Maternal thyroid disease and its effects on the fetus and perinatal outcomes

In general, it is recommended that babies with congenital hypothyroidism be managed in consultation with a pediatric endocrine specialist. The primary care provider or the pediatric endocrine specialist will give instructions for how often the blood tests are monitored. Pregnancy leads to physiological changes in the thyroid gland, which can result in altered thyroid hormone levels. These changes are primarily driven by the increased production of human chorionic gonadotropin (hCG), a hormone produced by the placenta.

Metabolic and cardiovascular effects

• However, the majority of pregnant women tolerate Synthroid well, with minimal side effects.
• It needs careful management as this abnormality can hinder mental development and may cause compressive goiter in infants.
• Prior to your consultation, it may be helpful to gather relevant information, such as your medical history, previous thyroid function test results, and any current medications or supplements you are taking.
• When thyroid hormone deficiency is detected at birth it is called “congenital hypothyroidism”.
• Furthermore, women with GDM seem to be more susceptible to developing Type-2 Diabetes Mellitus (TDM2) and hypertension later in life (16).

Reports of hypocalcemia, respiratory distress, down syndrome, cardiovascular abnormalities, and urogenital malformations have also been observed 39. In addition, the offspring’s decreased cognitive and motor functioninghas also been seen 38,40. Throughout the first trimester, there is a rise in thyroxine-binding globulin (TBG) which is maintained at the same levels during the second trimester. This augmentation of TBG synthesis is caused by higher maternal estrogen levels, which also causes sialylation and, more critically, because of reduced clearance by the liver 1. Because of an increase in maternal thyroid hormone production, there is an increase in concentration, resulting in a rise in total T3 and T4 levels, also causing a boost in the thyroid hormone production in the mother.

Thyroidectomy is rarely needed and only reserved for patients who cannot tolerate thioamides due to severe side effects or when euthyroidism cannot be achieved despite using large doses of thioamides. Surgery is also an option in patients who have a large goiter causing compression issues. Continuous variables were checked for normal distribution using the Kolmogorov–Smirnov test, and were presented as mean (standard deviation, SD) for normally distributed data and as median (IQR) for skewed data. Continuous variables were compared among the 3 groups by using Kruskal–Wallis H test, categorical variables were presented as the frequency (percentage) and compared by using the Chi-square test or Fisher exact test among the 3 groups.

Pediatric Thyroid Information

In pregnancy, there are changes in the ranges of both these hormones requiring the use of gestational trimester-specific reference ranges. Another condition that can develop in premature infants is the so called “delayed TSH elevation” (dTSH) which is characterized by a rise in TSH at the second screening after a first normal screening. This condition occurs predominantly in preterm infants, in low birth weight newborns and in newborns admitted to NICU. The period of time in which it occurs is variable, usually between 2 and 6 weeks of life.

• The most common cause of gestational hypothyroidism is a deficiency in iodine levels 11.
• When appropriately prescribed and monitored, taking Synthroid during pregnancy can provide several benefits for both the mother and the baby.
• In cases of females who have had hypothyroidism since before must get treated before they plan to conceive.

However, it is unknown whether LT4 treatment for pregnant women with mild SCH and TPOAb− have impact on fetal growth. Hypothyroidism during pregnancy is a significant threat not only to the mother but also to her infant. There is synthroid route a considerable risk of developmental anomalies and hindrances in the growth of infants in terms of intelligence and physical well-being. Since a pregnant mother can be diagnosed with hypothyroidism which can be present before she conceives or may develop it during her pregnancy, known as gestational hypothyroidism, it is necessary to identify the signs and symptoms as early as possible and get the required treatment.

In order to do this, parents must fill their baby’s levothyroxine prescription in a timely manner, and let their doctor know if they need a refill. The thyroid gland is a butterfly-shaped endocrine gland that is located in the lower front of the neck, just above the collarbone. The thyroid’s job is to make thyroid hormones, which are released into the blood and then carried to every tissue in the body. In children, thyroid hormone helps to ensure that growth and development occur normally and that the body’s energy, metabolism, heart, muscles, and other organs are working properly. Thyroid hormone is important for your baby’s brain development as well as growth, therefore, untreated congenital hypothyroidism can lead to intellectual disabilities and growth failure.

Linear regression model was performed to compare the Untreated and Treated mild SCH with TPOAb− groups with Euthyroid group in terms of birth weight Z-score. Crude model was built without adjustment for any covariates, while the adjusted model was adjusted for the covariates. To assess the effect of LT4 treatment, the Untreated and Treated mild SCH with TPOAb− groups were compared, the analysis methods were similar to the preceding analyses. The model 1 was adjusted for the covariates mentioned above and the model 2 was additionally adjusted for TSH level 16. After delivery, levothyroxine therapy should be returned to the prepregnancy dose, and the TSH checked 6–8 weeks postpartum.

Some studies have shown an increase in pregnancy-induced hypertension (high blood pressure of pregnancy) in women with hyperthyroidism. Given the limited evidence, we conducted a birth cohort study to investigate the effect of LT4 treatment on fetal growth and birth weight among mild SCH pregnant women with TPOAb−. This condition is characterized by excessive production of thyroid hormones, which can have various effects on the mother and the developing baby. On the other hand, pregnancy can also lead to an underactive thyroid, known as hypothyroidism, where the thyroid gland does not produce enough hormones. Both hyperthyroidism and hypothyroidism can have significant implications for the health of the mother and the baby.

Enhancing Healthcare Team Outcomes

The etiology of this condition is heterogeneous; among the causes, there could be iodine excess or iodine deficiency. Zung et al. studied the risk factors that can determine dTSH in newborns admitted to NICU, concluding that both gestational age and birth weight are less important than the severity of the clinical conditions, to determine dTSH (67). Cavarzere P. et al. carried out a retrospective study to evaluate the incidence of dTSH in LBW neonates, showing that 57.5% of newborn with a weight lower than 2500 grams presented dTSH. They concluded that a second screening performed at 15 days of life in preterm infants is essential to identify dTSH (68).

In cases of females who have had hypothyroidism since before must get treated before they plan to conceive. After their levels reach the desired limit, women must wait for some time before they can conceive and get pregnant to prevent any harmful reactions that may hinder the baby’s growth due to the presence of the drugs consumed for treatment. Mothers who develop gestational hypothyroidism must get treated as soon as they are diagnosed. Iodine is recommended for people living in areas with severe deficiency of iodine because of the inability and non-feasibility of salt iodization in such areas.