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Pregnancy and the thyroid

Published online by Cambridge University Press:  10 October 2008

P Kendall-Taylor*
Affiliation:
Department of Medicine, University of Newcastle upon Tyne, UK.
*
P Kendall-Taylor, Endocrine Unit, Department of Medicine, Medical School, University of Newcastle upon Tyne, NE2 4HH

Extract

The normal thyroid secretes thyroxine (T4) and, to a lesser extent, triiodothyronine (T3). The T4 is transported in the circulation to peripheral tissues largely bound to thyroxine binding globulin (TBG); T3, which is produced in peripheral tissues by deiodination of T4, also binds to TBG. It is, however, the free thyroid hormone concentration which determines the metabolic state, by its action on T3 nuclear receptors in the cells of kidney, heart, liver, anterior pituitary and other tissues.

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Articles
Copyright
Copyright © Cambridge University Press 1993

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References

1Hershman, JM, Lee, HY, Sugawara, M, Mirell, J, Pang, XP, Yanagisawa, M et al. Human chorionic gonadotropin stimulates iodide uptake, adenylate cyclase and deoxyribonucleic acid synthesis in cultured rat thyroid cells. J Clin Endocrinol Metab 1988; 67: 7479.CrossRefGoogle ScholarPubMed
2Yoshikawa, N, Nishikawa, M, Horimoto, M, Yoshimura, M, Sawaragi, S, Horikoshi, Y et al. Thyroid stimulating activity in sera of normal pregnant women. J Clin Endocrinol Metab 1989; 69: 891–95.CrossRefGoogle ScholarPubMed
3Hershman, JM. Role of human chorionic gonadotrophin as thyroid stimulator. J Clin Endocrinol Metab 1992; 74: 258–59.Google Scholar
4Ball, R, Freeman, DB, Holmes, JC, Midgely, JEM, Sheehan, P. Low-normal concentrations of free thyroxine in late pregnancy. Clin Chem 1989; 35: 1891–96.CrossRefGoogle ScholarPubMed
5Chan, BY, Swaminathan, R. Serum thyrotrophin concentration measured by sensitive assays in normal pregnancy. Br J Obstet Gynaecol 1988; 95: 1332–36.CrossRefGoogle ScholarPubMed
6Price, A, Griffiths, H, Morris, BW. A longitudinal study of thyroid function in pregnancy. Clin Chem 1989; 35: 275–78.CrossRefGoogle ScholarPubMed
7Burrow, GN. Thyroid function and disease. Philadelphia: WB Saunders, 1989: 292.Google Scholar
8Kventy, J, Poulsen, HK. Nuclear thyroxine and 3,5,3' -triiodothyronine receptors in human mononuclear blood cells during pregnancy. Acta Endocrinol 1984; 105: 1923.Google Scholar
9Rasmussen, NG, Hornnes, PJ, Hegedus, L. Ultrasonographically determined thyroid size in pregnancy and postpartum. Am J Obstet Gynecol 1989; 160: 1216–20.CrossRefGoogle Scholar
10Fisher, DA, Polk, DH. Development of the thyroid. Bailliére’s Clin Endocrinol Metab 1989; 3: 627–57.Google Scholar
11Thorpe-Beeston, JG, Nicolaides, KH, McGregor, AM. Fetal thyroid function. Thyroid 1992; 2: 207–17.Google Scholar
12Thorpe-Beeston, JG, Nicolaides, KH, McGregor, AM. Maturation of the secretion of thyroid hormone and thyroid stimulating hormone in the fetus. N Engl J Med 1991; 324: 532–36.CrossRefGoogle ScholarPubMed
13Ballabio, M, Nicolini, U, Jowett, T, Ruiz de Elvira, MC, Ekins, PR, Rodeck, CH. Maturation of thyroid function in normal human fetuses. Clin Endocrinol 1989; 31: 565–71.CrossRefGoogle Scholar
14Yoshida, K, Sakurada, T, Takahashi, T, Furuhashi, N, Kaise, K, Yoshinga, K. Measurement of TSH in human amniotic fluid. Clin Endocrinol 1986; 25: 313–18.CrossRefGoogle ScholarPubMed
15Fisher, DA, Klein, HA. Thyroid development and disorders of thyroid function in the newborn. N Engl J Med 1981; 304: 702–12.CrossRefGoogle ScholarPubMed
