Vol 72, No 5 (2021)
Guidelines / Expert consensus
Published online: 2021-10-29

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Thyroid diseases in pregnancy: guidelines of the Polish Society of Endocrinology [Choroby tarczycy w ciąży: zalecenia postępowania Polskiego Towarzystwa Endokrynologicznego]

Alicja Hubalewska-Dydejczyk1, Malgorzata Trofimiuk-Müldner1, Marek Ruchala2, Andrzej Lewiński3, Tomasz Bednarczuk4, Wojciech Zgliczyński5, Anhelli Syrenicz6, Beata Kos-Kudla7, Barbara Jarząb8, Małgorzata Gietka-Czernel5, Ewelina Szczepanek-Parulska2, Jolanta Krajewska8, Elzbieta Andrysiak-Mamos6, Arkadiusz Zygmunt9, Malgorzata Karbownik-Lewińska3
Pubmed: 34855189
Endokrynol Pol 2021;72(5):425-488.

Abstract

Appropriate care of pregnant women with coexisting thyroid dysfunction is still a subject of much controversy. In recent years, there has been a dynamic increase in the number of scientific reports on the diagnosis and treatment of thyroid diseases in women planning pregnancy, pregnant women, and women in the postpartum period. These mainly concern the management of hypothyroidism, autoimmune thyroid diseases, and fertility disorders. Therefore, the Polish Society of Endocrinology deemed it necessary to update the guidelines on principles of diagnostic and therapeutic management in this group of patients, previously published in 2011. The recommendations were prepared by Polish experts according to evidence based medicine principles, if such data were available.

 

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References

  1. Hubalewska-Dydejczyk A, Lewiński A, Milewicz A, et al. [Management of thyroid diseases during pregnancy]. Endokrynol Pol. 2011; 62(4): 362–381.
  2. Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017; 27(3): 315–389.
  3. Dong AC, Stephenson MD, Stagnaro-Green AS. The Need for Dynamic Clinical Guidelines: A Systematic Review of New Research Published After Release of the 2017 ATA Guidelines on Thyroid Disease During Pregnancy and the Postpartum. Front Endocrinol (Lausanne). 2020; 11: 193.
  4. Thompson W, Russell G, Baragwanath G, et al. Maternal thyroid hormone insufficiency during pregnancy and risk of neurodevelopmental disorders in offspring: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018; 88(4): 575–584.
  5. Levie D, Korevaar TIM, Mulder TA, et al. Maternal Thyroid Function in Early Pregnancy and Child Attention-Deficit Hyperactivity Disorder: An Individual-Participant Meta-Analysis. Thyroid. 2019; 29(9): 1316–1326.
  6. Hales C, Taylor PN, Channon S, et al. Controlled Antenatal Thyroid Screening II: Effect of Treating Maternal Suboptimal Thyroid Function on Child Behavior. J Clin Endocrinol Metab. 2020; 105(3).
  7. Swiglo BA, Murad MH, Schünemann HJ, et al. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab. 2008; 93(3): 666–673.
  8. Kostecka-Matyja M, Fedorowicz A, Bar-Andziak E, et al. Reference Values for TSH and Free Thyroid Hormones in Healthy Pregnant Women in Poland: A Prospective, Multicenter Study. Eur Thyroid J. 2017; 6(2): 82–88.
  9. Vaidya B, Hubalewska-Dydejczyk A, Laurberg P, et al. Treatment and screening of hypothyroidism in pregnancy: results of a European survey. Eur J Endocrinol. 2012; 166(1): 49–54.
  10. Dong AC, Stagnaro-Green A. Differences in Diagnostic Criteria Mask the True Prevalence of Thyroid Disease in Pregnancy: A Systematic Review and Meta-Analysis. Thyroid. 2019; 29(2): 278–289.
  11. Pop VJ, Broeren MA, Wiersinga WM, et al. Thyroid disease symptoms during early pregnancy do not identify women with thyroid hypofunction that should be treated. Clin Endocrinol (Oxf). 2017; 87(6): 838–843.
  12. Castillo Lara M, Vilar Sánchez Á, Cañavate Solano C, et al. "Hypothyroidism screening during first trimester of pregnancy". BMC Pregnancy Childbirth. 2017; 17(1): 438.
  13. Karcaaltincaba D, Ozek MA, Ocal N, et al. Prevalences of subclinical and overt hypothyroidism with universal screening in early pregnancy. Arch Gynecol Obstet. 2020; 301(3): 681–686.
  14. Prummel MF, Wiersinga WM. Thyroid autoimmunity and miscarriage. Eur J Endocrinol. 2004; 150(6): 751–755.
  15. Korevaar TIM, Derakhshan A, Taylor PN, et al. Consortium on Thyroid and Pregnancy — Study Group on Preterm Birth. Association of Thyroid Function Test Abnormalities and Thyroid Autoimmunity With Preterm Birth: A Systematic Review and Meta-analysis. JAMA. 2019; 322(7): 632–641.
  16. Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril. 2015; 104(3): 545–553.
