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Thyroid disease in pregnancy

^1. Department of Obstetrics and Gynaecology, West Middlesex University Hospital, Twickenham Road, Isleworth TW7 6AF, UK Email: joanna.girling{at}wmuh.nhs.uk (corresponding author)

Key content:

• Trimester-specific reference ranges should be used to interpret thyroid function during pregnancy.
  
• The fetus requires maternal thyroxine in the first trimester.
  
• Optimal management of hypothyroidism should be achieved prior to conception; pregnant women may need to alter their dose of thyroxine in early pregnancy.
  
• Treatment for hyperthyroidism can often be reduced in the third trimester, to minimise the risk of fetal hyperthyroidism, and then restored postnatally.
  
• Human chorionic gonadotrophin-driven hyperthyroidism in hyperemesis gravidarum usually resolves by 20 weeks and does not require antithyroid medication, although thyrotoxicosis must be excluded.
  

Learning objectives:

• To understand the basis of and treatment options for hypothyroidism in pregnancy.
  
• To appreciate the fetal and neonatal implications of maternal thyrotoxicosis.
  

Ethical issues:

• Worldwide, iodine deficiency has devastating neurological effects on the fetus, many of which can be prevented by supplementation.
  

Please cite this article as: Girling J. Thyroid disease in pregnancy. The Obstetrician & Gynaecologist 2008;10:237–243.

Keywords hyperemesis gravidarum / hyperthyroidism / hypothyroidism / iodine deficiency