Skip to main content

Thyroid Disease During Pregnancy

Assessment of the Mother

  • Chapter
Handbook of Clinical Laboratory Testing During Pregnancy

Part of the book series: Current Clinical Pathology ((CCPATH))

Abstract

Because of the normal physiologic changes associated with pregnancy, maternal thyroid status is often difficult to assess. This chapter focuses on the evaluation of the mother and examines changes that occur both in normal pregnancy and thyroid disease states during pregnancy. A careful clinical review of the patient’s history, symptoms, and laboratory measurements will aid the physician in an accurate assessment of maternal thyroid status to avoid inappropriate management of the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Larseb PR, Davies TF, Hay ID. The thyroid gland. In: Wilson JD, Foster DW, Kronenberg HM, Larsen PR, eds. Williams Textbool of Endocrinology. Philadelphia: W.B. Saunders, 1998:389-515.

    Google Scholar 

  2. Ain KB, Mori Y, Refetoff S. Reduced clearance rate of thyroxine-binding glogulin (TBG) with increased sialylation: a mechanism for estrogen-induced elevation of serum TBG concentration. J Clin Endocrinol Metab 1987; 65: 689–696.

    Article  PubMed  CAS  Google Scholar 

  3. Skjoldebrand L, Brundin J, Carlstrom A, Pettersson T. Thyroid associated components in serum during normal pregnancy. Acta Endocrinol (Copenh) 1982; 100: 504–511.

    CAS  Google Scholar 

  4. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev 1997; 18: 404–433.

    Article  PubMed  CAS  Google Scholar 

  5. Brent GA. Maternal thyroid function: interpretation of thyroid function tests in pregnancy. Clin Obstet Gynecol 1997; 40: 3–15.

    Article  PubMed  CAS  Google Scholar 

  6. Glinoer D. Thyroid regulation and dysfunction in the pregnant patient. In: www.thyroidmanager.org/ thyroidbook.htm, eds. The Thyroid and Its Diseases. Endocrine Education, Inc., 2001, pp. 1–14.

    Google Scholar 

  7. 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.

    Article  PubMed  CAS  Google Scholar 

  8. Burrow GN, Fisher DA, Larsen PR. Maternal and fetal thyroid function. N Engl J Med 1994; 331: 1072–1078.

    Article  PubMed  CAS  Google Scholar 

  9. Fisher DA, Polk DH, Wu SY. Fetal thyroid metabolism: a pluralistic system. Thyroid 1994; 4: 367–371.

    Article  PubMed  CAS  Google Scholar 

  10. ACOG Practice Bulletin No. 37. Thyroid disease in pregnancy. Am Fam Physician 2002; 100 (2): 387–396.

    Google Scholar 

  11. Demers LM, Spencer CA. Laboratory medicine practice guidelines: laboratory support for the diagnosis and monitoring of thyroid disease. National Academy of Clinical Biochemistry, 2002.

    Google Scholar 

  12. Glinoer D. Maternal and fetal impact of chronic iodine deficiency. Clin Obstet Gynecol 1997; 40: 102–116.

    Article  PubMed  CAS  Google Scholar 

  13. McElduff A. Measurement of free thyroxine (T4) levels in pregnancy. Austr NZ Obstet Gynecol 1999; 39: 158–161.

    Article  CAS  Google Scholar 

  14. Pansesar NS, Li CY, Rogers MS. Reference intervals for thyroid hormones in pregnant Chinese women. Ann Clin Biochem 2001; 38: 329–332.

    Article  Google Scholar 

  15. Spencer CA, Wang C-C. Thyroglobulin measurement: techniques, clinical benefits, and pitfalls. Endocrinol Metab Clin North Am 1995; 24: 841–863.