  17. Poppe K, Bisschop P, Fugazzola L, et al. 2021 European Thyroid Association Guideline on Thyroid Disorders prior to and during Assisted Reproduction. Eur Thyroid J. 2021; 9(6): 281–295.
  18. Andersson M, de Benoist B, Delange F, et al. WHO Secretariat. Prevention and control of iodine deficiency in pregnant and lactating women and in children less than 2-years-old: conclusions and recommendations of the Technical Consultation. Public Health Nutr. 2007; 10(12A): 1606–1611.
  19. World Health Organization. Assessment of iodine deficiency disorders and monitoring their elimination. A guide for programme managers. 3rd ed. WHO, Geneva 2007.
  20. Dold S, Zimmermann MB, Jukic T, et al. Universal Salt Iodization Provides Sufficient Dietary Iodine to Achieve Adequate Iodine Nutrition during the First 1000 Days: A Cross-Sectional Multicenter Study. J Nutr. 2018; 148(4): 587–598.
  21. Trofimiuk-Müldner M, Konopka J, Sokołowski G, et al. Current iodine nutrition status in Poland (2017): is the Polish model of obligatory iodine prophylaxis able to eliminate iodine deficiency in the population? Public Health Nutr. 2020; 23(14): 2467–2477.
  22. Zygmunt A, Adamczewski Z, Zygmunt A, et al. An assessment of the effectiveness of iodine prophylaxis in pregnant women--analysis in one of reference gynaecological-obstetric centres in Poland. Endokrynol Pol. 2015; 66(5): 404–411.
  23. Zygmunt A, Lewinski A. Iodine prophylaxis in pregnant women in Poland - where we are? (update 2015). Thyroid Res. 2015; 8: 17.
  24. Toloza FJK, Motahari H, Maraka S. Consequences of Severe Iodine Deficiency in Pregnancy: Evidence in Humans. Front Endocrinol (Lausanne). 2020; 11: 409.
  25. Stinca S, Andersson M, Herter-Aeberli I, et al. Moderate-to-Severe Iodine Deficiency in the "First 1000 Days" Causes More Thyroid Hypofunction in Infants Than in Pregnant or Lactating Women. J Nutr. 2017; 147(4): 589–595.
  26. Hynes KL, Otahal P, Hay I, et al. Mild iodine deficiency during pregnancy is associated with reduced educational outcomes in the offspring: 9-year follow-up of the gestational iodine cohort. J Clin Endocrinol Metab. 2013; 98(5): 1954–1962.
  27. Hynes KL, Otahal P, Burgess JR, et al. Reduced Educational Outcomes Persist into Adolescence Following Mild Iodine Deficiency in Utero, Despite Adequacy in Childhood: 15-Year Follow-Up of the Gestational Iodine Cohort Investigating Auditory Processing Speed and Working Memory. Nutrients. 2017; 9(12).
  28. van Mil NH, Tiemeier H, Bongers-Schokking JJ, et al. Low urinary iodine excretion during early pregnancy is associated with alterations in executive functioning in children. J Nutr. 2012; 142(12): 2167–2174.
  29. Bath S, Steer C, Golding J, et al. Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Lancet. 2013; 382(9889): 331–337.
  30. Levie D, Korevaar TIM, Bath SC, et al. Association of Maternal Iodine Status With Child IQ: A Meta-Analysis of Individual Participant Data. J Clin Endocrinol Metab. 2019; 104(12): 5957–5967.
  31. Levie D, Bath SC, Guxens M, et al. Maternal Iodine Status During Pregnancy Is Not Consistently Associated with Attention-Deficit Hyperactivity Disorder or Autistic Traits in Children. J Nutr. 2020; 150(6): 1516–1528.
  32. Abel MH, Ystrom E, Caspersen IH, et al. Maternal Iodine Intake and Offspring Attention-Deficit/Hyperactivity Disorder: Results from a Large Prospective Cohort Study. Nutrients. 2017; 9(11).
  33. Threapleton DE, Snart CJP, Keeble C, et al. Maternal iodine status in a multi-ethnic UK birth cohort: Associations with child cognitive and educational development. Paediatr Perinat Epidemiol. 2021; 35(2): 236–246.
  34. Snart CJ, Threapleton DE, Keeble C, et al. Maternal iodine status, intrauterine growth, birth outcomes and congenital anomalies in a UK birth cohort. BMC Med. 2020; 18(1): 132.
  35. Yang J, Liu Y, Liu H, et al. Associations of maternal iodine status and thyroid function with adverse pregnancy outcomes in Henan Province of China. J Trace Elem Med Biol. 2018; 47: 104–110.
  36. Snart CJP, Keeble C, Taylor E, et al. Maternal Iodine Status and Associations with Birth Outcomes in Three Major Cities in the United Kingdom. Nutrients. 2019; 11(2).
  37. Nazeri P, Shab-Bidar S, Pearce EN, et al. Do maternal urinary iodine concentration or thyroid hormones within the normal range during pregnancy affect growth parameters at birth? A systematic review and meta-analysis. Nutr Rev. 2020; 78(9): 747–763.
