Changes in the physiology of the thyroid gland in pregnancy and the need for trimester-specific reference values in thyroid status a review

Baldzieva, Sanja and Jovevska, Svetlana (2022) Changes in the physiology of the thyroid gland in pregnancy and the need for trimester-specific reference values in thyroid status a review. Knowledge, 54 (4). pp. 583-588. ISSN 2545-4439

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Abstract

Pregnancy is a unique state of the female organism in which occur physiological changes that are necessary to maintain the pregnancy. To be able to respond to the increased metabolic needs of pregnancy and to maintain an adequate level of thyroid hormones in the blood, the thyroid gland responds with changes in its function and anatomy as well. Changes in thyroid function are mainly associated with increased levels of thyroxine-binding globulins in the blood. Their level increases as a result of estrogen stimulation in pregnancy and they are synthesized in the liver. Changes in the physiology of the thyroid gland during pregnancy also occur as a result of stimulation of the TSH receptors of the gland by the human chorionic gonadotropin hormone (hCG) which is secreted by the placental trophoblast.
Due to the difference in the physiology of the thyroid gland in and outside of pregnancy, a special interpretation of the results of functional thyroid tests is required. Changes in hormone values are transitory, especially expressed in the first trimester of pregnancy. A healthy pregnant patient without thyroid pathology or disease compensates for those changes and a sufficient amount of thyroid hormones is produced. The presence of thyroid hormones in an optimal concentration in the blood maintains a successful pregnancy and secures normal neurological development of the fetus. Diseases of the thyroid gland lead to a decrease its compensatory ability during pregnancy and the contributes to the inability to respond to the increased metabolic needs that follow.
The motive for this paper are the pregnant patients with undiagnosed or unrecognized thyroid gland diseases before pregnancy, where we encounter conditions when the thyroid gland cannot respond to the physiological changes that occur. One of the negative outcomes of this condition can be spontaneous pregnancy loss in the first trimester. Therefore, a special interpretation of the thyroid status in pregnancy is needed and the introduction of constant reference values that will apply only to pregnancy.
World recommendations designate reference values for TSH and thyroid hormones respectively for each trimester of pregnancy, the so-called trimester-specific reference values. In case of absence of trimester-specific reference values, there are recommendations regarding the special interpretation of thyroid function tests and reference values; as well as recommendations for using adjusted values according to demographic characteristics that will apply to all trimesters. This review of literature recommendations would help in the management of patients in order to achieve an optimal serum level of thyroid-stimulating hormone and achieve a successful pregnancy, thus imposing the need to introduce recommendations in our laboratories for thyroid analysis values specific to pregnancy, which will differ from those for the non-pregnant population.
Keywords: thyroid gland, thyrostimulating hormone, trimester-specific reference values

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine
Divisions:	Faculty of Medical Science
Depositing User:	Svetlana Jovevska
Date Deposited:	26 Jan 2023 19:16
Last Modified:	26 Jan 2023 19:16
URI:	https://eprints.ugd.edu.mk/id/eprint/30849

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