16Roti, E, Gnudi, A, Braverman, LE. The placental transport, synthesis and metabolism of hormones and drugs which affect thyroid function. Endocrin Rev 1981; 4: 131–49.CrossRefGoogle Scholar
17Morreale de Escobar, G, Obregon, MJ, de Ona, CR, Escobar del Rey, F. Comparison of maternal to fetal transfer of 3,5,3' -triiodothyronine versus thyroxine in rats. Acta Endocrinol 1989; 120: 2030.Google Scholar
18Vulsma, T, Gons, MH, de Vijder, JJM. Maternal-fetal transfer of thyroxine in congenital hypothyroidism due to a total organification defect or thyroid agenesis. N Engl J Med 1989; 321: 1316.CrossRefGoogle ScholarPubMed
19De Ona, CR, Obregon, MJ, Escobar del Rey, F, Morreale de Escobar, G. Developmental changes in rat brain 5' -deiodinase and thyroid hormones in the fetal period. Paediatr Res 1988; 24: 588–94.CrossRefGoogle Scholar
20Bernal, J, Pekonen, F. Ontogenesis of nuclear 3,5,3' -triiodothyronine receptors in human fetal brain. Endocrinology 1984; 114: 677–79.Google Scholar
21Roti, E, Gnudi, A, Braverman, LE, Robuschi, G, Emanueze, R, Bandini, P et al. Human cord blood concentrations of thyrotropin, thyroglobulin and iodothyronines after maternal administration of thyrotropin-releasing hormone. J Clin Endocrinol Metab 1981; 53: 813–17.CrossRefGoogle ScholarPubMed
22Gleicher, N, Siegel, I. Pregnancy and the immune state. In: Davies, TF ed. Autoimmune endocrine disease. New York: J Wiley & Sons, 1983: 225–45.Google Scholar
23Gall, SA. Maternal adjustments in the immune system in normal pregnancy. Clin Obstet Gynecol 1983; 26: 521–36.CrossRefGoogle ScholarPubMed
24Strelkaukas, AJ, Wilson, BS, Dray, S, Dodson, M. Inversion of levels of human T and B cells in early pregnancy. Nature 1975; 258: 331–32.Google Scholar
25Sridama, V, Pacini, F, Yang, S, Moawad, A, Reilly, M, de Groot, LJ. Decreased levels of helper T cells: a possible cause of immunodeficiency in pregnancy. N Engl J Med 1982; 307: 352–56.CrossRefGoogle ScholarPubMed
26Stagnaro-Green, A, Roman, SH, Cobin, RH, el Harazy, E, Wallenstein, S, Davies, TF. A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab 1992; 74: 645–53.Google Scholar
27Gardiner-Hill, H. Pregnancy complicating simple goitre and Graves’ disease. Lancet 1929; i: 120–24.CrossRefGoogle Scholar
28Amino, N, Tanizawa, U, Mori, H, Iwatani, Y, Yamada, T, Kurachi, K et al. Aggravation of thyrotoxicosis in early pregnancy and after delivery in Graves’ disease. J Clin Endocrinol Metab 1982; 55: 108–12.CrossRefGoogle ScholarPubMed
29Bouillon, R, Naesens, M, van Assche, FA et al. Thyroid function in patients with hyperemesis gravidarum. Am J Obstet Gynecol 1982; 143: 922–26.CrossRefGoogle ScholarPubMed
30Chin, RKH, Lao, TTH. Thyroxine concentrations and outcome of hyperemetic pregnancies. Br J Obstet Gynaecol 1988; 95: 507509.Google Scholar
31Pekonen, F, Alfthan, H, Stenman, UH, Ylikorkala, O. Human chorionic gonadotrophin (hCG) and thyroid function in early human pregnancy: circadian variation and evidence for intrinsic thyrotrophic activity of hCG. J Clin Endocrinol Metab 1988; 66: 853–56.Google Scholar
32Desai, RK, Norman, RJ, Jialal, I, Joubert, SM. Spectrum of thyroid function abnormalities in gestational trophoblastic neoplasia. Clin Endocrinol 1988; 29: 583–92.Google Scholar
33Rajatanavin, R, Chailurkit, L, Srisupandit, S, Tungtrakul, S, Bunyaratvej, S. Trophoblastic hyperthyroidism: clinical and biochemical features in five cases. Am J Med 1988; 85: 237–41.Google Scholar
34Kendall-Taylor, P. Thyrotoxicosis. In: Grossman, A ed. Clinical endocrinology. Oxford: Blackwell Scientific Publications, 1992: 309–42.Google Scholar