  38. Mills JL, Ali M, Buck Louis GM, et al. Pregnancy Loss and Iodine Status: The LIFE Prospective Cohort Study. Nutrients. 2019; 11(3).
  39. Torlinska B, Bath SC, Janjua A, et al. Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC). Nutrients. 2018; 10(3).
  40. Mills JL, Buck Louis GM, Kannan K, et al. Delayed conception in women with low-urinary iodine concentrations: a population-based prospective cohort study. Hum Reprod. 2018; 33(3): 426–433.
  41. Pharoah P, Buttfield IH, Hetzel BS. Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. The Lancet. 1971; 297(7694): 308–310.
  42. Aburto NJ, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. WHO Library Cataloguing-in-Publication Data, Geneva 2014.
  43. Mohammed H, Marquis GS, Aboud F, et al. Pre-pregnancy iodized salt improved children's cognitive development in randomized trial in Ethiopia. Matern Child Nutr. 2020; 16(3): e12943.
  44. Gowachirapant S, Jaiswal N, Melse-Boonstra A, et al. Effect of iodine supplementation in pregnant women on child neurodevelopment: a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2017; 5(11): 853–863.
  45. Bliddal S, Boas M, Hilsted L, et al. Increase in thyroglobulin antibody and thyroid peroxidase antibody levels, but not preterm birth-rate, in pregnant Danish women upon iodine fortification. Eur J Endocrinol. 2017; 176(5): 603–612.
  46. Bliddal S, Boas M, Hilsted L, et al. Thyroid function and autoimmunity in Danish pregnant women after an iodine fortification program and associations with obstetric outcomes. Eur J Endocrinol. 2015; 173(6): 709–718.
  47. Sun J, Teng D, Li C, et al. Association between iodine intake and thyroid autoantibodies: a cross-sectional study of 7073 early pregnant women in an iodine-adequate region. J Endocrinol Invest. 2020; 43(1): 43–51.
  48. Shi X, Han C, Li C, et al. Optimal and safe upper limits of iodine intake for early pregnancy in iodine-sufficient regions: a cross-sectional study of 7190 pregnant women in China. J Clin Endocrinol Metab. 2015; 100(4): 1630–1638.
  49. Levie D, Derakhshan A, Shu H, et al. The Association of Maternal Iodine Status in Early Pregnancy with Thyroid Function in the Swedish Environmental Longitudinal, Mother and Child, Asthma and Allergy Study. Thyroid. 2019; 29(11): 1660–1668.
  50. Medici M, Ghassabian A, Visser W, et al. Women with high early pregnancy urinary iodine levels have an increased risk of hyperthyroid newborns: the population-based Generation R Study. Clin Endocrinol (Oxf). 2014; 80(4): 598–606.
  51. Kobaly K, Mandel SJ. Hyperthyroidism and Pregnancy. Endocrinol Metab Clin North Am. 2019; 48(3): 533–545.
  52. Andersen SL, Olsen J, Carlé A, et al. Hyperthyroidism incidence fluctuates widely in and around pregnancy and is at variance with some other autoimmune diseases: a Danish population-based study. J Clin Endocrinol Metab. 2015; 100(3): 1164–1171.
  53. Tan JYL, Loh KC, Yeo GSH, et al. Transient hyperthyroidism of hyperemesis gravidarum. BJOG. 2002; 109(6): 683–688.
  54. Andersen SL, Knøsgaard L. Management of thyrotoxicosis during pregnancy. Best Pract Res Clin Endocrinol Metab. 2020; 34(4): 101414.
  55. Casey BM, Dashe JS, Wells CE, et al. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005; 105(2): 239–245.
  56. Derakhshan A, Peeters R, Taylor P, et al. Association of maternal thyroid function with birthweight: a systematic review and individual-participant data meta-analysis. Lancet Diabetes Endocrinol. 2020; 8(6): 501–510.
  57. Andersen SL, Olsen J, Wu CS, et al. Low Birth Weight in Children Born to Mothers with Hyperthyroidism and High Birth Weight in Hypothyroidism, whereas Preterm Birth Is Common in Both Conditions: A Danish National Hospital Register Study. Eur Thyroid J. 2013; 2(2): 135–144.
  58. Andersen SL, Olsen J, Wu CS, et al. Spontaneous abortion, stillbirth and hyperthyroidism: a danish population-based study. Eur Thyroid J. 2014; 3(3): 164–172.
  59. Medici M, Korevaar TIM, Schalekamp-Timmermans S, et al. Maternal early-pregnancy thyroid function is associated with subsequent hypertensive disorders of pregnancy: the generation R study. J Clin Endocrinol Metab. 2014; 99(12): E2591–E2598.
  60. Cooper D, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol. 2013; 1(3): 238–249.
  61. Laurberg P, Andersen SL. Therapy of endocrine disease: antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk? Eur J Endocrinol. 2014; 171(1): R13–R20.