    PubMed  CAS  Google Scholar 

  16. Mestman J, Goodwin TM, Montoro MM. Thyroid disorders of pregnancy. Endocrinol Metab Clin North Am 1995; 24: 41–71.

    PubMed  CAS  Google Scholar 

  17. Glinoer D, DeNayer P, Bourdoux P, et al. Regulation of maternal thyroid during pregnancy. J Clin Endocrinol Metab 1990; 71: 276–287.

    Article  PubMed  CAS  Google Scholar 

  18. Dafnis E, Sabatini S. The effect of pregnancy on renal function: physiology and pathophysiology. Am J Med Sci 1992; 303: 184–205.

    Article  PubMed  CAS  Google Scholar 

  19. Pochin EE. The iodine uptake of the human thyroid throughout the menstrual cycle and in pregnancy. Clin Sci 1952; 11: 441–445.

    PubMed  CAS  Google Scholar 

  20. Thilly CH, Vanderpas JB, Bebe N, et al. Iodine deficiency, other trace elements, and goitrogenic factors in the etiopathogeny of iodine deficiency disorders (IDD). Biol Trace Elem Res 1992; 32: 229–243.

    Article  PubMed  CAS  Google Scholar 

  21. Goodwin TM, Hershman JM. Hyperthyroidism due to inappropriate production of human chorionic gonadotropin. Clin Obstet Gynecol 1997; 40: 32–44.

    Article  PubMed  CAS  Google Scholar 

  22. Kosugi S, Mori T. TSH receptor and LH receptor. Endocrinol J 1995; 45: 587–606.

    Google Scholar 

  23. 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.

    Article  PubMed  CAS  Google Scholar 

  24. Mann K, Schneider N, Hoermann R. Thyrotropic activity of acidic isolectric varients of human chorionic gonadotropin from trophoblastic tumors. Endocrinol 1986; 118: 1558–1566.

    Article  CAS  Google Scholar 

  25. Guillaume J, Schussler GC, Goldman J, Wassel P, Bach L. Components of the total serum 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; 0: 678–684.

    Article  CAS  Google Scholar 

  26. Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid 1995; 5: 425–434.

    Article  PubMed  CAS  Google Scholar 

  27. Yoshikowa N, Nishikawa M, Horimoto M, et al. Thyroid-stimulating activity in sera of normal pregnant women. J Clin Endocrinol Metab 1989; 69: 891–895.

    Article  Google Scholar 

  28. Yoshimura M, Hershman JM, Pang XP, Berg L, Pekary AE. Activation of the thyrotropin (TSH) receptor by human chorionic gonadotropin and leutinizing hormone in Chinese hamster ovary cells expressing functional human TSH receptors. J Clin Endocrinol Metab 1993; 77: 1009–1013.

    Article  PubMed  CAS  Google Scholar 

  29. Ball R, Freedman DB, Holmes JC, Midgley JEM, Sheehan CP. Low-normal concentrations of free thyroxin in serum in late pregnancy: physiological fact, not detected artifact. Clin Chem 1989; 35: 1891–1896.

    PubMed  CAS  Google Scholar 

  30. Tomer Y, Huber GK, Davies TF. Human chorionic gonadotropin (hCG) interacts directly with recombinant human TSH receptors. J Clin Endocrinol Metab 1992; 74: 1477–1479.

    Article  PubMed  CAS  Google Scholar 

  31. Davies TF, Platzer M. hCG-induced TSH receptor activation and growth acceleration in FRTL-5 thyroid cells. Endocrinol 1986; 118: 2149–2151.

    Article  CAS  Google Scholar 

  32. Glinoer D, DeNayer P, Robyn C, Lejeune B, Kinthaert J, Meuris S. Serum levels of intact human chorionic gonadotropin (hCG) and its free alpha and beta subunits, in relation to maternal thyroid stimulation during normal pregnancy. J Endocrinol Invest 1993; 16: 881–888.

    PubMed  CAS  Google Scholar 

  33. Norman RJ, Green-Thompson RW, Jialal I, Soutter WP, Pillay NL, Joubert SM. Hyperthyroidism in gestational trophoblastic neoplasia. Clin Endocrinol 1981; 15: 395–401.

