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Postpartum Management of Women Begun on Levothyroxine during Pregnancy.

Stagnaro-Green A - Front Endocrinol (Lausanne) (2015)

Bottom Line: Data over the last 20 years have reported a strong association between subclinical hypothyroidism and adverse maternal/fetal events.Consequently, an ever increasing number of women are being initiated on levothyroxine for the first time during pregnancy.Based on an understanding of the physiology of the thyroid gland during pregnancy and postpartum, and the personal clinical experience of the author, recommendations for the postpartum management of women who were started on levothyroxine during pregnancy are presented.

View Article: PubMed Central - PubMed

Affiliation: University of Illinois Rockford College of Medicine , Rockford, IL , USA.

ABSTRACT
During pregnancy, the thyroid gland must produce 50% more thyroid hormone to maintain the euthyroid state. Women with decreased thyroid reserve preconception, most typically due to Hashimoto's thyroiditis, may develop hypothyroidism during pregnancy. Data over the last 20 years have reported a strong association between subclinical hypothyroidism and adverse maternal/fetal events. As a result of this association, an increasing number of women are being screened for thyroid disease either preconception or at the first prenatal visit. Consequently, an ever increasing number of women are being initiated on levothyroxine for the first time during pregnancy. At present, there are very limited guidelines related to the management of the thyroid disease in these women postpartum. Based on an understanding of the physiology of the thyroid gland during pregnancy and postpartum, and the personal clinical experience of the author, recommendations for the postpartum management of women who were started on levothyroxine during pregnancy are presented.

No MeSH data available.


Related in: MedlinePlus

Pregnancy-thyroid stress test. Pictorial representation of the fact that during pregnancy, the thyroid gland mostly secretes 50% more hormone than the non-pregnant state, and therefore pregnancy represents a stress test for the thyroid.
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Figure 1: Pregnancy-thyroid stress test. Pictorial representation of the fact that during pregnancy, the thyroid gland mostly secretes 50% more hormone than the non-pregnant state, and therefore pregnancy represents a stress test for the thyroid.

Mentions: Pregnancy has a profound impact on the thyroid gland and on thyroid function (1). Estrogen levels, which are elevated during pregnancy, result in a dramatic increase in thyroxine binding globulin. Increased thyroxine-binding globulin levels, transplacental transfer of thyroxine, and changes in deiodinase activity, necessitate a 50% rise in total thyroxine production so as to maintain adequate levels of free thyroid hormone (2). Women with a normal functioning thyroid gland remain euthyroid throughout pregnancy due to this compensatory mechanism. Pregnancy therefore teaches us that the healthy thyroid gland has significant reserve as it can accommodate up to the 50% increase in thyroid hormone production while maintaining the euthyroid state. On the other hand, women with decreased thyroidal reserve preconception, most typically due to Hashimoto’s thyroiditis, may develop subclinical hypothyroidism during pregnancy (3). Furthermore, women with unidentified subclinical hypothyroidism preconception may progress to overt hypothyroidism once pregnant. In essence, pregnancy serves as a stress test for the thyroid gland (Figure 1), bringing out hypothyroidism in women with underlying thyroid disease.


Postpartum Management of Women Begun on Levothyroxine during Pregnancy.

Stagnaro-Green A - Front Endocrinol (Lausanne) (2015)

Pregnancy-thyroid stress test. Pictorial representation of the fact that during pregnancy, the thyroid gland mostly secretes 50% more hormone than the non-pregnant state, and therefore pregnancy represents a stress test for the thyroid.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663256&req=5

Figure 1: Pregnancy-thyroid stress test. Pictorial representation of the fact that during pregnancy, the thyroid gland mostly secretes 50% more hormone than the non-pregnant state, and therefore pregnancy represents a stress test for the thyroid.
Mentions: Pregnancy has a profound impact on the thyroid gland and on thyroid function (1). Estrogen levels, which are elevated during pregnancy, result in a dramatic increase in thyroxine binding globulin. Increased thyroxine-binding globulin levels, transplacental transfer of thyroxine, and changes in deiodinase activity, necessitate a 50% rise in total thyroxine production so as to maintain adequate levels of free thyroid hormone (2). Women with a normal functioning thyroid gland remain euthyroid throughout pregnancy due to this compensatory mechanism. Pregnancy therefore teaches us that the healthy thyroid gland has significant reserve as it can accommodate up to the 50% increase in thyroid hormone production while maintaining the euthyroid state. On the other hand, women with decreased thyroidal reserve preconception, most typically due to Hashimoto’s thyroiditis, may develop subclinical hypothyroidism during pregnancy (3). Furthermore, women with unidentified subclinical hypothyroidism preconception may progress to overt hypothyroidism once pregnant. In essence, pregnancy serves as a stress test for the thyroid gland (Figure 1), bringing out hypothyroidism in women with underlying thyroid disease.

Bottom Line: Data over the last 20 years have reported a strong association between subclinical hypothyroidism and adverse maternal/fetal events.Consequently, an ever increasing number of women are being initiated on levothyroxine for the first time during pregnancy.Based on an understanding of the physiology of the thyroid gland during pregnancy and postpartum, and the personal clinical experience of the author, recommendations for the postpartum management of women who were started on levothyroxine during pregnancy are presented.

View Article: PubMed Central - PubMed

Affiliation: University of Illinois Rockford College of Medicine , Rockford, IL , USA.

ABSTRACT
During pregnancy, the thyroid gland must produce 50% more thyroid hormone to maintain the euthyroid state. Women with decreased thyroid reserve preconception, most typically due to Hashimoto's thyroiditis, may develop hypothyroidism during pregnancy. Data over the last 20 years have reported a strong association between subclinical hypothyroidism and adverse maternal/fetal events. As a result of this association, an increasing number of women are being screened for thyroid disease either preconception or at the first prenatal visit. Consequently, an ever increasing number of women are being initiated on levothyroxine for the first time during pregnancy. At present, there are very limited guidelines related to the management of the thyroid disease in these women postpartum. Based on an understanding of the physiology of the thyroid gland during pregnancy and postpartum, and the personal clinical experience of the author, recommendations for the postpartum management of women who were started on levothyroxine during pregnancy are presented.

No MeSH data available.


Related in: MedlinePlus