expected change assessment thyroid pregnancy Pregnancy hyperthyroidism Pregnancy hypothyroidism Pregnancy TSH Pregnancy, thyroid guidelines

Which of the following is an expected change in the assessment of the thyroid during pregnancy?

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  20. Glinoer D. The regulation of thyroid function in pregnancy: pathways of endocrine adaptation from physiology to pathology. Endocr Rev. 1997;18 3:404-433.

  21. Persechini ML, Gennero I, Grunenwald S, Vezzosi D, Bennet A, Caron P. Decreased IGF-1 concentration during the first trimester of pregnancy in women with normal somatotroph function. Pituitary. 2015;18 4:461-464.

  22. Murillo-Llorente M, Fajardo-Montañana C, Pérez-Bermejo M, Vila-Candel R, Gómez-Vela J, Velasco I. Intra-individual variability in TSH levels of healthy women during the first half of pregnancy. Endocrinol Diabetes Nutr. 2017;64 6:288-294.

  23. Chan SY, Vasilopoulou E, Kilby MD. The role of the placenta in thyroid hormone delivery to the fetus. Nat Clin Pract Endocrinol Metab. 2009;5 1:45-54.

  24. Reh A, Grifo J, Danoff A. What is a normal thyroid-stimulating hormone (TSH) level? Effects of stricter TSH thresholds on pregnancy outcomes after in vitro fertilization. Fertil Steril. 2010;94 7:2920-2922.

  25. Karmon AE, Batsis M, Chavarro JE, Souter I. Preconceptional thyroid-stimulating hormone levels and outcomes of intrauterine insemination among euthyroid infertile women. Fertil Steril. 2015;103 1:258-263.

  26. Korevaar TI, Steegers EA, Pop VJ, Broeren MA, Chaker L, de Rijke YB, et al. Thyroid autoimmunity impairs the thyroidal response to human chorionic gonadotropin: two population- based prospective cohort studies. J Clin Endocrinol Metab. 2017;102 1:69-77.

  27. Thienpont LM, Beastall G, Christofides ND, Faix JD, Ieiri T, Miller WG, et al. Proposal of a candidate international conventional reference measurement procedure for free thyroxine in serum. Clin Chem Lab Med. 2007;45 7:934-936.

  28. d'Herbomez M, Forzy G, Gasser F, Massart C, Beaudonnet A, Sapin R. Clinical evaluation of nine free thyroxine assays: persistent problems in particular populations. Clin Chem Lab Med. 2003;41 7:942-947.

  29. Wald NJ. The triple test. Clin Chem. 2014;60 1:269-270.

  30. Laurberg P, Andersen SL. Endocrinology in pregnancy: Pregnancy and the incidence, diagnosing and therapy of Graves'disease. Eur J Endocrinol. 2016;175 5:R219-30.

  31. Casey BM, Dashe JS, Wells CE, McIntire DD, Leveno KJ, Cunningham FG. Subclinical hyperthyroidism and pregnancy outcomes. Obstet Gynecol. 2006;107 2 Pt 1:337-341.

  32. Thienpont LM, Van Uytfanghe K, Beastall G, Faix JD, Ieiri T, Miller WG, et al. Report of the IFCC working group for standardization of thyroid function tests;part 1: thyroid-stimulating hormone. Clin Chem. 2010;56 6:902-911.

  33. Thienpont LM, Van Uytfanghe K, Beastall G, Faix JD, Ieiri T, Miller WG, et al. Report of the IFCC working group for standardization of thyroid function tests;part 2: free thyroxine and free triiodothyronine. Clin Chem. 2010;56 6:912-920.

  34. Thienpont LM, Van Uytfanghe K, Beastall G, Faix JD, Ieiri T, Miller WG, et al. Report of the IFCC working group for standardization of thyroid function tests;part 3: total thyroxine and total triiodothyronine. Clin Chem. 2010;56 6:921-929.

  35. Pop VJ, Biondi B, Wijnen HA, Kuppens SM, Lvader H. Maternal thyroid parameters, body mass index and subsequent weight gain during pregnancy in healthy euthyroid women. Clin Endocrinol (Oxf). 2013;79 4:577-583.

  36. De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012;97 8:2543-2565.

  37. Moon HW, Chung HJ, Park CM, Hur M, Yun YM. Establishment of trimester-specific reference intervals for thyroid hormones in Korean pregnant women. Ann Lab Med. 2015;35 2:198-204.

  38. Bestwick JP, John R, Maina A, Guaraldo V, Joomun M, Wald NJ, et al. Thyroid stimulating hormone and free thyroxine in pregnancy: expressing concentrations as multiples of the median (MoMs). Clin Chim Acta. 2014;430:33-37. doi:10.1016/j.cca2013.12.030.

  39. Ashoor G, Kametas NA, Akolekar R, Guisado J, Nicolaides KH. Maternal thyroid function at 11-13 weeks of gestation. Fetal Diagn Ther. 2010;27 3:156-163.

