals are particularly critical during pregnancy, when thyroid insufficiency has been linked to poor obstetric outcomes and neuro-developmental impairments in the fetus. Knowing the natural changes in hormone concentrations that occur throughout pregnancy allows for customized supplementation of iodine when needed.

Graphical Abstract

[1]
Glinoer, D. What happens to the normal thyroid during pregnancy? Thyroid, 1999, 9(7), 631-635.
[http://dx.doi.org/10.1089/thy.1999.9.631] [PMID: 10447005]
[2]
Stathatos, N. Anatomy and physiology of the thyroid gland.The thyroid and its diseases; Springer: Cham, 2019, pp. 3-12.
[http://dx.doi.org/10.1007/978-3-319-72102-6_1]
[3]
Harington, C.R. Physiology of the thyroid gland. BMJ, 1936, 2(3964), 1320-1322.
[http://dx.doi.org/10.1136/bmj.2.3964.1320] [PMID: 20780378]
[4]
Smallridge, R.C.; Glinoer, D.; Hollowell, J.G.; Brent, G. Thyroid function inside and outside of pregnancy: What do we know and what don’t we know? Thyroid, 2005, 15(1), 54-59.
[http://dx.doi.org/10.1089/thy.2005.15.54] [PMID: 15687824]
[5]
Casey, B.M.; Leveno, K.J. Thyroid disease in pregnancy. Obstet. Gynecol., 2006, 108(5), 1283-1292.
[http://dx.doi.org/10.1097/01.AOG.0000244103.91597.c5] [PMID: 17077257]
[6]
Pérez-lópez, F.R. Iodine and thyroid hormones during pregnancy and postpartum. Gynecol. Endocrinol., 2007, 23(7), 414-428.
[http://dx.doi.org/10.1080/09513590701464092] [PMID: 17701774]
[7]
Soldin, O.P. Thyroid function testing in pregnancy and thyroid disease: Trimester-specific reference intervals. Ther. Drug Monit., 2006, 28(1), 8-11.
[http://dx.doi.org/10.1097/01.ftd.0000194498.32398.7b] [PMID: 16418685]
[8]
Cignini, P.; Cafà, E.V.; Giorlandino, C.; Capriglione, S.; Spata, A.; Dugo, N. Thyroid physiology and common diseases in pregnancy: Review of literature. J. Prenat. Med., 2012, 6(4), 64-71.
[PMID: 23272277]
[9]
Ben-Zeev, Z.S.; Peniakov, M.; Felszer, C.; Weiner, S.A.; Lahad, A.; Almashanu, S.; Tenenbaum Rakover, Y. Usefulness of thyroid function assessment in infants born to mothers with thyroid dysfunction during pregnancy. Eur. Thyroid J., 2022, 11(4), e220055.
[http://dx.doi.org/10.1530/ETJ-22-0055] [PMID: 35613337]
[10]
Männistö, T.; Mendola, P.; Grewal, J.; Xie, Y.; Chen, Z.; Laughon, S.K. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J. Clin. Endocrinol. Metab., 2013, 98(7), 2725-2733.
[http://dx.doi.org/10.1210/jc.2012-4233] [PMID: 23744409]
[11]
Sterrett, M. Maternal and fetal thyroid physiology. Clin. Obstet. Gynecol., 2019, 62(2), 302-307.
[http://dx.doi.org/10.1097/GRF.0000000000000439] [PMID: 31026229]
[12]
Nazarpour, S.; Ramezani Tehrani, F.; Simbar, M.; Azizi, F. Thyroid dysfunction and pregnancy outcomes. Iran. J. Reprod. Med., 2015, 13(7), 387-396.
[PMID: 26494985]
[13]
El Baba, K.A.; Azar, S.T. Thyroid dysfunction in pregnancy. Int. J. Gen. Med., 2012, 5, 227-230.
[PMID: 22419883]
[14]
Alemu, A.; Terefe, B.; Abebe, M.; Biadgo, B. Thyroid hormone dysfunction during pregnancy: A review. Int. J. Reprod. Biomed., 2016, 14(11), 677-686.
[http://dx.doi.org/10.29252/ijrm.14.11.677] [PMID: 27981252]
[15]
Stagnaro-Green, A. Overt hyperthyroidism and hypothyroidism during pregnancy. Clin. Obstet. Gynecol., 2011, 54(3), 478-487.
[http://dx.doi.org/10.1097/GRF.0b013e3182272f32] [PMID: 21857178]
[16]
Moleti, M.; Di Mauro, M.; Sturniolo, G.; Russo, M.; Vermiglio, F. Hyperthyroidism in the pregnant woman: Maternal and fetal aspects. J. Clin. Transl. Endocrinol., 2019, 16, 100190.