  62. Song R, Lin H, Chen Y, et al. Effects of methimazole and propylthiouracil exposure during pregnancy on the risk of neonatal congenital malformations: A meta-analysis. PLoS One. 2017; 12(7): e0180108.
  63. Li X, Liu GY, Ma JL, et al. Risk of congenital anomalies associated with antithyroid treatment during pregnancy: a meta-analysis. Clinics. 2015; 70(6): 453–459.
  64. Andersen SL, Knøsgaard L, Olsen J, et al. Maternal Thyroid Function, Use of Antithyroid Drugs in Early Pregnancy, and Birth Defects. J Clin Endocrinol Metab. 2019; 104(12): 6040–6048.
  65. Seo GiH, Kim TH, Chung JH. Antithyroid Drugs and Congenital Malformations: A Nationwide Korean Cohort Study. Ann Intern Med. 2018; 168(6): 405–413.
  66. Yu W, Wu Na, Li L, et al. Side Effects of PTU and MMI in the treatment of Hyperthyroidism: a Systemic Review and Meta-analysis. Endocr Pract. 2020; 26(2): 207–217.
  67. Andersen SL, Andersen S. Antithyroid drugs and birth defects. Thyroid Res. 2020; 13: 11.
  68. Andersen SL, Olsen J, Laurberg P. Antithyroid Drug Side Effects in the Population and in Pregnancy. J Clin Endocrinol Metab. 2016; 101(4): 1606–1614.
  69. Kahaly GJ, Bartalena L, Hegedüs L, et al. 2018 European Thyroid Association Guideline for the Management of Graves' Hyperthyroidism. Eur Thyroid J. 2018; 7(4): 167–186.
  70. Yoshihara Ai, Noh JY, Watanabe N, et al. Substituting Potassium Iodide for Methimazole as the Treatment for Graves' Disease During the First Trimester May Reduce the Incidence of Congenital Anomalies: A Retrospective Study at a Single Medical Institution in Japan. Thyroid. 2015; 25(10): 1155–1161.
  71. Gietka-Czernel M, Dębska M, Kretowicz P, et al. Hyperthyroidism during pregnancy — the role of measuring maternal TSH receptor antibodies and foetal ultrasound monitoring. Endokrynol Pol. 2014; 65(4): 259–268.
  72. van Dijk MM, Smits IH, Fliers E, et al. Maternal Thyrotropin Receptor Antibody Concentration and the Risk of Fetal and Neonatal Thyrotoxicosis: A Systematic Review. Thyroid. 2018; 28(2): 257–264.
  73. Banigé M, Polak M, Luton D, et al. Research Group for Perinatal Dysthyroidism (RGPD) Study Group. Prediction of Neonatal Hyperthyroidism. J Pediatr. 2018; 197: 249–254.e1.
  74. Mandel SJ, Cooper DS. The use of antithyroid drugs in pregnancy and lactation. J Clin Endocrinol Metab. 2001; 86(6): 2354–2359.
  75. Lee SY, Pearce EN. Testing, Monitoring, and Treatment of Thyroid Dysfunction in Pregnancy. J Clin Endocrinol Metab. 2021; 106(3): 883–892.
  76. Karbownik-Lewińska M. Niedoczynność tarczycy u kobiet w wieku prokreacyjnym, ze szczególnym uwzględnieniem okresu ciąży. In: Karbownik-Lewińska M. ed. Choroby tarczycy a ciąża. Termedia, Poznań 2018: 51–64.
  77. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87(2): 489–499.
  78. Knøsgaard L, Andersen S, Hansen ABo, et al. Thyroid function abnormalities and thyroid autoantibodies in Danish pregnant women. Clin Endocrinol (Oxf). 2020; 93(3): 329–338.
  79. Andersen SL, Christensen PA, Knøsgaard L, et al. Classification of Thyroid Dysfunction in Pregnant Women Differs by Analytical Method and Type of Thyroid Function Test. J Clin Endocrinol Metab. 2020; 105(11).
  80. Korevaar TIM, Medici M, Visser TJ, et al. Thyroid disease in pregnancy: new insights in diagnosis and clinical management. Nat Rev Endocrinol. 2017; 13(10): 610–622.
  81. Chen S, Zhou X, Zhu H, et al. Preconception TSH and pregnancy outcomes: a population-based cohort study in 184 611 women. Clin Endocrinol (Oxf). 2017; 86(6): 816–824.
  82. Karbownik-Lewinska M, Marcinkowska M, Stepniak J, et al. TSH ≥2.5 mIU/l is Associated with the Increased Oxidative Damage to Membrane Lipids in Women of Childbearing Age with Normal Thyroid Tests. Horm Metab Res. 2017; 49(5): 321–326.
  83. Karbownik-Lewińska M, Stępniak J, Żurawska A, et al. Less Favorable Lipid Profile and Higher Prevalence of Thyroid Antibodies in Women of Reproductive Age with High-Normal TSH-Retrospective Study. Int J Environ Res Public Health. 2020; 17(6).
  84. Vila G, Fleseriu M. Fertility and Pregnancy in Women With Hypopituitarism: A Systematic Literature Review. J Clin Endocrinol Metab. 2020; 105(3).
