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Preconception management of thyroid dysfunction

Okosieme, Onyebuchi, Khan, Ishrat and Taylor, Peter 2018. Preconception management of thyroid dysfunction. Clinical Endocrinology 89 (3) , pp. 269-279. 10.1111/cen.13731

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Abstract

Uncorrected thyroid dysfunction in pregnancy has well‐recognized deleterious effects on foetal and maternal health. The early gestation period is one of the critical foetal vulnerability during which maternal thyroid dysfunction may have lasting repercussions. Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre‐empt and mirror the adaptive changes in the thyroid gland by careful levothyroxine dose adjustments to ensure adequate foetal thyroid hormone delivery in pregnancy. In hyperthyroidism, the goal of preconception therapy is to control hyperthyroidism while curtailing the unwanted side effects of foetal and maternal exposure to antithyroid drugs. Thus, pregnancy should be deferred until a stable euthyroid state is achieved, and definitive therapy with radioiodine or surgery should be considered in women with Graves’ disease planning future pregnancy. Women with active disease who are imminently trying to conceive should be switched to propylthiouracil either preconception or at conception in order to minimize the risk of birth defects from carbimazole or methimazole exposure. Optimal strategies for women with borderline states of thyroid dysfunction namely subclinical hypothyroidism, isolated hypothyroxinaemia and thyroid autoimmunity remain uncertain due to the dearth of controlled interventional trials. Future trial designs should aspire to recruit and initiate therapy before conception or as early as possible in pregnancy

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Blackwell Publishing
ISSN: 0300-0664
Date of First Compliant Deposit: 18 April 2019
Date of Acceptance: 23 April 2018
Last Modified: 28 Jun 2019 06:40
URI: http://orca-mwe.cf.ac.uk/id/eprint/117407

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