[http://dx.doi.org/10.1016/j.jcte.2019.100190] [PMID: 31049292]
[17]
Luewan, S.; Chakkabut, P.; Tongsong, T. Outcomes of pregnancy complicated with hyperthyroidism: A cohort study. Arch. Gynecol. Obstet., 2011, 283(2), 243-247.
[http://dx.doi.org/10.1007/s00404-010-1362-z] [PMID: 20087627]
[18]
Polak, M.; Legac, I.; Vuillard, E.; Guibourdenche, J.; Castanet, M.; Luton, D. Congenital hyperthyroidism: The fetus as a patient. Horm. Res., 2006, 65(5), 235-242.
[PMID: 16582565]
[19]
Gargallo Fernández, M. Hyperthyroidism and pregnancy. Endocrinol. Nutr., 2013, 60(9), 535-543.
[PMID: 23477757]
[20]
Wenstrom, K.D.; Weiner, C.P.; Williamson, R.A.; Grant, S.S. Prenatal diagnosis of fetal hyperthyroidism using funipuncture. Obstet. Gynecol., 1990, 76(3 Pt 2), 513-517.
[PMID: 2381636]
[21]
Andersen, S.L.; Andersen, S. Hyperthyroidism in pregnancy: Evidence and hypothesis in fetal programming and development. Endocr. Connect., 2021, 10(2), R77-R86.
[http://dx.doi.org/10.1530/EC-20-0518] [PMID: 33444223]
[22]
Earl, R.; Crowther, C.A.; Middleton, P. Interventions for hyperthyroidism pre-pregnancy and during pregnancy. Cochrane Libr., 2013, (11)CD008633
[http://dx.doi.org/10.1002/14651858.CD008633.pub3] [PMID: 24249524]
[23]
Azizi, F.; Amouzegar, A. Management of hyperthyroidism during pregnancy and lactation. Eur. J. Endocrinol., 2011, 164(6), 871-876.
[http://dx.doi.org/10.1530/EJE-10-1030] [PMID: 21389085]
[24]
Chang, D.L.F.; Pearce, E.N. Screening for maternal thyroid dysfunction in pregnancy: A review of the clinical evidence and current guidelines. J. Thyroid Res., 2013, 2013, 1-8.
[http://dx.doi.org/10.1155/2013/851326] [PMID: 23762776]
[25]
Lazarus, J.H. Thyroid function in pregnancy. Br. Med. Bull., 2011, 97(1), 137-148.
[http://dx.doi.org/10.1093/bmb/ldq039] [PMID: 21186204]
[26]
Boesen, S.A.H.; Long, M.; Wielsøe, M.; Mustieles, V.; Fernandez, M.F.; Bonefeld-Jørgensen, E.C. Exposure to Perflouroalkyl acids and foetal and maternal thyroid status. A review Environ. Health, 2020, 19(1), 107.
[http://dx.doi.org/10.1186/s12940-020-00647-1] [PMID: 33050930]
[27]
Fernandez Rodriguez, B.; Perez Diaz, A.J. Evaluation of a follow up protocol of infants born to mothers with antithyroid antibodies during pregnancy. J. Matern. Fetal Neonatal Med., 2018, 31(3), 312-319.
[http://dx.doi.org/10.1080/14767058.2017.1285886] [PMID: 28118762]
[28]
Stagnaro-Green, A.; Pearce, E. Thyroid disorders in pregnancy. Nat. Rev. Endocrinol., 2012, 8(11), 650-658.
[http://dx.doi.org/10.1038/nrendo.2012.171] [PMID: 23007317]
[29]
LeBeau, S.O.; Mandel, S.J. Thyroid disorders during pregnancy. Endocrinol. Metab. Clin. North Am., 2006, 35(1), 117-136. vii
[http://dx.doi.org/10.1016/j.ecl.2005.09.009] [PMID: 16310645]
[30]
Lao, T.T. Thyroid disorders in pregnancy. Curr. Opin. Obstet. Gynecol., 2005, 17(2), 123-127.
[http://dx.doi.org/10.1097/01.gco.0000162179.15360.08] [PMID: 15758602]
[31]
Yazbeck, C.F.; Sullivan, S.D. Thyroid disorders during pregnancy. Med. Clin. North Am., 2012, 96(2), 235-256.
[http://dx.doi.org/10.1016/j.mcna.2012.01.004] [PMID: 22443973]
[32]
Pop, V.J.; Broeren, M.A.; Wiersinga, W.M.; Stagnaro-Green, A. Thyroid disease symptoms during early pregnancy do not identify women with thyroid hypofunction that should be treated. Clin. Endocrinol., 2017, 87(6), 838-843.