  40. Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population based study. J Clin Endocrinol Metab. 2013;98 9:3694-3701.

  41. Ashoor G, Maiz N, Rotas M, Jawdat F, Nicolaides KH. Maternal thyroid function at 11 to 13 weeks of gestation and subsequent fetal death. Thyroid. 2010;20 9:989-993.

  42. Benhadi N, Wiersinga WM, Reitsma JB, Vrijkotte TG, Van der Wal MF, Bonsel GJ. Ethnic differences in TSH but not in free T4 concentrations or TPO antibodies during pregnancy. Clin Endocrinol (Oxf). 2007;66 6:765-770.

  43. La'ulu SL, Roberts WL. Second-trimester reference intervals for thyroid tests: the role of ethnicity. Clin Chem. 2007;53 9:1658-1664.

  44. Kachuei M, Jafari F, Kachuei A, Keshteli AH. Prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome. Arch Gynecol Obstet. 2012;285 3:853-856.

  45. Monteleone P, Parrini D, Faviana P, Carletti E, Casarosa E, Uccelli A, et al. Female infertility related to thyroid autoimmunity: the ovarian follicle hypothesis. Am J Reprod Immunol. 2011;66 2:108-114.

  46. Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27 3:315-389.

  47. Medici M, Korevaar TI, Visser WE, Visser TJ, Peeters RP. Thyroid function in pregnancy: what is normal?. Clin Chem. 2015;61 5:704-713.

  48. Pappa T, Anselmo J, Mamanasiri S, Dumitrescu AM, Weiss RE, Refetoff S. Prenatal diagnosis of resistance to thyroid hormone and its clinical implications. J Clin Endocrinol Metab. 2017;102 10:3775-3782.

  49. Roelfsema F, Veldhuis JD. Thyrotropin secretion patterns in health and disease. Endocr Rev. 2013;34 5:619-657.

  50. Roti E, Bartalena L, Minelli R, Salvi M, Gardini E, Pistolesi A, et al. Circadian thyrotropin variations are preserved in normal pregnant women. Eur J Endocrinol. 1995;133 1:71-74.

  51. Robinson H, Robinson P, D'Emden M, Mahomed K. Management of thyroid disease in pregnancy-Room for improvement in the first trimester. Obstet Med. 2016;9 3:126-129.

  52. Tingi E, Syed AA, Kyriacou A, Mastorakos G, Kyriacou A. Benign thyroid disease in pregnancy: A state of the art review. J Clin Transl Endocrinol. 2016;6:37-49. doi:10.1016/j.jcte.2016.11.001.

  53. Budenhofer BK, Ditsch N, Jeschke U, Gärtner R, Toth B. Thyroid (dys-)function in normal and disturbed pregnancy. Arch Gynecol Obstet. 2013;287 1:1-7.

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  55. Faupel-Badger JM, Hsieh CC, Troisi R, Lagiou P, Potischman N. Plasma volume expansion in pregnancy: implications for biomarkers in population studies. Cancer Epidemiol Biomarkers Prev. 2007;16 9:1720-1723.

  56. Lazarus J, Brown RS, Daumerie C, Hubalewska-Dydejczyk A, Negro R, Vaidya B. European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014;3 2:76-94.

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  58. Yalamanchi S, Cooper DS. Thyroid disorders in pregnancy. Curr Opin Obstet Gynecol. 2015;27 6:406-415.

  59. Krassas G, Karras SN, Pontikides N. Thyroid diseases during pregnancy: a number of important issues. Hormones (Athens). 2015;14 1:59-69.

  60. Abalovich M, Gutierrez S, Alcaraz G, Maccallini G, Garcia A, Levalle O. Overt and subclinical hypothyroidism complicating pregnancy. Thyroid. 2002;12 1:63-68.

What is an expected change in the assessment of the thyroid during pregnancy?

Issues: During pregnancy, normal thyroid activity undergoes significant changes, including a two- to threefold increase in thyroxine-binding globulin concentrations, a 30-100% increase in total triiodothyronine and thyroxine concentrations, increased serum thyroglobulin, and increased renal iodide clearance.

How does pregnancy affect the thyroid?

How does pregnancy normally affect thyroid function? Two pregnancy-related hormones—human chorionic gonadotropin (hCG) and estrogen—cause increased thyroid hormone levels in the blood. Made by the placenta, hCG is similar to TSH and mildly stimulates the thyroid to produce more thyroid hor- mone.

How does TSH change during pregnancy?

TSH levels decreased gradually at weeks 5 to 6 to the lowest point at weeks 9 to 12 (range 0.07 – 3.28 mU/L). This is followed by a rise back to an intermediate value at weeks 15 to 19 (range 1.29 – 3.29 mU/L).

Which thyroid hormone values increase during pregnancy?

In the second trimester the upper normal for TSH increases to 3.5mIU/l. The free T4 increases to the upper limit of the normal range in the first trimester.

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