  85. Lee SY, Cabral HJ, Aschengrau A, et al. Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes. J Clin Endocrinol Metab. 2020; 105(5).
  86. Abalovich M, Amino N, Barbour LA, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2007; 92(8 Suppl): S1–47.
  87. Stagnaro-Green A, Abalovich M, Alexander E, et al. American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and Postpartum. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011; 21(10): 1081–1125.
  88. De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97(8): 2543–2565.
  89. Lazarus J, Brown RS, Daumerie C, et al. 2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children. Eur Thyroid J. 2014; 3(2): 76–94.
  90. Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. J Clin Endocrinol Metab. 2005; 90(9): 5483–5488.
  91. Lewandowski KC, Garnysz K, Horzelski W, et al. Subclinical thyroid dysfunction in the first trimester of pregnancy: 'Disease' versus physiological (pulsatile) variation in TSH concentrations. Clin Endocrinol (Oxf). 2020; 93(6): 739–745.
  92. Hernández M, López C, Soldevila B, et al. Impact of TSH during the first trimester of pregnancy on obstetric and foetal complications: Usefulness of 2.5 mIU/L cut-off value. Clin Endocrinol (Oxf). 2018; 88(5): 728–734.
  93. Kianpour M, Aminorroaya A, Amini M, et al. Thyroid-stimulating hormone (TSH) serum levels and risk of spontaneous abortion: A prospective population-based cohort study. Clin Endocrinol (Oxf). 2019; 91(1): 163–169.
  94. Zhang Y, Sun W, Zhu S, et al. The Impact of Thyroid Function and TPOAb in the First Trimester on Pregnancy Outcomes: A Retrospective Study in Peking. J Clin Endocrinol Metab. 2020; 105(3).
  95. Li C, Zhou J, Huang Z, et al. The Clinical Value and Variation of Antithyroid Antibodies during Pregnancy. Dis Markers. 2020; 2020: 8871951.
  96. Kiefer FW, Klebermass-Schrehof K, Steiner M, et al. Fetal/Neonatal Thyrotoxicosis in a Newborn From a Hypothyroid Woman With Hashimoto Thyroiditis. J Clin Endocrinol Metab. 2017; 102(1): 6–9.
  97. Decallonne B, Martens PJ, Van den Bruel A, et al. Graves Disease With Thyroid-Stimulating Hormone Receptor-Blocking Autoantibodies During Pregnancy. Ann Intern Med. 2020; 172(11): 767–769.
  98. Kahaly GJ. Management of Graves Thyroidal and Extrathyroidal Disease: An Update. J Clin Endocrinol Metab. 2020; 105(12).
  99. Loh JA, Wartofsky L, Jonklaas J, et al. The magnitude of increased levothyroxine requirements in hypothyroid pregnant women depends upon the etiology of the hypothyroidism. Thyroid. 2009; 19(3): 269–275.
  100. Dhillon-Smith RK, Middleton LJ, Sunner KK, et al. Levothyroxine in Women with Thyroid Peroxidase Antibodies before Conception. N Engl J Med. 2019; 380(14): 1316–1325.
  101. Sun X, Hou N, Wang H, et al. A Meta-Analysis of Pregnancy Outcomes With Levothyroxine Treatment in Euthyroid Women With Thyroid Autoimmunity. J Clin Endocrinol Metab. 2020; 105(4).
  102. Hou Y, Liu A, Li J, et al. Different Thyroidal Responses to Human Chorionic Gonadotropin Under Different Thyroid Peroxidase Antibody and/or Thyroglobulin Antibody Positivity Conditions During the First Half of Pregnancy. Thyroid. 2019; 29(4): 577–585.
  103. Korevaar T, Muetzel R, Medici M, et al. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. Lancet Diabetes Endocrinol. 2016; 4(1): 35–43.
  104. Jansen T, Korevaar T, Mulder T, et al. Maternal thyroid function during pregnancy and child brain morphology: a time window-specific analysis of a prospective cohort. Lancet Diabetes Endocrinol. 2019; 7(8): 629–637.
  105. Wiersinga WM, Duntas L, Fadeyev V, et al. 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Eur Thyroid J. 2012; 1(2): 55–71.
  106. Gietka-Czernel M, Hubalewska-Dydejczyk A, Kos-Kudła B, et al. Expert opinion on liquid L-thyroxine usage in hypothyroid patients and new liquid thyroxine formulation - Tirosint SOL [Opinia ekspertów dotycząca stosowania płynnej postaci lewotyroksyny oraz nowego preparatu Tirosint SOL u chorych na niedoczynność tarczycy]. Endokrynol Pol. 2020; 71(5): 441–465.
  107. Galofré JC, Haber RS, Mitchell AA, et al. Increased postpartum thyroxine replacement in Hashimoto's thyroiditis. Thyroid. 2010; 20(8): 901–908.
  108. Dosiou C, Medici M. Management of Endocrine Disease: Isolated maternal hypothyroxinemia during pregnancy: knowns and unknowns. Eur J Endocrinol. 2017; 176(1): R21–R38.
