Management of endocrine disorders in pregnancy Part I—thyroid and parathyroid disease

The Regulation of Thyroid Function in Pregnancy: Pathways of Endocrine Adaptation from Physiology to Pathology

“…Several recent reports have discussed thyroid hormone replacement during pregnancy in women with a previously established diagnosis of primary hypothyroidism. In the 1980s, the need for a systematic adjustment of the T 4 replacement dose during pregnancy was not recognized, and it was actually stated (surprisingly enough still stated in the 1990s) that women with hypothyroidism rarely required a change in T 4 replacement (207,208). In fact at that time, only anecdotal reports described isolated clinical cases in which a pregnant woman became severely hypothyroid during gestation when her replacement dose was not adjusted; such cases were thought to represent exceptions, hence justifying publication (209).…”

Hyperthyroidism Associated With Hyperemesis Gravidarum

“…Thyrotoxicosis is reportedly a rare complication of pregnancy, occurring in about 1 in 1000 cases 8 . In 95% of cases presenting during pregnancy, the hyperthyroidism is attributable to Graves' disease which if untreated is associated with adverse effects on the fetus, including low birthweight, neonatal thyrotoxicosis and increased perinatal mortality 9 . Non‐Graves' hyperthyroidism is a recognised feature of trophoblastic tumours, which secrete variants of hCG 7 and also of hyperemesis gravidarum 8 …”