35Sugrue, D, McEvoy, N, Feely, J, Drury, MI. Hyperthyroidism in the land of Graves: results of treatment by surgery, radioiodine and carbimazole in 837 cases. Quart J Med 1980; 193: 5161.Google Scholar
36Davis, LE, Lucas, MJ, Hankins, GDV, Roark, ML, Cunningham, FG. Thyrotoxicosis complicating pregnancy. Am J Obstet Gynecol 1989; 160: 6370.Google Scholar
37Momotani, N, Ito, K, Hamada, N, Ban, Y, Nishikawa, Y, Mimura, T. Maternal hyperthyroidism and congenital malformations in the offspring. Clin Endocrinol 1984; 20: 695700.Google Scholar
38Marchant, B, Lees, JFH, Alexander, WD. Antithyroid drugs. In: Hershman, JM, Bray, GA eds. The thyroid: physiology and treatment of disease. Oxford: Pergamon Press, 1979: 209–52.Google Scholar
39Burrow, GN. The management of thyrotoxicosis in pregnancy. N Engl J Med 1985; 313: 562–65.CrossRefGoogle ScholarPubMed
40Cooper, DS. Antithyroid drugs. N Engl J Med 1984; 311: 1353–62.Google Scholar
41McGregor, AM, Petersen, MM, McLachlan, SM, Rooke, P, Rees Smith, B, Hall, R. Carbimazole and the autoimmune response in Graves’ disease. N Engl J Med 1980; 303: 302307.Google Scholar
42Ramsay, I, Kaur, S, Krassas, G. Thyrotoxicosis in pregnancy: results of treatment by antithyroid drugs combined with T4. Clin Endocrinol 1983; 18: 7385.Google Scholar
43Hashizyme, K, Ichikawa, K, Nishii, Y, Koboyashi, M, Sakurai, A, Miyamoto, T et al. Effect of administration of thyroxine on the risk of postpartum recurrence of hyperthyroid Graves’ disease. J Clin Endocrin Metab 1992; 75: 610.Google Scholar
44Van Dijke, CP, Heydendael, RJ, De Kleine, MJ. Methimazole, carbimazole and congenital skin defects. Ann Intern Med 1987; 106: 6061.CrossRefGoogle ScholarPubMed
45Williams, RH, Kay, GA, Jandorf, BJ. Thiouracil. Its absorption, distribution and excretion. J Clin Invest 1944; 23: 613–35.CrossRefGoogle ScholarPubMed
46Kampmann, JP, Hansen, JM, Johansen, K, Helweg, J. Propyl thiouracil in human milk. Revision of a dogma. Lancet 1980; i: 736–37.CrossRefGoogle Scholar
47Low, LCK, Lang, J, Alexander, WD. Excretion of carbimazole and propylthiouracil in breast milk. Lancet 1979; ii: 1011.Google Scholar
48Tegler, L, Lindström, B. Antithyroid drugs in milk. Lancet 1980; ii: 591.CrossRefGoogle Scholar
49Lamberg, BA, Ikonen, E, österlund, K, Teramo, K, Pekonen, F, Peltola, J et al. Antithyroid treatment of maternal hyperthyroidism during lactation. Clin Endocrinol 1984; 21: 8187.Google Scholar
50Fisher, DA. The thyroid gland. In: Brook, GD ed. Paediatric endocrinology. London: Blackwell Scientific, 1988: 309–37.Google Scholar
51Munro, DS, Dirmikis, SM, Humphries, H, Smith, T, Broadhead, GD. The role of thyroid stimulating immunoglobulins of Graves’ disease in neonatal thyrotoxicosis. Br J Obstet Gynaecol 1978; 85: 837–43.Google Scholar
52Zakarija, M, McKenzie, JM, Hoffman, WH. Predication and therapy of intrauterine and late onset neonatal hyperthyroidism. J Clin Endocrinal Metab 1986; 62: 368–71.CrossRefGoogle Scholar
53Tamaki, H, Amino, N, Aozasa, M, Mori, M, Iwatani, Y, Tachi, J et al. Universal predictive criteria for neonatal overt thyrotoxicosis requiring treatment. Am J Perinatol 1988; 5: 152–58.CrossRefGoogle ScholarPubMed
54Cove, DH, Johnston, P. Fetal hyperthyroidism: experience of treatment in four siblings. Lancet 1985; i: 430–32.CrossRefGoogle Scholar
55Hetzel, BS. The story of iodine deficiency. An international challenge in nutrition. Oxford: Oxford University Press, 1989.Google Scholar
56Kudlow, JE, Burrow, GN. Thyroid cancer and pregnancy. In: Greenfield, LD ed. Thyroid cancer. Florida: CRC Press, 1978: 199206.Google Scholar
57Delange, F, Bürgi, H. Iodine deficiency disorders in Europe. 1989. Bull WHO 1989; 67: 317–25.Google Scholar
