Thyroid Dysfunction during Pregnancy: A Review of the Current Guidelines

Thyroid disease commonly affects women of childbearing age and is the second most common endocrinological disorder diagnosed in pregnancy after gestational diabetes. In normal gestation, the thyroid gland adapts its structure and function to satisfy increasing functional demand. The marked physiological changes that occur during normal pregnancy make it necessary to use specific reference ranges in interpretation of thyroid function test. It is well documented that thyroid disorders are associated with maternal and fetal complications during gestation, and its deleterious effects can also extend beyond pregnancy and delivery. Available epidemiological data report widely varying prevalence rates of thyroid disorders during the antenatal period. However, the need for universal thyroid screening remains controversial. Subclinical thyroid dysfunction is very frequent but easily missed without specific screening programs. Furthermore, an appropriate management is crucial to prevent adverse maternal and fetal outcomes. Despite the correlation between thyroid function during pregnancy and maternal and fetal outcomes is a widely discussed issue, it remains important to clarify several points regarding screening, diagnosis, and treatment of thyroid dysfunction in pregnant ladies. In this article we try to discuss the physiological changes of the thyroid gland to meet the challenges of increased metabolic demands during pregnancy and focusing on pathological function changes; we also try to summarize the best way of screening, diagnosis and treatment of thyroid dysfunction during pregnancy to improve maternal and fetal outcomes.