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Caring for women with thyroid disorders in pregnancy

02 July 2018
Clinical Practice
02 July 2018
Volume 26 · Issue 7

Abstract

Thyroid hormone levels within the normal range are essential to support a healthy pregnancy. Since thyroid disorders are prevalent in women of childbearing age, midwives need to be fully aware of the implications of these conditions for the mother and fetus to ensure the best possible pregnancy outcomes. With increasing understanding about the interaction between the thyroid function of the mother and her offspring, this article is focused on the practical aspects of caring for women based on updated guidelines. This review considers the risks of maternal hypothyroidism and hyperthyroidism to the pregnant woman and her baby during and after pregnancy.

Thyroid disorders are prevalent in women of childbearing age and may therefore present during pregnancy. Awareness of the implications of thyroid disorders in pregnancy is therefore essential to ensure optimal outcomes for women and neonates (Lazarus, 2011). The key to good management of thyroid disease in pregnancy is close liaison between the GP, the midwife (in the community and in hospital), the endocrinologist and the obstetrician. This review will focus on the practical aspects of managing women with either hypothyroidism or hyperthyroidism in pregnancy and in the postpartum period.

Thyroid function is defined by levels of circulating thyroid hormones. When all thyroid parameters, namely free thyroxine (fT4), free triiodothyronine (fT3), and thyroid stimulating hormone (TSH), are abnormal, thyroid function is classified as either ‘overt hypothyroidism’ (thyroid deficiency) or ‘overt hyperthyroidism’ (thyroid hormone excess). If only TSH levels are abnormal but levels of fT4 and fT3 are normal, the disorder is termed ‘subclinical’; either subclinical hypothyroidism (TSH high) or subclinical hyperthyroidism (TSH low). The risks of both overt or subclinical thyroid disease will be discussed below.

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Thyroid disease
Pregnancy
Hypothyroidism
Postpartum
Graves' hyperthyroidism