[http://dx.doi.org/10.1111/cen.13433] [PMID: 28746798]
[33]
Mandel, S.J.; Spencer, C.A.; Hollowell, J.G. Are detection and treatment of thyroid insufficiency in pregnancy feasible? Thyroid, 2005, 15(1), 44-53.
[http://dx.doi.org/10.1089/thy.2005.15.44] [PMID: 15687823]
[34]
Kennedy, R.L.; Malabu, U.H.; Jarrod, G.; Nigam, P.; Kannan, K.; Rane, A. Thyroid function and pregnancy: Before, during and beyond. J. Obstet. Gynaecol., 2010, 30(8), 774-783.
[http://dx.doi.org/10.3109/01443615.2010.517331] [PMID: 21126112]
[35]
Granfors, M.; Åkerud, H.; Berglund, A.; Skogö, J.; Sundström-Poromaa, I.; Wikström, A.K. Thyroid testing and management of hypothyroidism during pregnancy: A population-based study. J. Clin. Endocrinol. Metab., 2013, 98(7), 2687-2692.
[http://dx.doi.org/10.1210/jc.2013-1302] [PMID: 23690313]
[36]
Zhou, M.; Wang, M.; Li, J.; Luo, X.; Lei, M. Effects of thyroid diseases on pregnancy outcomes. Exp. Ther. Med., 2019, 18(3), 1807-1815.
[http://dx.doi.org/10.3892/etm.2019.7739] [PMID: 31410141]
[37]
Poppe, K.; Velkeniers, B.; Glinoer, D. The role of thyroid autoimmunity in fertility and pregnancy. Nat. Clin. Pract. Endocrinol. Metab., 2008, 4(7), 394-405.
[http://dx.doi.org/10.1038/ncpendmet0846] [PMID: 18506157]
[38]
Davis, L.E.; Leveno, K.J.; Cunningham, F.G. Hypothyroidism complicating pregnancy. Obstet. Gynecol., 1988, 72(1), 108-112.
[PMID: 3380497]
[39]
Teng, W.; Shan, Z.; Patil-Sisodia, K.; Cooper, D.S. Hypothyroidism in pregnancy. Lancet Diabetes Endocrinol., 2013, 1(3), 228-237.
[http://dx.doi.org/10.1016/S2213-8587(13)70109-8] [PMID: 24622371]
[40]
Casey, B.M.; Dashe, J.S.; Wells, C.E.; McIntire, D.D.; Byrd, W.; Leveno, K.J.; Cunningham, F.G. Subclinical hypothyroidism and pregnancy outcomes. Obstet. Gynecol., 2005, 105(2), 239-245.
[http://dx.doi.org/10.1097/01.AOG.0000152345.99421.22] [PMID: 15684146]
[41]
Sahay, R.; Nagesh, V.S. Hypothyroidism in pregnancy. Indian J. Endocrinol. Metab., 2012, 16(3), 364-370.
[http://dx.doi.org/10.4103/2230-8210.95667] [PMID: 22629500]
[42]
Smallridge, R.C.; Ladenson, P.W. Hypothyroidism in pregnancy: Consequences to neonatal health. J. Clin. Endocrinol. Metab., 2001, 86(6), 2349-2353.
[http://dx.doi.org/10.1210/jcem.86.6.7577] [PMID: 11397821]
[43]
Montoro, M.N. Management of hypothyroidism during pregnancy. Clin. Obstet. Gynecol., 1997, 40(1), 65-80.
[http://dx.doi.org/10.1097/00003081-199703000-00008] [PMID: 9103950]
[44]
Negro, R.; Stagnaro-Green, A. Diagnosis and management of subclinical hypothyroidism in pregnancy. BMJ, 2014, 349(oct064), g4929.
[http://dx.doi.org/10.1136/bmj.g4929] [PMID: 25288580]
[45]
Abalovich, M.; Gutierrez, S.; Alcaraz, G.; Maccallini, G.; Garcia, A.; Levalle, O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid, 2002, 12(1), 63-68.
[http://dx.doi.org/10.1089/105072502753451986] [PMID: 11838732]
[46]
Maraka, S.; Ospina, N.M.S.; O’Keeffe, D.T.; Espinosa De Ycaza, A.E.; Gionfriddo, M.R.; Erwin, P.J.; Coddington, C.C., III; Stan, M.N.; Murad, M.H.; Montori, V.M. Subclinical hypothyroidism in pregnancy: A systematic review and meta-analysis. Thyroid, 2016, 26(4), 580-590.
[http://dx.doi.org/10.1089/thy.2015.0418] [PMID: 26837268]
[47]
Rotondi, M.; Chiovato, L.; Pacini, F.; Bartalena, L.; Vitti, P. Management of subclinical hypothyroidism in pregnancy: A comment from the italian society of endocrinology and the italian thyroid association to the 2017 american thyroid association guidelines—“the italian way”. Thyroid, 2018, 28(5), 551-555.
