Thyroid Diseases in Pregnancy

✍ Scribed by Fereidoun Azizi (editor), Fahimeh Ramezani Tehrani (editor)

• Publisher: Springer
• Year: 2022
• Tongue: English
• Leaves: 252
• Category: Library

✦ Synopsis

This book provides a comprehensive overview of various thyroid disorders in pregnancy. Merging clinical evidence with their own professional experience, international experts in the field report on novel research and share insights on a broad range of topics, from addressing the normal physiology of the thyroid in pregnancy, to the safe treatment of disorders during pregnancy.

Given its scope, the book is chiefly intended for internists, obstetricians, gynecologists, endocrinologists and related sub-specialists; however, it will also benefit general physicians.

✦ Table of Contents

Preface
Contents
Contributors
Thyroid Function in Pregnancy
Normal Thyroid, Anatomy, Physiology
Thyroid Physiology and Function in Pregnancy
Iodine Metabolism
Thyroid Function Tests
Assessment of Thyroid Function in Pregnancy: Gestation-Specific Reference Intervals for Thyroid Function Tests in Pregnancy
Fetal Thyroid Gland (Embryology; Anatomy, Physiology)
Placental Transfer and Metabolism of Thyroid Hormones
Summary
References
Iodine Deficiency/Excess and Pregnancy Outcomes
Iodine Metabolism
World Status of Iodine Deficiency
Impact of Iodine Deficiency on Pregnancy Outcomes
Iodine Supplementation
Impact of Iodine Excess on Pregnancy Outcomes
Summary
References
Iodine Requirements in Pregnancy
Introduction
Sources of Iodine
Role of Iodine
Iodine Physiology During Pregnancy and Lactation
Studies of Iodine Status in Pregnancy
Studies Assessing the Effects of Maternal Iodine Status in Pregnancy
Prospective Studies of Maternal Iodine Supplementation in Pregnancy
Recommendations for Iodine Nutrition in Pregnancy and Lactation
Conclusion
References
Screening of Thyroid Function in Pregnancy
Introduction
Methods
Findings
The Condition Should Be an Important Health Problem
There Should Be an Accepted Treatment
Availability of Facilities for Diagnosis and Treatment
Recognizable Latent or Early Symptomatic Stage
Suitable Test or Examination
Acceptability of the Screening Test
Natural History of the Condition
Agreed Policy on Whom to Treat as Patients
Economical Reasoning of Screening
Continuity of Screening Program
Thyroid Autoimmunity and Pregnancy
Pregnancy Outcomes in Subclinical Hypothyroidism
Subclinical Hypothyroidism and Fetal-Offspring Outcomes
What Would Be Missed During Targeted Screening?
Cost-Effectiveness of Various Screening Methods
Summary
References
Preconception Counseling
Introduction
Preconception Counseling Regarding Iodine Status
Preconception Counseling Regarding Hypothyroidism and Autoimmune Thyroid Disease
Preconception Counseling Regarding Hyperthyroidism
Preconception Counseling Regarding Thyroid Nodules and Cancer
Summary
References
Maternal Clinical Hypothyroidism
Definition
Prevalence
Aetiology
Clinical Features
Diagnosis
Adverse Outcomes (Maternal, Foetal and Child Risks)
Preconception
During Pregnancy
Effects on Child Development
Treatment (Dosage, Goal, Outcomes)
Preconception Management
During Pregnancy
Overt Hypothyroidism Newly Diagnosed in Pregnancy
Overt Hypothyroidism Known Before Pregnancy
Hypothyroid Patients Adequately Treated Before Pregnancy
Hypothyroid Patients Inadequately Treated Before and In Early Pregnancy
At Post-partum
Monitoring
Preconception
During Pregnancy
After Delivery
Summary
References
Gestational Subclinical Hypothyroidism
Introduction
Definition of SCH
Reference Ranges for Serum TSH for Diagnosis of SCH
Measurement of FT4 and Thyroid Autoantibodies in the Diagnosis of SCH
Aetiology of Gestational SCH
Prevalence and Progression of Gestational SCH
Practical Approach to Management of SCH: Re-analysis of Our Data
Adverse Outcomes of SCH
Treatment Monitoring and Screening
Screening for Hypothyroidism in Pregnancy
Summary
References
Isolated Hypothyroxinemia During Pregnancy
Definition
Prevalence
Etiology
Iodine Deficiency
Iron Deficiency
Placental Angiogenic Factors
High BMI
hCG Levels
Older Age
