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Thyroid Dysfunction During Pregnany and After Delivery

  • Charles H. Emerson
Part of the Contemporary Endocrinology book series (COE, volume 2)

Abstract

The incidence, clinical features, diagnosis, and treatment of thyroid diseases differs among pregnant women, those who have recently been pregnant, and other individuals. These differences are considered here in the context of the two categories of thyroid dysfunction: thyrotoxicosis and hypothyroidism.

Keywords

Thyroid Hormone Antithyroid Drug Hyperemesis Gravidarum Serum Thyroid Hormone Lymphocytic Hypophysitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Norman RJ, Green-Thompson RW, Jialal I, Soutter WP, Pillay NL, Joubert SM. Hyperthyroidism in gestational trophoblastic neoplasia. Clin Endocrinol (Oxf) 1981; 15: 395–401.CrossRefGoogle Scholar
  2. 2.
    Kimura M, Amino N, Tamaki H, Ito E, Mitsuda N, Miyai K, Tanizawa O. Gestational thyrotoxicosis and hyperemesis gravidarum: possible role of hCG with higher stimulating activity. Clin Endocrinol (Oxf) 1993; 38: 345–350.CrossRefGoogle Scholar
  3. 3.
    Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH. Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism. Obstet Gynecol 1994; 84: 946–949.PubMedGoogle Scholar
  4. 4.
    Amino N, Tanizawa O, Mori H, Iwatani Y, Yamada T, Kurachi K, Kumahara Y, Miyai K. Aggrevation of thyrotoxicosis in early pregnancy and after delivery in Graves’ Disease. J Clin Endocrinol Metab 1982; 55: 108–112.PubMedCrossRefGoogle Scholar
  5. 5.
    Emerson CH. Thyroid disease during and after pregnancy. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid A Fundamental and Clinical Text. J.B. Lippencott, Philadelphia, 1996, pp. 1021–1031.Google Scholar
  6. 6.
    Jansson R, Dahlberg PA, Winsa B, Meirik O, Safwenberg J, Karlsson A. The postpartum period constitutes an important risk for the development of clinical Graves’ disease in young women. Acta Endocrinologica (Copenhagen) 1987; 116: 321–325.Google Scholar
  7. 7.
    Glinoer D, Lemone M. Goiter and pregnancy: a new insight into an old problem. Thyroid 1992; 2: 65–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Brander A, Kivisaari L. Ultrasonography of the thyroid during pregnancy J Clin Ultrasound 1989; 17: 403–406.CrossRefGoogle Scholar
  9. 9.
    Nelson M, Wickus GG, Caplan RH, Beguin EA. Thyroid gland size in pregnancy. An ultrasound and clinical study. J Reprod Med 1987; 32: 888–890.PubMedGoogle Scholar
  10. 10.
    Burke G. The thyrotropin stimulation test. Ann Int Med 1968; 69: 1127–1139.PubMedGoogle Scholar
  11. 11.
    Mandel SJ, Larsen PR, Seely EW, Brent GA. Increased need for thyroxine during pregnancy in women with primary hypothyroidism. N Engl J Med 1990; 323: 91–96.PubMedCrossRefGoogle Scholar
  12. 12.
    Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med 1994; 331: 1072–1078.PubMedCrossRefGoogle Scholar
  13. 13.
    Braverman LE. Iodine and the thyroid: 33 years of study. Thyroid 1994; 4: 351–356.PubMedCrossRefGoogle Scholar
  14. 14.
    Desai RK, Norman RJ, Jialal I, Joubert SM. Spectrum of thyroid function abnormalities in gestational trophoblastic neoplasia. Clin Endocrinol 1988; 29: 583–592.CrossRefGoogle Scholar
  15. 15.
    Hershman JM. Editorial: Role of human chorionic gonadotropin as a thyroid stimulator. J Clin Endocrinol Metab 1992; 74: 258–259.PubMedCrossRefGoogle Scholar
  16. 16.
    Tsuruta E, Tada H, Tamaki H, Kashiwal T, Asahl K, Takeoka K, Mitsuda N, Amino N. Pathogenic role of asialo human chorionic gonadotropin in gestational thyrotoxicosis. J Clin Endocrinol Metab 1995; 80: 350–355.PubMedCrossRefGoogle Scholar
  17. 17.
    Goodwin TM, Montoro M, Mestman JH. Transient hyperthyroidism and hyperemesis gravi-darum: clinical aspects. Am J Obstet Gynecol 1992; 167: 648–652.PubMedGoogle Scholar
  18. 18.
    Hershman JM, Lee HY, Sugawara M, Mirell CJ, Pang XP, Yanagisawa M, Pekary AE Human chorionic gonadotropin stimulates iodide uptake, adenylate cyclase, and deoxyribonucleic acid synthesis in cultured rat thyroid cells. J Clin Endocrinol Metab 1988; 67: 74–79.PubMedCrossRefGoogle Scholar
