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          Thyroid Disease in Pregnancy: New Insights in Diagnosis and Clinical Management

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          Thyroid hormone check up is usually done during pregnancy since 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. A recent paper in Nature Reviews Endocrinology has reviewed the available literature.

          Research has pointed out even to milder forms of thyroid dysfunction to be associated with these adverse pregnancy outcomes. The definitions of both overt and subclinical thyroid dysfunction have changed considerably over last few years since data has shown commonly used fixed upper limits of 2.5 mU/l or 3.0 mU/l for TSH are too low to define an abnormal thyroid function.

           

          Some latest research has also shown the reference ranges to be not necessarily the best cut-off for identifying pregnancies at high risk of adverse outcomes. Also, thyroid peroxidase autoantibody positivity and high or low concentrations of HCG seem to have a more prominent role in the interpretation of thyroid dysfunction than previously thought. The review found not much data is available on the effects of thyroid disease treatment, but several studies show clinicians should be aware of the potential for overtreatment with levothyroxine.

          The review has included research from last decade on reference ranges for TSH, determinants of thyroid dysfunction, risks of adverse outcomes and options for treatment into perspective. There is also an overview of the current views on thyroid physiology during pregnancy and strategies to identify high-risk individuals who might benefit from levothyroxine treatment.

          Ref: https://www.nature.com/nrendo/journal/vaop/ncurrent/full/nrendo.2017.93.html


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