Multiparity
Lower Level of Education
Thyroid Peroxidase Antibodies and Autoimmunity
Exposure to Environmental Contaminants
Hypertension
Smoking
Anxiety
Twin Pregnancy
Clinical Features
Diagnosis
Adverse Outcomes
Treatment
Monitoring
Summary
References
Maternal Hyperthyroidism
Definition
Prevalence and Aetiology
Foetal-Maternal Relationships
Clinical Presentation
Diagnosis
Management
Management Goals and Monitoring
Clinical Scenarios
Autoimmune Disease (Graves’ Disease)
Other Non-autoimmune Clinical Scenarios
Importance of TRAbs Assessment During Pregnancy
Foetal Ultrasonography
Umbilical Cord Sampling
Maternal and Foetal Aspects, Pregnancy Outcomes
Maternal Aspects of Uncontrolled Thyrotoxicosis
Foetal Aspects and Pregnancy Outcomes
Conclusions
Summary
References
Gestational Transient Hyperthyroidism
Introduction
Definition
Prevalence
Pathophysiology
Clinical Features
Clinical, Laboratory, and Imaging Diagnosis
Management
Pregnancy and Neonatal Outcomes
Summary
References
Thyroid Storm and Neonatal Hyperthyroidism
Introduction
Signs and Symptoms, Differential Diagnosis
Diagnosis
Treatment
Neonatal Hyperthyroidism
The Value of TRAb and Pathogenesis of Neonatal Hyperthyroidism
Clinical Manifestation of Neonatal Hyperthyroidism
Diagnosis
Umbilical Cord Blood Sampling, Cordocentesis in Diagnosis of Neonatal Hyperthyroidism
Treatment
Summary
References
Autoimmune Thyroid Disease in Pregnancy
Prevalence
Etiology and Influencing Factors
Maternal Adaptations During Pregnancy
How Thyroid Autoantibodies Negatively Effect on Reproduction and Pregnancy?
TSH-Dependent Pathological Mechanisms
TSH-Independent Pathological Mechanisms
Changes of Thyroid Autoantibodies During Pregnancy
Factors that Could Be Associated with the Development of Antibodies
Factors Reducing the Levels of Thyroid Autoantibodies [3]
Reference Interval and Cutoff Value for Thyroid Autoantibodies
Do Pregnant Women Need to Be Universally Screened for Thyroid Autoimmunity?
What Are the Adverse Fertility and Pregnancy Outcomes of Thyroid Antibodies?
How Should TPOAb+ Women Be Monitored During Pregnancy?
Does Levothyroxine Reduce the Risk of Adverse Pregnancy Outcomes in Euthyroid Women Who Are Thyroid Autoantibody Positive?
Does Levothyroxine Reduce the Risk of Adverse Pregnancy Outcomes in Subclinical Hypothyroid Women Who Are Thyroid Autoantibody Positive?
Is Thyroid Autoimmunity Associated with Adverse Neurodevelopmental Outcomes? And Does Levothyroxine Reduce These Adverse Outcomes?
What Is the Role of Selenium in Treatment of Women with Thyroid Autoimmunity?
What Is the Role of Intravenous Immunoglobulin Therapy or Corticosteroid Therapy in Treatment of Women with Thyroid Autoimmunity?
Should Euthyroid/Subclinical Hypothyroid TPOAb- Positive Women Be Monitored After Pregnancy?
Does Maternal Thyroid Autoimmunity Induce Thyroid Autoimmunity in Offsprings?
Summary
References
Thyroid Nodules and Thyroid Cancer in the Pregnant Woman
Introduction
Thyroid Nodules During Pregnancy
Evaluation and Diagnosis
Evaluation and Management of Thyroid Cancer During Pregnancy
Incidence
Prognosis
Surgical Treatment During Pregnancy
Management of Preexisting Thyroid Cancer During Pregnancy
Pregnancy and Radioactive Iodine
Summary
References
Postpartum Thyroiditis: Diagnosis and Management
Definition
Epidemiology
Etiology
Clinical Presentation
PPT and Postpartum Depression
Thyroid Dysfunction and Breastfeeding
Laboratory Studies
Ultrasound
Differential Diagnosis
Permanent Hypothyroidism
Treatment
Risk Factors
Prevention
Conclusion
Summary
References
Postpartum Thyrotoxicosis
Introduction
Postpartum Alterations of Thyroid Antibodies
Clinical Presentation
Laboratory Findings
Etiology
Management
Management of Breast-Feeding Women
Monitoring and follow-Up
Summary
References
Thyroid and Infertility
Introduction
Hypothyroidism and Infertility
Hyperthyroidism and Infertility
Thyroid Autoimmunity and Infertility
Summary
References
Thyroid Disorders and Hormonal Contraceptives
Introduction
Physiological Consideration
Guide for Clinical Practice
Hypothyroidism
Hyperthyroidism
Autoimmunity
Summary
References