    Article  CAS  Google Scholar 

  34. Mestman J. Perinatal thyroid dysfunction: prenatal diagnosis and treatment. Medscape Women’ s Health 1997; 2: 1–11.

    Google Scholar 

  35. Glinoer D. Thyroid hyperfunction during pregnancy. Thyroid 1998; 8: 859–864.

    Article  PubMed  CAS  Google Scholar 

  36. Wang C, Crapo LM. The epidemiology of thyroid disease and implications for screening. Endocrinol Metab Clin North Am 1997; 26: 189–218.

    Article  PubMed  CAS  Google Scholar 

  37. Masiukiewicz US, Burrow GN. Hyperthyroidism in pregnancy: diagnosis and treatment. Thyroid 1999; 9: 647–652.

    Article  PubMed  CAS  Google Scholar 

  38. Mestman JH. Hyperthyroidism in pregnancy. Endocrinol Metab Clin North Am 1998; 27: 127–149.

    Article  PubMed  CAS  Google Scholar 

  39. Hamburger JH. Diagnosis and management of Graves’ disease in pregnancy. Thyroid 1992; 2: 219–224.

    Article  PubMed  CAS  Google Scholar 

  40. Lazarus JH. Treatment of hyper-and hypothyroidism in pregnancy. J Endocrinol Invest 1993; 16: 391–396.

    PubMed  CAS  Google Scholar 

  41. Mestman JH. Hyperthyroidism in pregnancy. Clin Obstet Gynecol 1997; 40: 45–64.

    Article  PubMed  CAS  Google Scholar 

  42. Bishnoi A, Sachmechi I. Thyroid disease in pregnancy. Am Fam Physician 1996; 53: 215–220.

    PubMed  CAS  Google Scholar 

  43. Lazarus JH. Thyroid disease in relation to pregnancy: a decade of change. Clin Endocrinol 2000; 53: 265–278.

    Article  CAS  Google Scholar 

  44. Mitsuda N, Tamaki H, Amino N, Hosono T, Miyai K, Tanizawa O. Risk factors for developmental disorders in infants born to women with Graves’ disease. Obstet Gynecol 1992; 80: 359–364.

    PubMed  CAS  Google Scholar 

  45. NĂ¼ĂŸgens Z, Roggenkämper P, Schweikert HU. Entwicklung einer endokrinen orbitopathie während einer schwangerschaft. Klin Monatsbl Augenheilkd 1993; 202: 130–133.

    Article  PubMed  Google Scholar 

  46. Amino N, Tada H, Hidaka Y. Autoimmune thyroid disease in pregnancy. J Endocrinol Invest 1996; 19: 59–69.

    PubMed  CAS  Google Scholar 

  47. Jones BM, Kwok JSY, Kung AWC. Changes in cytokine production during pregnancy in patients with Graves’ disease. Thyroid 2000; 10: 701–707.

    Article  PubMed  CAS  Google Scholar 

  48. Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990; 71: 661–669.

    Article  PubMed  CAS  Google Scholar 

  49. Nohr SB, Jorgenson A, Pederson KM, Laurberg P. Postpartum thyroid dysfunction in pregnant thyroid peroxidase antibody positive women living in an area with mild to moderate iodine deficiency: is iodine supplementation safe? J Clin Endocrinol Metab 2000; 85: 3191–3198.

    Article  PubMed  CAS  Google Scholar 

  50. Pop VJ, DeVries E, van Baar AL, et al. Maternal thyroid peroxidase antibodies during pregnancy: a marker for impaired child development? J Clin Endocrinol Metab 1995; 80: 3561–3566.

    Article  PubMed  CAS  Google Scholar 

  51. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549–555.

    Article  PubMed  CAS  Google Scholar 

  52. Hollowell JG, Staehling NW, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum thyrotropin, thyroxine, and thyroid antibodies in the United States population (1988–1994): national health and nutrition examination survey (NHAANES III). J Clin Endocrinol Metab 2002; 87: 489–499.

