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BEST PRACTICE NO 184 Screening for thyroid disease in pregnancy

Centre for Endocrine and Diabetes Sciences, Cardiff University, Cardiff CF14 4XN, Wales, UK

Correspondence to:
Professor J H Lazarus
Department of Medicine, Llandough Hospital, Cardiff CF64 2XX, UK; Lazarus{at}cf.ac.uk
ABSTRACT
Although gestational hyperthyroidism is uncommon (0.2%), hypothyroidism (autoimmune disease or suboptimal iodine intake) occurs in 2.5% of women and is predictive of reduced neonatal and child neuropsychological development and maternal obstetric complications. Postpartum thyroid dysfunction (PPTD) occurs in 5–9% of women and is associated with antithyroid peroxidase antibodies (antiTPOAb) in 10% of women in early pregnancy. Therefore, screening for thyroid dysfunction in pregnancy should be considered. T4 and thyroid stimulating hormone measurements could be used to screen for hypothyroidism, which would require levothyroxine intervention treatment. T4 supply is crucial to fetal nervous system maturation; currently, the recommended daily iodine intake is 200 µg, and this is not always achieved, even in the UK. At present, a randomised prospective trial is ongoing to provide the evidence base for this screening strategy. Meanwhile, it is reasonable to (a) optimise iodine nutrition during pregnancy; (b) ascertain women with known thyroid disease; (c) identify women at increased risk of thyroid disease—for example, those with other autoimmune diseases. PPTD can be predicted by measurement of antiTPOAb in early gestation.

Abbreviations: antiTPOAb, antithyroid peroxidase antibody; FT4, free T4; PPTD, postpartum thyroid dysfunction; TSH, thyroid stimulating hormone; TSHRAb, thyroid stimulating hormone receptor stimulating antibodies

Keywords: screening; thyroid; pregnancy; postpartum

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