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Cited by 441Thyroid Disorders and TreatmentsThyroid Cancer Diagnosis and TreatmentMaternal Mental Health During Pregnancy and Postpartum

Thyroid disease in pregnancy: new insights in diagnosis and clinical management

Korevaar, Tim I. M., Medici, Marco, Visser, Theo J., Peeters, Robin P.·2017·Nature Reviews Endocrinology
DOI 10.1038/nrendo.2017.93
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Abstract

Adequate thyroid hormone availability is important for an uncomplicated pregnancy and optimal fetal growth and development. Overt thyroid disease is associated with a wide range of adverse obstetric and child development outcomes. An increasing number of studies now indicate that milder forms of thyroid dysfunction are also associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over the past few years, as new data indicate that the commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for thyroid-stimulating hormone (TSH) are too low to define an abnormal thyroid function. Furthermore, some studies now show that the reference ranges are not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. In addition, data suggest that thyroid peroxidase autoantibody positivity and high or low concentrations of human chorionic gonadotropin seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. Data on the effects of thyroid disease treatment are lacking, but some studies indicate that clinicians should be aware of the potential for overtreatment with levothyroxine. Here, we put studies from the past decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. In addition, we provide an overview of the current views on thyroid physiology during pregnancy and discuss strategies to identify high-risk individuals who might benefit from levothyroxine treatment.

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  • Pregnant women are particularly at risk of developing iodine deficiency due to increased thyroidal demands and increased urinary excretion.

    “Pregnant women are particularly at risk of developing iodine deficiency due to increased thyroidal demands and increased urinary excretion.69,70”

    From Hypothyroidism (2024) · cites this paper as [70]

  • Poor control of hypothyroidism in women with established hypothyroidism during pregnancy is associated with adverse obstetric outcomes, including fetal loss, premature birth, abnormal birthweight, and pre-eclampsia, as well as poor neurocognitive outcomes in the offspring.

    “Poor control of hypothyroidism in women with established hypothyroidism during pregnancy is associated with adverse obstetric outcomes, including fetal loss, premature birth, abnormal birthweight, and pre-eclampsia, as well as poor neurocognitive outcomes in the offspring.70”

    From Hypothyroidism (2024) · cites this paper as [70]

  • Maternal gestational thyroid function has a crucial impact on pregnancy, fetal, and neonatal outcomes.

    “The maternal gestational thyroid function has a crucial impact on pregnancy, fetal, and neonatal outcomes; therefore, TD occurring during pregnancy, especially if overt, require a prompt correction [71, 72].”

    From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [72]

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Authors
Korevaar, T. I. M., Medici, M., Visser, T. J., & Peeters, R. P.
Affiliations
Erasmus MC (NL)
Corresponding author
Korevaar, Tim I. M.
ORCID
Venue
Nature Reviews Endocrinology
Publisher
Springer Science and Business Media LLC
Published
2017-08-04
Volume
13
Issue
10
Pages
610-622
ISSN
  • 1759-5029 (ISSN-L)
  • 1759-5037
DOI
10.1038/nrendo.2017.93
OpenAlex
W2744492484
Cited by
441
References
128
Citations by year
2026: 37 · 2025: 59 · 2024: 55 · 2023: 54 · 2022: 79 · 2021: 52 · 2020: 41 · 2019: 32 · 2018: 30 · 2017: 1 · 2014: 1
FWCI
4.12
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Nature Reviews Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
thyroid disease in pregnancy, subclinical thyroid dysfunction, thyroid peroxidase antibodies, human chorionic gonadotropin, adverse pregnancy outcomes, fetal development, high-risk pregnancy identification
MeSH terms
Adult, Female, Gestational Age, Humans, Hyperthyroidism, Hypothyroidism, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prenatal Diagnosis, Thyroid Diseases, Thyroid Function Tests, Thyroid Hormones, Randomized Controlled Trials as Topic, Treatment Outcome

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