    Article  PubMed  CAS  Google Scholar 

  53. Nordyke RA, Gilbert FI, Miyamoto LA, Fleury KA. The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto’s thyroiditis. Arch Intern Med 1993; 153: 862–865.

    Article  PubMed  CAS  Google Scholar 

  54. Cove DH, Johnston P. Fetal hyperthyroidism: experience of treatment in four siblings. Lancet 1985; 1: 430–432.

    Article  PubMed  CAS  Google Scholar 

  55. Ueta Y, Fukui H, Murakami M, et al. Development of primary hypothyroidism with the appearance of blocking-type antibody to thyrotropin receptor in Grave’s disease in late pregnancy. Thyroid 1999; 9: 179–182.

    Article  PubMed  CAS  Google Scholar 

  56. Gupa MK. Thyrotropin-receptor antibodies in thyroid diseases: advances in detection techniques and clinical application. Clin Chem Acta 2000; 293: 1–29.

    Article  Google Scholar 

  57. Costaglioa S, Morganthaler NG, Hoermann R, et al. Second generation assay for thyrotropin receptor antibodies has superior diagnostic sensitivity for Graves’ disease. J Clin Endocrinol Metab 1999; 84: 90–97.

    Article  Google Scholar 

  58. Skuza KA, Sills IN, Stene M, Rapaport R. Prediction of neonatal hyperthyroidism in infants born to mothers with Graves disease. J Pediatr 1996; 128: 264–268.

    Article  PubMed  CAS  Google Scholar 

  59. Wallace C, Couch R, Ginsberg J. Fetal thyrotoxicosis: a case report and recommendations for prediction, diagnosis and treatment. Thyroid 1995; 5: 125–128.

    Article  PubMed  CAS  Google Scholar 

  60. Polk DH. Diagnosis and management of altered fetal thyroid status. Fetal Drug Ther 2002; 21: 647–662.

    Google Scholar 

  61. Fantz CR, Dagogo-Jack S, Ladenson JH, Gronowski AM. Thyroid function during pregnancy. Clin Chem 1999; 45: 2250–2258.

    PubMed  CAS  Google Scholar 

  62. Gardner DF, Cruikshank DP, Hayes PM, Cooper DS. Pharmacology of propylthiourcil (PTU) in pregnant hyperthyroid women: correlation of maternal PTU concentrations with cord serum thyroid function tests. J Clin Endocrinol Metab 1986; 62: 217–220.

    Article  PubMed  CAS  Google Scholar 

  63. Mulder JE. Thyroid disease in women. Med Clin North Am 1998; 82: 103–125.

    Article  PubMed  CAS  Google Scholar 

  64. Goodwin TM, Montoro M, Mestman JH. Transient hyperthyroidism and hyperemesis gravidarum: clinical aspects. Am J Obstet Gynecol 1992; 167: 648–652.

    PubMed  CAS  Google Scholar 

  65. Rodien P, Bremont C, Sanson M-LR, et al. Familial gestational hyperthyroidism caused by a mutant thyrotropin receptor hypersensitive to human chorionic gonadotropin. N Engl J Med 1998; 339: 11823–1826.

    Article  Google Scholar 

  66. Mazzaferri EL. Evaluation and management of common thyroid disorders in women. Am J Obstet Gynecol 1997; 176: 507–514.

    Article  PubMed  CAS  Google Scholar 

  67. Caffrey TJ. Transient hyperthyroidism of hyperemesis gravidarum: a sheep in wolf’s clothing. J Am Board Fam Pract 2000; 13: 35–38.

    PubMed  CAS  Google Scholar 

  68. Goodwin TM, Montoro M, Mestman JH, Pekary AE, Hershman JM. The role of chorionic gonadotropin in transient hyperthyroidism of hyperemesis gravidarum. J Clin Endocrinol Metab 1992; 75: 1333–1337.

