LA CONSULTA SEMANAL

CONSULTA

1: Int J Gynaecol Obstet. 2002 Nov;79(2):171-80. 

ACOG practice bulletin. Thyroid disease in pregnancy. Number 37, August 2002. American College of Obstetrics and Gynecology.

American College of Obstetrics and Gynecology.

Because thyroid disease is the second most common endocrine disease affecting women of reproductive age, obstetricians often care for patients who have been previously diagnosed with alterations in thyroid gland function. In addition, both hyperthyroidism and hypothyroidism may initially manifest during pregnancy. Obstetric conditions, such as gestational trophoblastic disease or hyperemesis gravidarum, may themselves affect thyroid gland function. This document will review the thyroid-related pathophysiologic changes created by pregnancy and the maternal-fetal impact of thyroid disease.

Publication Types:

    Guideline

2: Obstet Gynecol. 2002 Aug;100(2):387-96. 

ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 37, August 2002. (Replaces Practice Bulletin Number 32, November 2001). Thyroid disease in pregnancy.

American College of Obstetricians and Gynecologists..

Because thyroid disease is the second most common endocrine disease affecting women of reproductive age, obstetricians often care for patients who have been previously diagnosed with alterations in thyroid gland function. In addition, both hyperthyroidism and hypothyroidism may initially manifest during pregnancy. Obstetric conditions, such as gestational trophoblastic disease or hyperemesis gravidarum, may themselves affect thyroid gland function. This document will review the thyroid-related pathophysiologic changes created by pregnancy and the maternal-fetal impact of thyroid disease.

Publication Types:

    Guideline

3: J Clin Endocrinol Metab. 2001 Jun;86(6):2354-9. [Texto completo]

The use of antithyroid drugs in pregnancy and lactation.

Mandel SJ, Cooper DS.

Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. smandel@mail.med.upenn.edu

Publication Types:

    Review

4: Aten Primaria. 2001 Feb 28;27(3):190-6. 

Thyroid disease in pregnancy

[Article in Spanish]

Puigdevall V, Laudo C, Herrero B, del Rio C, Carnicero R, del Rio MJ.

Unidad de Endocrinologia, Hospital General del INSALUD, Soria. Publication Types:

    Review

5: Hosp Med. 2000 Dec;61(12):834-40. 

Thyroid disease in pregnancy.

Girling JC.

Department of Obstetrics and Gynaecology, West Middlesex University Hospital, Isleworth TW7 6AF.

Some interesting recent developments have influenced the modern management of thyroid disease in pregnancy and enhanced our understanding of the interaction between maternal and fetal thyroid function, including the complex role of the placenta. This article will review the latest ideas in this area.

Publication Types:

    Review

6: Clin Endocrinol (Oxf). 2000 Sep;53(3):265-78. 

Thyroid disease in relation to pregnancy: a decade of change.

Lazarus JH, Kokandi A.

Department of Medicine, University of Wales College of Medicine, Cardiff, UK.

Inspection of the references cited in this review indicates that much work has occurred in the area of thyroid and pregnancy during the last decade. Significant advances in our understanding of the immunology of pregnancy and the effect of thyroid disease on this process have taken place. The role of hCG in the physiology of pregnancy and its relevance to thyroid function has been an emerging theme. There is still no clear explanation for the association between thyroid antibodies and infertility or miscarriage. During the last decade a general concensus has developed in relation to the management of hyperthyroidism in pregnancy although there are still variations in antithyroid drug use at this time. The aetiological classification of congenital hyper- and hypothyroidism utilizing new technologies has opened up a new perspective on these disorders. Attention has been drawn to the importance of treating maternal hypothyroidism with adequate thyroid replacement therapy and to the possibility of impaired child neuropsychological development consequent on low maternal thyroid hormone concentration in early gestation in non iodine deficient areas. Significant advances have been made during the last decade in the description of the clinical features and in our understanding of the pathogenesis of postpartum thyroid disease. The importance of long-term follow up of selected patient groups has also been emphasized.

Publication Types:

    Review

7: Clin Chem. 1999 Dec;45(12):2250-8. 

Thyroid function during pregnancy.

Fantz CR, Dagogo-Jack S, Ladenson JH, Gronowski AM.

Department of Pathology and Division of Endocrinology, Washington University School of Medicine, Saint Louis, MO 63110, USA.

BACKGROUND: This Case Conference reviews the normal changes in thyroid activity that occur during pregnancy and the proper use of laboratory tests for the diagnosis of thyroid dysfunction in the pregnant patient. CASE: A woman in the 18th week of pregnancy presented with tachycardia, increased blood pressure, severe vomiting, increased total and free thyroid hormone concentrations, a thyroid-stimulating hormone (TSH) concentration within the reference interval, and an increased human chorionic gonadotropin (hCG) beta-subunit concentration. 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. Furthermore, hCG has mild thyroid stimulating activity. Pregnancy produces an overall increase in thyroid activity, which allows the healthy individual to remain in a net euthyroid state. However, both hyper- and hypothyroidism can occur in pregnant patients. In addition, two pregnancy-specific conditions, hyperemesis gravidarum and gestational trophoblastic disease, can lead to clinical hyperthyroidism. The normal changes in thyroid activity and the association of pregnancy with conditions that can cause hyperthyroidism necessitates careful interpretation of thyroid function tests during pregnancy. CONCLUSION: Assessment of thyroid function during pregnancy should be done with a careful clinical evaluation of the patient's symptoms as well as measurement of TSH and free, not total, thyroid hormones. Measurement of thyroid autoantibodies may also be useful in selected cases to detect maternal Graves disease or Hashimoto thyroiditis and to assess risk of fetal or neonatal consequences of maternal thyroid dysfunction.

Publication Types:

    Review