  19. 19.
    Kennedy RL, Darne J, Cohn M, Price A, Davies R, Blumsohn A, Griffiths H. Human chorionic gonadotropin man not be responsible for thyroid-stimulating activity in normal pregnancy serum. J Clin Endocrinol Metab 1992; 74: 260–265.PubMedCrossRefGoogle Scholar
  20. 20.
    Pekonen F, Alfthan H, Stenman U-H, Ylikorkala O. Human chorionic gonadotropin (hCG) and thyroid function in early human pregnancy: circadian variation and evidence for intrinsic thyrotropic activity of hCG. J Clin Endocrinol Metab 1988; 66: 853–856.PubMedCrossRefGoogle Scholar
  21. 21.
    Wide L, Lee JY,Rasmussen C. 4 A change in the isoforms of human chorionic gonadotropin occurs around the 13th week of gestation. J Clin Endocrinol Metab 1994; 78: 1419–1423.PubMedCrossRefGoogle Scholar
  22. 22.
    Yoshimura M, Pekary AE, Pang XP, Berg L, Goodwin TM, Hershman JM. Thyrotropic activity of basic isoelectric forms of human chorionic gonadotropin extracted from hydatidiform mole tissues. J Clin Endocrinol Metab 1994; 78: 862–866.PubMedCrossRefGoogle Scholar
  23. 23.
    Hayslip CC, Baker JR Jr, Wartofsky L, Klein TA, Opsahl MS, Burman KD. Natural killer cell activity and serum autoantibodies in women with postpartum thyroiditis. J Clin Endocrinol Metab 1988; 66: 1089–1093.PubMedCrossRefGoogle Scholar
  24. 24.
    Vargas MT, Briones-Urbina R, Gladman D, Papsin FR, Walfish PG. Antithyroid microsomal autoantibodies and HLA-DR5 are associated with postpartum thyroid dysfunction: evidence supporting an autoimmune pathogenesis. J Clin Endocrinol Metab 1988; 67: 327–333.PubMedCrossRefGoogle Scholar
  25. 25.
    Othman S, Phillips DIW, Parkes AB, Richards CJ, Harris B, Fung H, Darke C, John R, Hall R, Lazarus JH. A long-term follow-up of postpartum thyroiditis. Clin Endocrinol (Oxf) 1990; 32: 559–564.CrossRefGoogle Scholar
  26. 26.
    Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Wallenstein S, Davies TF. A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab 1992; 74: 645–653.PubMedCrossRefGoogle Scholar
  27. 27.
    LiVolsi VA. Postpartum thyroiditis the pathology slowly unravels. Am J Clin Pathol 1993; 100: 193–195.PubMedGoogle Scholar
  28. 28.
    Jaume JC, Parkes AB, Lazarus JH, Hall R, Costante G, McLachlan SM, Rapoport B. Thyroid peroxidase autoantibody fingerprints. II. A longitudinal study in postpartum thyroiditis. J Clin Endocrinol Metab 1995; 80: 1000–1005.PubMedCrossRefGoogle Scholar
  29. 29.
    Parkes AB, Othman S, Hall R, John R, Richards CJ, Lazarus JH. The role of complement in the pathogenesis of postpartum thyroiditis. J ClinEndocrinol Metab 1994; 79: 395–400.CrossRefGoogle Scholar
  30. 30.
    Roti E, Emerson CH. Clinical review 29: postpartum thyroiditis. J Clin Endocrinol Metab 1992; 74: 3–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Alvarez-Marfany M, Roman SH, Drexler AJ, Robertson C, Stagnaro-Green A. Long-term prospective study of postpartum thyroid dysfunction in women with insulin dependent diabetes mellitus. J Clin Endocrinol Metab 1994; 79: 10–16.PubMedCrossRefGoogle Scholar
  32. 32.
    Hume RF Jr, Killam AP. Maternal Physiology. In: Scott JR, DiSaia PJ, Hammond CB, Spellacy WN, eds. Danforth’s Obstetrics and Gynecology. JB Lippincott, Philadelphia. 1990; pp. 93–100.Google Scholar
  33. 33.
    Gilroy RJ, Mangura BT, Lavietes MH. Rib cage and abdominal volume displacements during breathing and pregnancy. Am Rev Resp Dis 1988; 137: 668–672.PubMedGoogle Scholar
  34. 34.
    Yamamoto T, Amino N, Tanizawa O, Doi K, Ichihara K, Azukizawa M, Miyai K. Longitudinal study or serum thyroid hormones, chorionic gonadotrophin and thyrotrophin during and after normal pregnancy. Clin Endocrinol 1979; 10: 459–468.CrossRefGoogle Scholar
  35. 35.
    Weeke J, Dybkjaer L, Granlie K, Eskjaer Jensen S, Kjaerulff F, Laurberg P, Magnusson B. A longitudinal study of serum TSH, and total and free iodothyronines during normal pregnancy. Acta Endocrinologica (Copenhagen) 1982; 101: 531–537.Google Scholar
  36. 36.