58Glinoer, D, Delange, F, Laboureur, I, De Nayer, P, Lejeune, B, Kinthaert, J et al. Maternal and neonatal thyroid function at birth in an area of marginally low iodine intake. J Clin Endocrinol Metab 1992; 75: 800805.Google Scholar
59Dussault, JH, Ruel, J. Thyroid hormones and brain development. Ann Rev Physiol 1987; 49: 321–34.Google Scholar
60Man, EB, Brown, JF, Serunian, SA. Maternal hypothyroxinaemia: psychoneurological deficits in progeny. Ann Clin Lab Sci 1991; 21: 227–39.Google ScholarPubMed
61Davis, LE, Leveno, KJ, Cunningham, FG. Hypothyroidism complicating pregnancy. Obstet Gynecol 1988; 72: 108–12.Google Scholar
62Delange, F, Fisher, DA, Glinoer, D eds. In: Research in congenital hypothyroidism. New York & London: Plenum Press, 1989.Google Scholar
63Thilly, CH, Roger, G, Lagasse, R, Tshibangu, D, Vanderpas, JB, Berquist, H et al. Fetomaternal relationship, fetal hypothyroidism and psychomotor retardation. In: Ermans, AM et al. eds. The role of cassava in the etiology of endemic goitre. Canada: IDRC, 1980: 111–20.Google Scholar
64Walfish, PG, Chan, JYC. Post partum hyperthyroidism. Clin Endocrin Metab 1985; 14: 417–47.Google Scholar
65Matsuura, N, Yamada, Y, Nohara, Y, Konishi, J, Kasagi, K, Endo, K et al. Familial neonatal transient hypothyroidism due to maternal TSH-binding inhibitor immunoglobulins. N Engl J Med 1980; 303: 738–41.Google Scholar
66Van der Gaag, RD, Drexhage, HA, Dussault, JR. Role of maternal immunoglobulins blocking TSH-induced thyroid growth in sporadic forms of congenital hypothyroidism. Lancet 1985; i: 246–50.Google Scholar
67Hadeed, AJ, Asay, LD, Klein, AH, Fisher, DA. Significance of transient hypothyroxinaemia in premature infants with and without respiratory distress syndrome. Pediatrics 1981; 68: 494–98.CrossRefGoogle ScholarPubMed
68New England Regional Screening Program and the New England Congenital Hypothyroidism Collaborative. Pitfalls in screening for congenital hypothyroidism. Pediatrics 1982; 70: 165200.Google Scholar
69La Franchi, SH, Hanna, CE, Krainz, PL, Skeels, MR, Miyahara, RS, Sesser, DE. Screening for congenital hypothyroidism with specimen collection at two time periods: results of the northwest regional screening program. Pediatrics 1985; 76: 734–40.Google Scholar
70Fisher, DA, Foley, BL. Early treatment of congenital hypothyroidism. Pediatrics 1989; 83: 785–89.Google Scholar
71Heyerdahl, S, Kase, BF, Lie, SO. Intellectual development in children with congenital hypothyroidism in relation to recommended thyroxine treatment. J Pediatr 1991; 118: 850–57.Google Scholar
72Roberton, HEW. Lassitude coldness and hair changes following pregnancy, and their response to treatment with thyroid extract. Br Med J 1948; 2(suppl): 9394.Google Scholar
73Amino, N, Miyai, K. Postpartum autoimmune endocrine syndrome. In: Davies, TF ed. Autoimmune endocrine disease. New York: John Wiley & Sons, 1983: 247–72.Google Scholar
74Jansson, R, Dahlberg, DA, Karlsson, FA. Post partum thyroiditis. Baillières Clin Endocrinol Metab 1988; 2: 619–35.CrossRefGoogle Scholar
75Hod, M, Sharony, R, Friedman, S et al. Pregnancy and thyroid carcinoma: a review of incidence, course and prognosis. Obstet Gynecol Surv 1989; 44: 774.Google Scholar
76Jansson, R, Bernander, S, Karlsson, A, Levin, K, Nilsson, G. Autoimmune thyroid dysfunction in the postpartum period. J Clin Endocrinol Metab 1984; 58: 681–87.CrossRefGoogle ScholarPubMed
77Nikolai, TF, Turney, SL, Roberts, RC. Post partum lymphocytic thyroiditis. Arch Intern Med 1987; 147: 221–24.CrossRefGoogle ScholarPubMed
78Fung, HY, Kologlu, M, Collison, K, John, R, Richards, CJ, Hall, R et al. Post partum thyroid dysfunction in mid Glamorgan. Br Med J 1988; 296: 241–44.Google Scholar