[http://dx.doi.org/10.1089/thy.2017.0424] [PMID: 29644934]
[48]
Glinoer, D. The regulation of thyroid function during normal pregnancy: Importance of the iodine nutrition status. Best Pract. Res. Clin. Endocrinol. Metab., 2004, 18(2), 133-152.
[http://dx.doi.org/10.1016/j.beem.2004.03.001] [PMID: 15157832]
[49]
Glinoer, D. The regulation of thyroid function in pregnancy: Pathways of endocrine adaptation from physiology to pathology. Endocr. Rev., 1997, 18(3), 404-433.
[http://dx.doi.org/10.1210/edrv.18.3.0300] [PMID: 9183570]
[50]
Hershman, J.M. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract. Res. Clin. Endocrinol. Metab., 2004, 18(2), 249-265.
[http://dx.doi.org/10.1016/j.beem.2004.03.010] [PMID: 15157839]
[51]
Glinoer, D. Thyroid hyperfunction during pregnancy. Thyroid, 1998, 8(9), 859-864.
[http://dx.doi.org/10.1089/thy.1998.8.859] [PMID: 9777758]
[52]
Romano, R.; Jannini, E.A.; Pepe, M.; Grimaldi, A.; Olivieri, M.; Spennati, P.; Cappa, F.; D’Armiento, M. The effects of iodoprophylaxis on thyroid size during pregnancy. Am. J. Obstet. Gynecol., 1991, 164(2), 482-485.
[http://dx.doi.org/10.1016/S0002-9378(11)80004-9] [PMID: 1992688]
[53]
Nelson, M.; Wickus, G.G.; Caplan, R.H.; Beguin, E.A. Thyroid gland size in pregnancy. An ultrasound and clinical study. J. Reprod. Med., 1987, 32(12), 888-890.
[PMID: 3323500]
[54]
Kung, A.W.C.; Chau, M.T.; Lao, T.T.; Tam, S.C.F.; Low, L.C.K. The effect of pregnancy on thyroid nodule formation. J. Clin. Endocrinol. Metab., 2002, 87(3), 1010-1014.
[http://dx.doi.org/10.1210/jcem.87.3.8285] [PMID: 11889153]
[55]
Escobar, G.M.; Obregón, M.J.; Rey, F.E. Maternal thyroid hormones early in pregnancy and fetal brain development. Best Pract. Res. Clin. Endocrinol. Metab., 2004, 18(2), 225-248.
[http://dx.doi.org/10.1016/j.beem.2004.03.012] [PMID: 15157838]
[56]
Norstedt Wikner, B.; Skjöldebrand Sparre, L.; Stiller, C.O.; Källén, B.; Asker, C. Maternal use of thyroid hormones in pregnancy and neonatal outcome. Acta Obstet. Gynecol. Scand., 2008, 87(6), 617-627.
[http://dx.doi.org/10.1080/00016340802075103] [PMID: 18568461]
[57]
Feely, J. The physiology of thyroid function in pregnancy. Postgrad. Med. J., 1979, 55(643), 336-339.
[http://dx.doi.org/10.1136/pgmj.55.643.336] [PMID: 382166]
[58]
Smyth, P.P.A. Variation in iodine handling during normal pregnancy. Thyroid, 1999, 9(7), 637-642.
[http://dx.doi.org/10.1089/thy.1999.9.637] [PMID: 10447006]
[59]
Berbel, P.; Obregón, M.J.; Bernal, J.; Rey, F.E.; Escobar, G.M. Iodine supplementation during pregnancy: A public health challenge. Trends Endocrinol. Metab., 2007, 18(9), 338-343.
[http://dx.doi.org/10.1016/j.tem.2007.08.009] [PMID: 17962037]
[60]
Moleti, M.; Trimarchi, F.; Vermiglio, F. Thyroid physiology in pregnancy. Endocr. Pract., 2014, 20(6), 589-596.
[http://dx.doi.org/10.4158/EP13341.RA] [PMID: 24449667]
[61]
Zimmermann, M.B. The impact of iodised salt or iodine supplements on iodine status during pregnancy, lactation and infancy. Public Health Nutr., 2007, 10(12A), 1584-1595.
[http://dx.doi.org/10.1017/S1368980007360965] [PMID: 18053283]
[62]
Thangaratinam, S.; Tan, A.; Knox, E.; Kilby, M.D.; Franklyn, J.; Coomarasamy, A. Association between thyroid autoantibodies and miscarriage and preterm birth: Meta-analysis of evidence. BMJ, 2011, 342(may09 1), d2616.
[http://dx.doi.org/10.1136/bmj.d2616] [PMID: 21558126]