    Guillaume J, Schussler GC, Goldman J, Wassel P, Bach L. Components of the total thyroid hormone concentrations during pregnancy: high free thyroxine and blunted thyrotropin (TSH) response to TSH-releasing hormone in the first trimester. J Clin Endocrinol Metab 1985; 60: 678.PubMedCrossRefGoogle Scholar
  37. 37.
    Glinoer D, De Nayer P, Bourdoux P, Lemone M, Robyn C, Van Steirteghem A, Kinthaert J, Lejeune B. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab 1990; 71: 276–286.PubMedCrossRefGoogle Scholar
  38. 38.
    Thomas R, Reid RL. Thyroid Disease and Reproductive Dysfunction: A Review. Obstet Gynecol 1987; 70: 789–798.Google Scholar
  39. 39.
    Mandel SJ, Brent GA, Larsen PR. Review of antithyroid drug use during pregnancy and report of a case of aplasia cutis. Thyroid 1994; 4: 129–133.PubMedCrossRefGoogle Scholar
  40. 40.
    Burrow GN. Thyroid function and hyperfunction during gestation. Endocr Rev 1993; 14: 194–202.PubMedGoogle Scholar
  41. 41.
    Wing DA, Millar LK, Koonings PP, Montoro MN, Mestman JH. A comparison of propylthiouracil versus methimazole in the treatment of hyperthyroidism in pregnancy. Am J Obstet Gynecol 1994; 170: 90–95.PubMedGoogle Scholar
  42. 42.
    Cooper DS, Goldminz D, Levin AA, Ladenson PW, Daniels GH, Molitch ME, Ridgway EC. Agranulocytosis associated with antithyroid drugs. Effects of patient age and drug dose. Ann Intern Med 1983; 98 (1): 26–29.PubMedGoogle Scholar
  43. 43.
    Roti E, Gardini E, Minelli R, Salvi M, Robuschi G and Braverman LE. Effects of single and multiple daily doses of methimazole on serum thyroid hormone concentrations in hyperthyroid patients. Ann Intern Med 1989; 111: 181–182.PubMedGoogle Scholar
  44. 44.
    Ramsay I, Kaur S, Krassas G. Thyrotoxicosis in pregnancy: results of treatment by antithyroid drugs combined with T4. Clin Endocrinol 1983; 18: 73–85.CrossRefGoogle Scholar
  45. 45.
    Cove DH, Johnston P. Fetal hyperthyroidism: experience of treatment in four siblings. Lancet 1985; 1: 430–432.PubMedCrossRefGoogle Scholar
  46. 46.
    Thorpe-Beeston JG, Nicholaides KH, Felton CV, Butler J, McGregor MM. Maturation of the secretion of thyroid hormone and thyroid-stimulating hormone in the fetus. N Engl J Med 1991; 324: 532–536.PubMedCrossRefGoogle Scholar
  47. 47.
    Wallace C, Couch R, Ginsberg J. Fetal thyrotoxicosis and recommendations for prediction, diagnosis and treatment. Thyroid 1995; 5: 125–128.PubMedCrossRefGoogle Scholar
  48. 48.
    Cooper DS. Treatment of thyrotoxicosis. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text. JB Lippincott, Philadelphia, 1996, p. 727.Google Scholar
  49. 49.
    Kaplan MM. Monitoring thyroxine treatment during pregnancy. Thyroid 1992; 2: 147–152.PubMedCrossRefGoogle Scholar
  50. 50.
    Kamijo K, Saito T, Sato M, Yachi A, Mukai A, Fukusi M, Takasugi N. Transient subclinical hypothyroidism in early pregnancy. Endocrino Japonica 1990; 37: 397–403.CrossRefGoogle Scholar
  51. 51.
    Nelson JC, Palmer FJ. A remission of goitrous hypothyroidism during pregnancy. J Clin Endocrinol Metab 1975; 40: 383–386.PubMedCrossRefGoogle Scholar
  52. 52.
    Pestell RG, Best JD, Alford FP. Lymphocytic hypophysitis. The clinical spectrum of the disorder and evidence for an autoimmune pathogenesis. Clin Endocrinol (Oxf) 1990; 33: 457–466.CrossRefGoogle Scholar
  53. 53.
    Patel MC, Guneratne N, Haq N, West TW, Weetman AP, Clayton RN. Peripartum hypopituitarism and lymphocytic hypophysitis. Quart J Med 1995; 88: 571–580.Google Scholar
  54. 54.
    Emerson CH. Central Hypothyroidism and hyperthyroidism. Med Cli N Am 1985; 69: 1019–1034.Google Scholar
  55. 55.
    Leung AS, Millar LK, Koonings PP, Montoro M, Mestman JH. Perinatal outcome in hypo-thyroid pregnancies. Obstet Gynecol 1993; 81: 349–353.PubMedGoogle Scholar
  56. 56.
    Roti E, Fang SL, Green K, Emerson CH, Braverman LE. Human placenta is an active site of thyroxine and 3,3 ’,5-triiodothyronine tyrosyl ring deiodination. J Clin Endocrinol Metab 1981; 53: 498–501.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Charles H. Emerson

There are no affiliations available

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