title: Current challenges in the pharmacological management of thyroid dysfunction in pregnancy.
abstract: Thyroid dysfunction is common in pregnancy and has adverse fetal and maternal health consequences. A number of challenges in the management of gestational thyroid dysfunction remain unresolved including uncertainties in optimal thresholds for correction of hypothyroidism and strategies for pharmacological management of hyperthyroidism. Areas covered: We addressed key challenges and areas of uncertainty in the management of thyroid dysfunction in pregnancy. Expert commentary: Gestational thyroid hormone reference intervals vary according to population ethnicity, iodine nutrition, and assay method and each population should derive trimester specific reference intervals for use in pregnancy. Subclinical hypothyroidism and isolated hypothyroxinaemia are common in pregnancy but there is no consensus on the benefits of correcting these conditions. Although observational studies show potential benefits of levothyroxine on child neurocognitive function these benefits are have not been supported by two controlled trials. Carbimazole should be avoided in the first trimester of pregnancy due to risk of congenital anomalies but recent studies would suggest that this risk is present to a lesser magnitude with propylthiouracil. Current international guidelines recommend the use of propylthiouracil in the first trimester and switching to carbimazole for the remainder of pregnancy but the benefits and practicalities of this approach is unproven.
authors: a Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine , Cardiff University , Cardiff , CF14 4XN , UK.
authors: I
authors: I
authors: Khan
authors: a Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine , Cardiff University , Cardiff , CF14 4XN , UK.|b Endocrine and Diabetes Department , Prince Charles Hospital, Cwm Taf University Health Board , Merthyr Tydfil , UK.
authors: O E
authors: OE
authors: Okosieme
authors: a Thyroid Research Group, Institute of Molecular and Experimental Medicine, School of Medicine , Cardiff University , Cardiff , CF14 4XN , UK.
authors: J H
authors: JH
authors: Lazarus
mesh_terms: D013956:Antithyroid Agents / Q000009:adverse effects / Q000627:therapeutic use; D002231:Carbimazole / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000188:drug therapy*; D007037:Hypothyroidism / Q000150:complications / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000503:physiopathology; D013963:Thyroid Hormones / Q000378:metabolism / Q000627:therapeutic use; D013974:Thyroxine / Q000378:metabolism / Q000627:therapeutic use
chemical_list: D013956:Antithyroid Agents; D013963:Thyroid Hormones; D002231:Carbimazole; D013974:Thyroxine
keywords: Graves’ disease; Hyperthyroidism; antithyroid drugs; hypothyroidism; levothyroxine; pregnancy; screening; thyroid stimulating hormone (TSH); thyroxine