Background: Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2...

https://www.thyca.org/download/document/486/PregnancyandPostpartum.pdf

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Thyroid hormones (THs) play critical roles in the differentiation, growth, metabolism, and physiological function of virtually all tissues. TH binds to receptors that are ligand-regulatable transcription factors belonging to the nuclear hormone receptor superfamily. Tremendous progress has been made recently in our understanding of the molecular mechanisms that underlie TH action. In this review, we present the major advances in our knowledge of the molecular mechanisms of TH action and their implications for TH action in specific tissues, resistance to thyroid hormone syndrome, and genetically engineered mouse models.

Physiological and molecular basis of thyroid hormone action.

ContextPatients with serum thyroid-stimulating hormone (TSH) levels outside
the reference range and levels of free thyroxine (FT4) and triiodothyronine
(T3) within the reference range are common in clinical practice.
The necessity for further evaluation, possible treatment, and the urgency
of treatment have not been clearly established.ObjectivesTo define subclinical thyroid disease, review its epidemiology, recommend
an appropriate evaluation, explore the risks and benefits of treatment and
consequences of nontreatment, and determine whether population-based screening
is warranted.Data SourcesMEDLINE, EMBASE, Biosis, the Agency for Healthcare Research and Quality,
National Guideline Clearing House, the Cochrane Database of Systematic Reviews
and Controlled Trials Register, and several National Health Services (UK)
databases were searched for articles on subclinical thyroid disease published
between 1995 and 2002. Articles published before 1995 were recommended by
expert consultants.Study Selection and Data ExtractionA total of 195 English-language or translated papers were reviewed.
Editorials, individual case studies, studies enrolling fewer than 10 patients,
and nonsystematic reviews were excluded. Information related to authorship,
year of publication, number of subjects, study design, and results were extracted
and formed the basis for an evidence report, consisting of tables and summaries
of each subject area.Data SynthesisThe strength of the evidence that untreated subclinical thyroid disease
is associated with clinical symptoms and adverse clinical outcomes was assessed
and recommendations for clinical practice developed. Data relating the progression
of subclinical to overt hypothyroidism were rated as good, but data relating
treatment to prevention of progression were inadequate to determine a treatment
benefit. Data relating a serum TSH level higher than 10 mIU/L to elevations
in serum cholesterol were rated as fair but data relating to benefits of treatment
were rated as insufficient. All other associations of symptoms and benefit
of treatment were rated as insufficient or absent. Data relating a serum TSH
concentration lower than 0.1 mIU/L to the presence of atrial fibrillation
and progression to overt hyperthyroidism were rated as good, but no data supported
treatment to prevent these outcomes. Data relating restoration of the TSH
level to within the reference range with improvements in bone mineral density
were rated as fair. Data addressing all other associations of subclinical
hyperthyroid disease and adverse clinical outcomes or treatment benefits were
rated as insufficient or absent. Subclinical hypothyroid disease in pregnancy
is a special case and aggressive case finding and treatment in pregnant women
can be justified.ConclusionsData supporting associations of subclinical thyroid disease with symptoms
or adverse clinical outcomes or benefits of treatment are few. The consequences
of subclinical thyroid disease (serum TSH 0.1-0.45 mIU/L or 4.5-10.0 mIU/L)
are minimal and we recommend against routine treatment of patients with TSH
levels in these ranges. There is insufficient evidence to support population-based
screening. Aggressive case finding is appropriate in pregnant women, women
older than 60 years, and others at high risk for thyroid dysfunction.

https://jamanetwork.com/journals/jama/articlepdf/197994/JSR30016.pdf

Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

Objective: The aim was to update the guidelines for the management of thyroid dysfunction during pregnancy and postpartum published previously in 2007. A summary of changes between the 2007 and 2012 version is identified in the Supplemental Data (published on The Endocrine Society's Journals Online web site at http://jcem.endojournals.org). Evidence: This evidence-based guideline was developed according to the U.S. Preventive Service Task Force, grading items level A, B, C, D, or I, on the basis of the strength of evidence and magnitude of net benefit (benefits minus harms) as well as the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: The guideline was developed through a series of e-mails, conference calls, and one face-to-face meeting. An initial draft was prepared by the Task Force, with the help of a medical writer, and reviewed and commented on by members of The Endocri...

/pdf/management-of-thyroid-dysfunction-during-pregnancy-and-575y0c8uhf.pdf

Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline

https://www.fertstert.org/article/S0015-0282(08)01392-7/pdf

The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report

Background When thyroid deficiency occurs simultaneously in a pregnant woman and her fetus, the child's neuropsychological development is adversely affected. Whether developmental problems occur when only the mother has hypothyroidism during pregnancy is not known. Methods In 1996 and 1997, we measured thyrotropin in stored serum samples collected from 25,216 pregnant women between January 1987 and March 1990. We then located 47 women with serum thyrotropin concentrations at or above the 99.7th percentile of the values for all the pregnant women, 15 women with values between the 98th and 99.6th percentiles, inclusive, in combination with low thyroxine levels, and 124 matched women with normal values. Their seven-to-nine-year-old children, none of whom had hypothyroidism as newborns, underwent 15 tests relating to intelligence, attention, language, reading ability, school performance, and visual–motor performance. Results The children of the 62 women with high serum thyrotropin concentrations performed sli...

https://www.nejm.org/doi/pdf/10.1056/NEJM199908193410801

Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.

When both the fetus and mother have thyroid deficiency, it can be expected that neuropsychological development will be compromised, but it is not clear whether similar problems occur when only the mother is hypothyroid. This study reviewed thyrotropin (TSH) values in stored sera from >25,000 pregnant women. Forty-seven had serum TSH values at or above the 99.7th percentile for all pregnant women, and 15 others had levels between the 98th and 99.6th percentiles as well as a low thyroxine level (below 99.7 nmol/liter). The hypothyroid women were matched with 124 women whose TSH values were normal, and their children underwent 15 tests when they were 7 to 9 years of age. These tests evaluated intelligence, language function, attention, reading ability, visuomotor function, and performance at school.
None of the infants in this study had congenital hypothyroidism. The hypothyroid and normothyroid women were comparable demographically and in their pregnancies. Case children performed less well than control children on all of the neuropsychological tests. Full-scale Wechsler IQ scores were an average of 4 points lower in the children of hypothyroid mothers than in the comparison group; 15 and 5 percent, respectively, had scores of 85 or below. IQ scores of the children of the 48 women not treated for hypothyroidism during pregnancy were an average of 7 points lower than those of control children, and 19 percent had scores of 85 or less. When examined 11 years after delivery, 64 percent of untreated women and 4 percent of control women had confirmed hypothyroidism.
These findings suggest that it may be worthwhile to routinely screen for hypothyroidism in early pregnancy. Testing at the first prenatal visit and prompt follow-up of those with positive results would permit timely treatment and could prevent adverse neuropsychological effects during early child development.
N Engl J Med 1999;341:549–555

Cheryl E. O’heir

Papers

Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child.

Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child