  109. Karbownik-Lewińska M. Izolowana hipotyroksynemia w ciąży. In: Karbownik-Lewińska M. ed. Choroby tarczycy a ciąża. Termedia, Poznań 2018: 65–70.
  110. Taylor PN, Muller I, Nana M, et al. Indications for treatment of subclinical hypothyroidism and isolated hypothyroxinaemia in pregnancy. Best Pract Res Clin Endocrinol Metab. 2020; 34(4): 101436.
  111. Yu X, Shan Z, Li C, et al. Iron deficiency, an independent risk factor for isolated hypothyroxinemia in pregnant and nonpregnant women of childbearing age in China. J Clin Endocrinol Metab. 2015; 100(4): 1594–1601.
  112. Yang Xi, Yu Y, Zhang C, et al. The Association Between Isolated Maternal Hypothyroxinemia in Early Pregnancy and Preterm Birth. Thyroid. 2020; 30(12): 1724–1731.
  113. Lazarus JH, Bestwick JP, Channon S, et al. Antenatal thyroid screening and childhood cognitive function. N Engl J Med. 2012; 366(6): 493–501.
  114. Casey BM, Thom EA, Peaceman AM, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy. N Engl J Med. 2017; 376(9): 815–825.
  115. Nazarpour S, Ramezani Tehrani F, Simbar M, et al. Effects of Levothyroxine on Pregnant Women With Subclinical Hypothyroidism, Negative for Thyroid Peroxidase Antibodies. J Clin Endocrinol Metab. 2018; 103(3): 926–935.
  116. Rao M, Zeng Z, Zhou F, et al. Effect of levothyroxine supplementation on pregnancy loss and preterm birth in women with subclinical hypothyroidism and thyroid autoimmunity: a systematic review and meta-analysis. Hum Reprod Update. 2019; 25(3): 344–361.
  117. Leo SDe, Pearce E. Autoimmune thyroid disease during pregnancy. Lancet Diabetes Endocrinol. 2018; 6(7): 575–586.
  118. Romitti M, Fabris VC, Ziegelmann PK, et al. Association between PCOS and autoimmune thyroid disease: a systematic review and meta-analysis. Endocr Connect. 2018; 7(11): 1158–1167.
  119. Negro R, Formoso G, Mangieri T, et al. Levothyroxine treatment in euthyroid pregnant women with autoimmune thyroid disease: effects on obstetrical complications. J Clin Endocrinol Metab. 2006; 91(7): 2587–2591.
  120. Negro R, Greco G, Mangieri T, et al. The influence of selenium supplementation on postpartum thyroid status in pregnant women with thyroid peroxidase autoantibodies. J Clin Endocrinol Metab. 2007; 92(4): 1263–1268.
  121. Korevaar TIM, Steegers EAP, Pop VJ, et al. Thyroid Autoimmunity Impairs the Thyroidal Response to Human Chorionic Gonadotropin: Two Population-Based Prospective Cohort Studies. J Clin Endocrinol Metab. 2017; 102(1): 69–77.
  122. Korevaar TIM, Pop VJ, Chaker L, et al. Dose Dependency and a Functional Cutoff for TPO-Antibody Positivity During Pregnancy. J Clin Endocrinol Metab. 2018; 103(2): 778–789.
  123. Thangaratinam S, Tan A, Knox E, et al. Association between thyroid autoantibodies and miscarriage and preterm birth: meta-analysis of evidence. BMJ. 2011; 342: d2616.
  124. Sitoris G, Veltri F, Kleynen P, et al. The Impact of Thyroid Disorders on Clinical Pregnancy Outcomes in a Real-World Study Setting. Thyroid. 2020; 30(1): 106–115.
  125. Szafarowska M, Molinska-Glura M, Jerzak MM. Anti-Müllerian hormone concentration as a biomarker of pregnancy success or failure. Neuro Endocrinol Lett. 2014; 35(4): 322–326.
  126. Min Yu, Wang X, Chen H, et al. The exploration of Hashimoto's Thyroiditis related miscarriage for better treatment modalities. Int J Med Sci. 2020; 17(16): 2402–2415.
  127. Henrichs J, Bongers-Schokking JJ, Schenk JJ, et al. Maternal thyroid function during early pregnancy and cognitive functioning in early childhood: the generation R study. J Clin Endocrinol Metab. 2010; 95(9): 4227–4234.
  128. Ghassabian A, Bongers-Schokking JJ, de Rijke YB, et al. Maternal thyroid autoimmunity during pregnancy and the risk of attention deficit/hyperactivity problems in children: the Generation R Study. Thyroid. 2012; 22(2): 178–186.
  129. Heikkinen AL, Päkkilä F, Hartikainen AL, et al. Maternal Thyroid Antibodies Associates With Cardiometabolic Risk Factors in Children at the Age of 16. J Clin Endocrinol Metab. 2017; 102(11): 4184–4190.
  130. Chen AX, Leung AM, Korevaar TIM. Thyroid Function and Conception. N Engl J Med. 2019; 381(2): 178–181.
  131. Negro R. Levothyroxine before conception in women with thyroid antibodies: a step forward in the management of thyroid disease in pregnancy. Thyroid Res. 2019; 12: 5.
  132. Wang H, Gao H, Chi H, et al. Effect of Levothyroxine on Miscarriage Among Women With Normal Thyroid Function and Thyroid Autoimmunity Undergoing In Vitro Fertilization and Embryo Transfer: A Randomized Clinical Trial. JAMA. 2017; 318(22): 2190–2198.
  133. Nazarpour S, Ramezani Tehrani F, Simbar M, et al. Effects of levothyroxine treatment on pregnancy outcomes in pregnant women with autoimmune thyroid disease. Eur J Endocrinol. 2017; 176(2): 253–265.
  134. Negro R, Schwartz A, Stagnaro-Green A. Impact of Levothyroxine in Miscarriage and Preterm Delivery Rates in First Trimester Thyroid Antibody-Positive Women With TSH Less Than 2.5 mIU/L. J Clin Endocrinol Metab. 2016; 101(10): 3685–3690.
  135. Ambroziak U, Hybsier S, Shahnazaryan U, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol. 2017; 44: 186–191.
  136. Mao J, Pop VJ, Bath SC, et al. Effect of low-dose selenium on thyroid autoimmunity and thyroid function in UK pregnant women with mild-to-moderate iodine deficiency. Eur J Nutr. 2016; 55(1): 55–61.
  137. Mantovani G, Isidori AM, Moretti C, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the "SERENA study", a randomized, double-blind, placebo-controlled trial. Endocrine. 2019; 66(3): 542–550.
  138. Duntas LH. Selenium and at-risk pregnancy: challenges and controversies. Thyroid Res. 2020; 13: 16.
  139. Stricker RB, Winger EE. Update on treatment of immunologic abortion with low-dose intravenous immunoglobulin. Am J Reprod Immunol. 2005; 54(6): 390–396.
  140. Turi A, Giannubilo SR, Zanconi S, et al. Preconception steroid treatment in infertile women with antithyroid autoimmunity undergoing ovarian stimulation and intrauterine insemination: a double-blind, randomized, prospective cohort study. Clin Ther. 2010; 32(14): 2415–2421.
  141. Litwicka K, Arrivi C, Varricchio MT, et al. In women with thyroid autoimmunity, does low-dose prednisolone administration, compared with no adjuvant therapy, improve in vitro fertilization clinical results? J Obstet Gynaecol Res. 2015; 41(5): 722–728.
  142. Di Bari F, Granese R, Le Donne M, et al. Autoimmune Abnormalities of Postpartum Thyroid Diseases. Front Endocrinol (Lausanne). 2017; 8: 166.
  143. Syrenicz A. Zapalenia tarczycy u kobiet w wieku prokreacyjnym, w ciąży i okresie poporodowym. In: Karbownik-Lewińska M. ed. Choroby tarczycy a ciąża. Poznań, Termedia 2018: 133–50.
  144. Syrenicz A, Koziołek M, Syrenicz M, Sowińska-Przepiera E. Zapalenia tarczycy. Zarys Endokrynologiczny. Wydawnictwo Pomorskiego Uniwersytetu Medycznego, Szczecin 2017: 97–107.
  145. Nguyen CT, Mestman JH. Postpartum Thyroiditis. Clin Obstet Gynecol. 2019; 62(2): 359–364.
  146. Stagnaro-Green A. Approach to the patient with postpartum thyroiditis. J Clin Endocrinol Metab. 2012; 97(2): 334–342.
  147. Hubalewska-Dydejczyk A, Duntas L, Gilis-Januszewska A. Pregnancy, thyroid, and the potential use of selenium. Hormones (Athens). 2020; 19(1): 47–53.
  148. Papaleontiou M, Haymart MR. Thyroid nodules and cancer during pregnancy, post-partum and preconception planning: Addressing the uncertainties and challenges. Best Pract Res Clin Endocrinol Metab. 2020; 34(4): 101363.
  149. Jarząb B, Dedecjus M, Słowińska-Klencka D, et al. Diagnostics and Treatment of Thyroid Carcinoma. Endokrynol Pol. 2016; 67(1): 74–107.
  150. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016; 26(1): 1–133.
  151. Cibas ES, Ali SZ. The 2017 Bethesda System for Reporting Thyroid Cytopathology. Thyroid. 2017; 27(11): 1341–1346.
  152. Angell TE, Alexander EK. Thyroid Nodules and Thyroid Cancer in the Pregnant Woman. Endocrinol Metab Clin North Am. 2019; 48(3): 557–567.
  153. Kuy S, Roman SA, Desai R, et al. Outcomes following thyroid and parathyroid surgery in pregnant women. Arch Surg. 2009; 144(5): 399–406; discussion 406.
  154. Vini L, Hyer S, Pratt B, et al. Management of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol. 1999; 140(5): 404–406.
  155. Boucek J, de Haan J, Halaska MJ, et al. International Network on Cancer, Infertility, and Pregnancy. Maternal and obstetrical outcome in 35 cases of well-differentiated thyroid carcinoma during pregnancy. Laryngoscope. 2018; 128(6): 1493–1500.
  156. Doherty CM, Shindo ML, Rice DH, et al. Management of thyroid nodules during pregnancy. Laryngoscope. 1995; 105(3 Pt 1): 251–255.
  157. Jastrzebska H, Gietka-Czernel M, Zgliczyński S, et al. [Pregnancy in women with thyroid cancer treated with suppressive doses of L-thyroxine]. Wiad Lek. 2001; 54 Suppl 1: 389–397.
  158. Nies M, Cantineau AEP, Arts EG, et al. Long-Term Effects of Radioiodine Treatment on Female Fertility in Survivors of Childhood Differentiated Thyroid Carcinoma. Thyroid. 2020; 30(8): 1169–1176.
  159. Sawka AM, Lakra DC, Lea J, et al. A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin Endocrinol (Oxf). 2008; 69(3): 479–490.
  160. Garsi JP, Schlumberger M, Rubino C, et al. Therapeutic administration of 131I for differentiated thyroid cancer: radiation dose to ovaries and outcome of pregnancies. J Nucl Med. 2008; 49(5): 845–852.
  161. Kim HOk, Lee K, Lee SM, et al. Association Between Pregnancy Outcomes and Radioactive Iodine Treatment After Thyroidectomy Among Women With Thyroid Cancer. JAMA Intern Med. 2020; 180(1): 54–61.
  162. Thomas N, Glod J, Derse-Anthony C, et al. Pregnancy on vandetanib in metastatic medullary thyroid carcinoma associated with multiple endocrine neoplasia type 2B. Clin Endocrinol (Oxf). 2018; 88(5): 754–756.
  163. Cho GJ, Kim SY, Lee HC, et al. Risk of Adverse Obstetric Outcomes and the Abnormal Growth of Offspring in Women with a History of Thyroid Cancer. Thyroid. 2019; 29(6): 879–885.
  164. Blackburn BE, Ganz PA, Rowe K, et al. Reproductive and gynecological complication risks among thyroid cancer survivors. J Cancer Surviv. 2018; 12(5): 702–711.
  165. Spiegel E, Spence AR, Czuzoj-Shulman N, et al. Pregnancy outcomes after thyroid cancer. J Perinat Med. 2019; 47(7): 710–716.
  166. Korevaar TIM, Haymart MR. A History of Thyroid Cancer Does Not Meaningfully Complicate Pregnancy. Thyroid. 2019; 29(6): 758–759.
  167. Vannucchi G, Perrino M, Rossi S, et al. Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol. 2010; 162(1): 145–151.
  168. Herzon FS, Morris DM, Segal MN, et al. Coexistent thyroid cancer and pregnancy. Arch Otolaryngol Head Neck Surg. 1994; 120(11): 1191–1193.
  169. Moosa M, Mazzaferri EL. Outcome of differentiated thyroid cancer diagnosed in pregnant women. J Clin Endocrinol Metab. 1997; 82(9): 2862–2866.
  170. Yasmeen S, Cress R, Romano PS, et al. Thyroid cancer in pregnancy. Int J Gynaecol Obstet. 2005; 91(1): 15–20.
  171. Messuti I, Corvisieri S, Bardesono F, et al. Impact of pregnancy on prognosis of differentiated thyroid cancer: clinical and molecular features. Eur J Endocrinol. 2014; 170(5): 659–666.
  172. Lee JC, Zhao JT, Clifton-Bligh RJ, et al. Papillary thyroid carcinoma in pregnancy: a variant of the disease? Ann Surg Oncol. 2012; 19(13): 4210–4216.
  173. Rakhlin L, Fish S, Tuttle RM. Response to Therapy Status Is an Excellent Predictor of Pregnancy-Associated Structural Disease Progression in Patients Previously Treated for Differentiated Thyroid Cancer. Thyroid. 2017; 27(3): 396–401.
  174. Chen AC, Livhits MJ, Du L, et al. Recent Pregnancy Is Not Associated with High-Risk Pathological Features of Well-Differentiated Thyroid Cancer. Thyroid. 2018; 28(1): 68–71.
  175. Rakhlin L, Fish S. Pregnancy as a risk factor for thyroid cancer progression. Curr Opin Endocrinol Diabetes Obes. 2018; 25(5): 326–329.
  176. Leboeuf R, Emerick LE, Martorella AJ, et al. Impact of pregnancy on serum thyroglobulin and detection of recurrent disease shortly after delivery in thyroid cancer survivors. Thyroid. 2007; 17(6): 543–547.
  177. Hirsch D, Levy S, Tsvetov G, et al. Impact of pregnancy on outcome and prognosis of survivors of papillary thyroid cancer. Thyroid. 2010; 20(10): 1179–1185.
  178. Thoma ME, McLain AC, Louis JF, et al. Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach. Fertil Steril. 2013; 99(5): 1324–1331.e1.