Daniel Glinoer, M.D., Ph.DProfessor of Internal Medicine & Cheif of the Endocrine DivisionUniversity Hospital Sant-Pierre - Universite Libre de Bruxelles, Brussels Belgium
Updated August 2008
Over the past twenty years there has been a major expansion of our knowledge regardingthyroid disorders associated with pregnancy. These advances relate to the optimalmanagement of pregnant women who are on l-thyroxine therapy, the impact of iodinedeficiency on the mother and developing fetus, the adverse effects of maternalhypothyroidism on mental development in their offspring, thyroid dysfunction associated withpostpartum thyroiditis, etc. Simultaneously, a doubling of the miscarriage rate has beenreported in studies in antibody-positive euthyroid women, and an increase in pretermdelivery has been found in women with subclinical hypothyroidism and/or thyroidautoimmunity. Given the rapidity of advances in this field, it is not surprising that somecontroversy surrounds the optimal detection and management of thyroid diseases duringpregnancy, especially since pregnant women may have a variety of known or undisclosedthyroid conditions (such as hypothyroidism and hyperthyroidism), the presence of thyroidautoantibodies, thyroid nodules, or insufficient iodine nutrition.Pregnancy may affect the course of thyroid disorders and, conversely, thyroid diseases mayaffect the course of pregnancy. Moreover, thyroid disorders (and their management) mayaffect both the pregnant woman and the developing fetus. Finally, pregnant women may beunder the care of multiple health care professionals, including obstetricians, nurse midwives,family practitioners, endocrinologists and/or internists, making the development of clinicalpractice guidelines all the more urgent and critical. Accordingly, an international task forcewas created under the auspices of the American Endocrine Society to review the bestevidence in the field and develop evidence-based guidelines. Members of the task forceincluded representatives from the Endocrine Society, American Thyroid Association (ATA),Association of American Clinical Endocrinologists (AACE), European Thyroid Association(ETA), Asia & Oceania Thyroid Association (AOTA), and the Latin American Thyroid Society(LATS). The task force worked for two years to develop the guidelines that were, eventually,approved by all the above-mentioned scientific international organizations. The task forcefinished its work in 2007. The guidelines were published in the Journal of ClinicalEndocrinology and Metabolism (August 2007) as a Supplement containing the completedocument and also in a shorter version or “Executive Summary” containing the main 35recommendations agreed upon by the committee 1.
MATERNAL THYROID PHYSIOLOGY
Numerous hormonal changes and metabolic demands occur during pregnancy, resulting inprofound and complex effects on thyroid function. As thyroid diseases are, in general, muchmore prevalent in women (than in men) during the childbearing period, it is not surprisingthat thyroid disorders such as chronic thyroiditis, hypothyroidism, Graves' disease, etc. are