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REVIEW  SUBCLINICAL ENDOCRINE DISEASE: OLD AND NEW CLINICAL SCENARIOS 

Minerva Endocrinology 2021 September;46(3):243-51

DOI: 10.23736/S2724-6507.21.03391-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Subclinical thyroid diseases and isolated hypothyroxinemia during pregnancy

Pietro LOCANTORE , Andrea CORSELLO, Caterina POLICOLA, Alfredo PONTECORVI

Unit of Endocrinology, Fondazione Policlinico Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy



Thyroid diseases in pregnancy are common. While data on management of overt diseases are clear, there is no consensus regarding subclinical thyroid disease. Many studies have tried to clarify the impact of subclinical thyroid disease on pregnancy outcomes without reaching universal conclusions. As several studies are present in literature, but no univocal indication is present to manage each condition, the present review tries to summarize the recent indications for such disease. The most updated guidelines are 2017 American thyroid association for thyroid disease during pregnancy, which at present represent the most accurate and reliable guide. Subclinical hyperthyroidism during pregnancy has not been associated with adverse outcomes and only needs follow up. Subclinical hypothyroidism is associated with adverse obstetric and offspring outcomes. At present thyroxine treatment is recommended in selected cases, as beneficial effects are not clear for all these patients. Data regarding the association between isolated hypothyroxinemia and adverse maternofetal outcome are controversial but treatment is not indicated. Autoimmune thyroid disease represents the main thyroid risk factor for adverse pregnancy outcomes. If patients have normal TSH values, treatment is not indicated. A possible thyroxine treatment can be evaluated on a case-by-case basis in euthyroid patients with history of abortion/infertility. In the last years, risks of subclinical thyroid dysfunction on the outcome of gestation and new-born have been scaled back. Further prospective studies are necessary to better understand thyroid dysfunction in pregnancy to perfectly target treatment in appropriate settings.


KEY WORDS: Thyroid disease; Hypothyroidism; Thyrotoxicosis; Pregnancy

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