    Article  PubMed  CAS  Google Scholar 

  69. Volumenie JL, Polak M, Guibourdenche J, et al. Management of fetal thyroid goiters: a report of 11 cases in a single perinatal unit. Prenat Diag 2000; 20: 799–806.

    Article  CAS  Google Scholar 

  70. Ecker JL, Musci TJ. Treatment of thyroid disease in pregnancy. Obstet Gynecol Clin North Am 1997; 24: 575–589.

    Article  PubMed  CAS  Google Scholar 

  71. Hershman JM. Hyperthyroidsim induced by trophoblastic thyrotropin. Mayo Clinic Proc 1972; 47: 913–918.

    CAS  Google Scholar 

  72. Mizouchi T, Nishimura R, Derappes C, et al. Structures of the asparagine-linked sugar chains of human chorionic gonadotropin produced in choriocarcinoma. J Biol Chem 1983; 258: 14126–14129.

    Google Scholar 

  73. Grodstein F, Goldman MB, Ryan L, Cramer DW. Self reported use of pharmaceuticals and primary ovulatory infertility. Epidemiology 1993; 4: 151–156.

    Article  PubMed  CAS  Google Scholar 

  74. Aldersberg MA, Burrow GN. Focus on primary care: thyroid function and dysfunction in women. Obstet Gynecol Sury 2002; 57: 51 - S7.

    Google Scholar 

  75. Reindollar RH, Novak M, Tho SPT, McDonough PG. Adult-onset amenorrhea: a study of 262 patients. Am J Obstet Gynecol 1986; 155: 531–543.

    PubMed  CAS  Google Scholar 

  76. Amino N, Miyai KJ, Onishi T, Hashimoto T, Arai K. Transient hypothyroidism after delivery in autoimmune thyroiditis. J Clin Endocrinol Metab 1976; 42: 296–301.

    Article  PubMed  CAS  Google Scholar 

  77. Kuijpens JL, Haan-Meulman MD, Vader HL, Pop VJ, Wiersinga WM, Drexhage HA. Cell-mediated immunity and postpartum thyroid dysfunction: a possibility for the prediction of disease. J Clin Endocrinol Metab 1998; 83: 1959–1966.

    Article  PubMed  CAS  Google Scholar 

  78. Gerstein HC. How common is postpartum thyroiditis? a methodologic overview of the literature. Arch Intern Med 1990; 150: 1397–1400.

    Article  PubMed  CAS  Google Scholar 

  79. Amino N, Mori T, Iwantani Y, et al. High prevalence of transient postpartum thyrotoxicosis and hypothyroidism. N Engl J Med 1982; 306: 849–852.

    Article  PubMed  CAS  Google Scholar 

  80. Lervang HH, Pryds O, Kristensen HP. Thyroid dysfunction after delivery: incidence and clinical course. Acta Med Scand 1987; 222: 369–374.

    Article  PubMed  CAS  Google Scholar 

  81. Emerson CH. Thyroid disease during and after pregnancy. In: Weiner JA, Ingbar SH, eds. The Thyroid. Philadelphia: Lippincott, 1991: 1263–1279.

    Google Scholar 

  82. Lazarus JH. Clinical manifestations of postpartum thyroid disease. Thyroid 2001; 9: 685–689.

    Article  Google Scholar 

  83. Othman S, Phillips DW, Parkes AB, et al. A long term follow-up of postpartum thyroiditis. Clin Endocrinol 1990; 32: 559–564.

    Article  CAS  Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Humana Press, Totowa, NJ

About this chapter

Cite this chapter

Fantz, C.R., Gronowski, A.M. (2004). Thyroid Disease During Pregnancy. In: Gronowski, A.M. (eds) Handbook of Clinical Laboratory Testing During Pregnancy. Current Clinical Pathology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-787-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-787-1_8

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4684-9862-2

  • Online ISBN: 978-1-59259-787-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics