Autoimmune thyroiditis and pregnancy: changes in the modern diagnostic and therapeutic paradigms

Platonova N.M.; Makolina N.P.; Rybakova A.A.; Troshina E.A.

doi:https://doi.org/10.17116/repro20202601129

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Abstract:

A sufficient level of thyroid hormones is crucial for normal course of pregnancy and fetal development. It has been proven that even subclinical thyroid dysfunction during pregnancy is associated with adverse outcomes for both mother and baby. The leading role in the development of thyroid dysfunction belongs to overt hypothyroidism in the outcome of autoimmune thyroiditis. Despite the progress achieved in the study of pathogenesis of this disease and the wide possibilities of using advanced laboratory technologies, there are currently a lot of diagnostic and clinical issues and uncertainties. Role of such markers, such as anti-TPO, thyroglobulin antibodies in the development and progression of hypothyroidism associated with obstetric complications and neuropsychiatric disorders in child. Also relevant is the issue of using high performance liquid chromatography MS/MS — tandem mass spectrometry (MS/MS) to develop trimester-specific intervals for thyroid hormones during pregnancy. In 2017, updated clinical guidelines were issued, in which experts discuss new reference values of TSH for pregnant women with an emphasis on ethnic features of the population. These recommendations change the diagnostic criteria and indications for initiating levothyroxine replacement therapy for treatment of hypothyroidism in pregnant women.

Keywords:

pregnancy

thyroid gland

autoimmunity

hypothyroidism

Authors:

Platonova N.M.

Endocrinology Research Centre, Moscow, Russia

Makolina N.P.

FGBU Éndokrinologicheskiĭ nauchnyĭ tsentr Minzdravsotsrazvitiia RF, Moskva

Rybakova A.A.

Endocrinology Research Centre, Moscow, Russia

Troshina E.A.

Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

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References:

Negro R, Stagnaro-Green A. Clinical aspects of hyperthyroidism, hypothyroidism, and thyroid screening in pregnancy. Endocrine Practice. 2014;21:1-34. https://doi.org/10.4158/EP13350.RA
Moreno-Reyes R, Glinoer D, Van Oyen H, Vandevijvere S. High prevalence of thyroid disorders in pregnant women in a mildly iodine-deficient country: a population-based study. The Journal of Clinical Endocrinology and Metabolism. 2013;98:3694-3701. https://doi.org/10.1210/jc.2013-2149
Haddow JE, Palomaki GE, Allan WC, Williams JR, Knight GJ, Gagnon J, O’Heir CE, Mitchell ML, Hermos RJ, Waisbren SE, Faix JD, Klein RZ. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. New England Journal of Medicine. 1999;341(8):549-555. https://doi.org/10.1056/NEJM199908193410801
Männistö T, Vääräsmäki M, Pouta A, Hartikainen AL, Ruokonen A, Surcel HM, Bloigu A, Järvelin MR, Suvanto-Luukkonen E. Perinatal outcome of children born to mothers with thyroid dysfunction or antibodies: a prospective population-based cohort study. The Journal of Clinical Endocrinology and Metabolism. 2009;94(3):772-779. https://doi.org/10.1210/jc.2008-1520
Su PY, Huang K, Hao JH, Xu YQ, Yan SQ, Li T, Xu YH, Tao FB. Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China. The Journal of Clinical Endocrinology and Metabolism. 2011;96(10):3234-3241. https://doi.org/10.5812/ijem.19378
Unuane D, Velkeniers B, Anckaert E, Schiettecatte J, Tournaye H, Haentjens P, Poppe K. Thyroglobulin autoantibodies: is there any added value in the detection of thyroid autoimmunity in women consulting for fertility treatment? Thyroid. 2013;23(8):1022-1028. https://doi.org/10.1089/thy.2012.0562
Glinoer D, Riahi M, Grün JP, Kinthaert J. Risk of subclinical hypothyroidism in pregnant women with asymptomatic autoimmune thyroid disorders. The Journal of Clinical Endocrinology and Metabolism. 1994;79(1):197-204. https://doi.org/10.1210/jcem.79.1.8027226
Johns LE, Ferguson KK, McElrath TF, Mukherjee B, Seely EW, Meeker JD. Longitudinal profiles of thyroid hormone parameters in pregnancy and associations with preterm birth. PLoS One. 2017; 12(1):e0169542.9. https://doi.org/10.1371/journal.pone.0169542
Korevaar TI, Steegers EA, Pop VJ, Broeren MA, Chaker L, de Rijke YB, Jaddoe VW, Medici M, Visser TJ, Tiemeier H, Peeters RP. Thyroid autoimmunity impairs the thyroidal response to human chorionic gonadotropin: two population-based prospective cohort studies. The Journal of Clinical Endocrinology and Metabolism. 2017;102(1):69-77. https://doi.org/10.1210/jc.2016-2942
Belniak E, Stelmasiak Z, Papuc E. Multiple sclerosis and other autoimmune diseases. Neurologia i Neurochirurgia Polska. 2007;41(3):259-266.
Francesko L, Aldo P. Autoimmune Hypothyroidism. Autoimmune Diseases in Endocrinology. 2007;2:137-176.
Stagnaro-Green A, Glinoer D. Thyroid autoimmunity and the risk of miscarriage. Best Practice and Research. Clinical Obstetrics and Gynaecology. 2004;18(2):167-181. https://doi.org/10.1016/j.beem.2004.03.007
Fadeev VV, Lesnikova SV, Mel’nichenko GA. Functional state of the thyroid gland in pregnant women in conditions of mild iodine deficiency: combined data of the Moscow study. Klinicheskaya i eksperimental’naya tireoidologiya. 2003;1(2):17-31. (In Russ.)
Kalinin AP, Potemkina EE, Pesheva VN. Immunological aspects of autoimmune thyroiditis. Problemy endokrinologii. 1994;1:56-58. (In Russ.)
Morgunov LYu. Vliyanie otdel’nyh vnutrennih boleznej na techenie autoimmunnogo tireoidita: Dis... kand. med. nauk. M. 2005. (In Russ.)
Perminova SG. Hypothyroidism and reproductive disorders of women. Gynecologiya. 2006;8(1):21-26. (In Russ.)
Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T4 and thyroid antibodies in the United States population (1988—1994) National Health and Nutrition Survey (NHANESM). The Journal of Clinical Endocrinology and Metabolism. 2002;87(2):486-488. https://doi.org/10.1210/jcem.87.2.8182
Prummel MF, Wiersinga WM. Thyroid peroxidase autoantibodies in euthyroid subjects. Best Practice and Research. Clinical Obstetrics and Gynaecology. 2005;19(1):1-15. https://doi.org/10.1016/j.beem.2004.11.003
Karanikas G, Schuetz M, Wahl K, Paul M, Kontur S, Pietschmann P, Kletter K, Dudczak R, Willheim M. Relation of anti-TPO autoantibody titre and T-lymphocyte cytokine production patterns in Hashimoto’s thyroiditis. Clinical Endocrinology. 2005;63(2):191-196. https://doi.org/10.1111/j.1365-2265.2005.02324.x
Chistiakov D. Immunogenetics of Hashimoto’s Thyroiditis. Journal of Autoimmune Diseases. 2005;2:15762980. https://doi.org/10.1186/1740-2557-2-1
Zantut-Wittmann D, Boechat LH, Pinto GA, da Silva Trevisan MA, Vassallo J. Autoimmune and non-autoimmune thyroid diseases have different patterns of cellular HLA class II expression. São Paulo Medical Journal. Revista Paulista de Medicina. 1999;117(4):161-164.
Medici M, Porcu E, Pistis G, Teumer A, Brown SJ, Jensen RA, Rawal R, Roef GL, Plantinga TS, Vermeulen SH, Lahti J, Simmonds MJ, Husemoen LL, Freathy RM, Shields BM, Pietzner D, Nagy R, Broer L, Chaker L, Korevaar TI, Plia MG, Sala C, Völker U, Richards JB, Sweep FC, Gieger C, Corre T, Kajantie E, Thuesen B, Taes YE, Visser WE, Hattersley AT, Kratzsch J, Hamilton A, Li W, Homuth G, Lobina M, Mariotti S, Soranzo N, Cocca M, Nauck M, Spielhagen C, Ross A, Arnold A, van de Bunt M, Liyanarachchi S, Heier M, Grabe HJ, Masciullo C, Galesloot TE, Lim EM, Reischl E, Leedman PJ, Lai S, Delitala A, Bremner AP, Philips DI, Beilby JP, Mulas A, Vocale M, Abecasis G, Forsen T, James A, Widen E, Hui J, Prokisch H, Rietzschel EE, Palotie A, Feddema P, Fletcher SJ, Schramm K, Rotter JI, Kluttig A, Radke D, Traglia M, Surdulescu GL, He H, Franklyn JA, Tiller D, Vaidya B, de Meyer T, Jørgensen T, Eriksson JG, O’Leary PC, Wichmann E, Hermus AR, Psaty BM, Ittermann T, Hofman A, Bosi E, Schlessinger D, Wallaschofski H, Pirastu N, Aulchenko YS, de la Chapelle A, Netea-Maier RT, Gough SC, Meyer Zu Schwabedissen H, Frayling TM, Kaufman JM, Linneberg A, Räikkönen K, Smit JW, Kiemeney LA, Rivadeneira F, Uitterlinden AG, Walsh JP, Meisinger C, den Heijer M, Visser TJ, Spector TD, Wilson SG, Völzke H, Cappola A, Toniolo D, Sanna S, Naitza S, Peeters RP. Identification of novel genetic loci associated with thyroid peroxidase antibodies and clinical thyroid disease. PLoS Genet. 2014;10(2): e1004123. https://doi.org/10.1371/journal.pgen.1004123
Bianchi DW, Zickwolf GK, Weil GJ, Sylvester S, DeMaria MA. Male fetal progenitor cells persist in maternal blood for as long as 27 years postpartum. Proceedings of the National Academy of Sciences. 1996;93(2):705-708. https://doi.org/10.1073/pnas.93.2.705
O’Donoghue K, Chan J, de la Fuente J, Kennea N, Sandison A, Anderson JR, Roberts IA, Fisk NM. Microchimerism in female bone marrow and bone decades after fetal mesenchymal stem-cell trafficking in pregnancy. The Lancet. 2004;364(9429):179-182. https://doi.org/10.1016/s0140-6736(04)16631-2
O’Donoghue K, Sultan HA, Al-Allaf FA, Anderson JR, Wyatt-Ashmead J, Fisk NM. Microchimeric fetal cells cluster at sites of tissue injury in lung decades after pregnancy. Reproductive BioMedicine Online. 2008;16(3):382-390. https://doi.org/10.1016/s1472-6483(10)60600-1
Miech RP. The role of fetal microchimerism in autoimmune disease. International Journal of Clinical and Experimental Medicine. 2010;3(2):164-168.
Teng W, Shan Z, Patil-Sisodia K, Cooper DS. Hypothyroidism in pregnancy. The Lancet Diabetes and Endocrinology. 2013;1(3):228-237. https://doi.org/10.1016/S2213-8587(13)70109-8
American College of Obstetrics and Gynecology. ACOG practice bulletin: thyroid disease in pregnancy. Number 37, August 2002. International Journal of Gynecology and Obstetrics. 2002;79:171-180. https://doi.org/10.1097/01.AOG.0000462945.27539.93
Spencer L, Bubner T, Bain E, Middleton P. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. The Cochrane Database of Systematic Reviews. 2015;21(9):CD011263. https://doi.org/10.1002/14651858.CD011263.pub2
Korevaar TI, Muetzel R, Medici M, Chaker L, Jaddoe VW, de Rijke YB, Steegers EA, Visser TJ, White T, Tiemeier H, Peeters RP. Association of maternal thyroid function during early pregnancy with offspring IQ and brain morphology in childhood: a population-based prospective cohort study. The Lancet Diabetes and Endocrinology. 2016;4(1):35-43. https://doi.org/10.1016/S2213-8587(15)00327-7
Alexander E, Pearce E, Brent G, Brown R, Chen H, Dosiou C, Grobman W, Laurberg P, Lazarus J, Mandel S, Peeters R, Sullivan S. 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. https://doi.org/10.1089/thy.2016.0457
Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, LiVosli VA, Niccoli-Sire P, John R, Ruf J, Smyth PP, Spencer CA, Stockigt JR, Guidelines Committee. National Academy of Clinical Biochemistry Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid. 2003;13:3-126. https://doi.org/10.1089/105072503321086962
De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, Eastman CJ, Lazarus JH, Luton D, Mandel SJ, Mestman J, Rovet J, Sullivan S. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism. 2012;97(8):2543-2565. https://doi.org/10.1210/jc.2011-2803
Yan YQ, Dong ZL, Dong L, Wang FR, Yang XM, Jin XY, Lin LX, Sun YN, Chen ZP. Trimester- and method- specific reference intervals for thyroid tests in pregnant Chinese women: methodology, euthyroid definition and iodine status can influence the setting of reference intervals. Clinical Endocrinology. 2011;74:262-269. https://doi.org/10.1111/j.1365-2265.2010.03910.x
Li C, Shan Z, Mao J, Wang W, Xie X, Zhou W, Li C, Xu B, Bi L, Meng T, Du J, Zhang S, Gao Z, Zhang X, Yang L, Fan C, Teng W. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women? The Journal of Clinical Endocrinology and Metabolism. 2014;99(1):73-79. https://doi.org/10.1210/jc.2013-1674
Marwaha RK, Chopra S, Gopalakrishnan S, Sharma B, Kanwar RS, Sastry A, Singh S. Establishment of reference range for thyroid hormones in normal pregnant Indian women. BJOG. 2008;115:602-660. https://doi.org/10.1111/j.1471-0528.2008.01673.x
Korevaar TI, Schalekamp-Timmermans S, de Rijke YB, Visser WE, Visser W, de Muinck Keizer-Schrama SM, Hofman A, Ross HA, Hooijkaas H, Tiemeier H, Bongers- Schokking JJ, Jaddoe VW, Visser TJ, Steegers EA, Medici M, Peeters RP. Hypothyroxinemia and TPO-antibody positivity are risk factors for premature delivery: the generation R study. The Journal of Clinical Endocrinology and Metabolism. 2013;98:4382-4390. https://doi.org/10.1210/jc.2013-2855
Moon HW, Chung HJ, Park CM, Hur M, Yun YM. Establishment of trimester-specific reference intervals for thyroid hormones in Korean pregnant women. Annals of Laboratory Medicine. 2015;35(2):198-204. https://doi.org/10.3343/alm.2015.35.2.198
Melnichenko GA, Rybakova AA. How to assess functional state of thyroid gland, and what should we do in situation when thyroid function tests are inadequate? Klinicheskaya i eksperimental’naya tireoidologiya. 2018;14(2):86-91. (In Russ.) https://doi.org/10.14341/ket9671
Toft AD, Beckett GJ. Measuring serum thyrotropin and thyroid hormone and assessing thyroid hormone transport. In: Braverman LE, Utiger RD, eds. Werner & Ingbar’s The Thyroid: a fundamental and clinical text. Lippincott, Williams & Wilkins, Philadelphia. 2005;9:329-344.
Anckaert E, Poppe K, Van Uytfanghe K, Schiettecatte J, Foulon W, Thienpont LM. FT4 immunoassays may display a pattern during pregnancy similar to the equilibrium dialysis ID-LC/tandem MS candidate reference measurement procedure in spite of susceptibility towards binding protein alterations. Clinica Chimica Acta. 2010; 411(17-18):1348-1353. https://doi.org/10.1016/j.cca.2010.05.032
Toft AD, Weeke J, Dybkjaer L, Granlie K, Eskjaer Jensen S, Kjaerulff E, Laurberg P, Magnusson B. A longitudinal study of serum TSH, and total and free iodothyronines during normal pregnancy. Acta Endocrinologica. 1982;101:531. https://doi.org/10.1530/acta.0.1010531
Kahric-Janicic N, Soldin SJ, Soldin OP, West T, Gu J, Jonklaas J. Tandem mass spectrometry improves the accuracy of free thyroxine measurements during pregnancy. Thyroid. 2007;17(1):303-311. https://doi.org/10.1089/thy.2006.0303
Thienpont LM, Van Uytfanghe K, Beastall G, Faix JD, Ieiri T, Miller WG, Nelson JC, Ronin C, Ross HA, Thijssen JH, Toussaint B; IFCC Working Group on Standardization of Thyroid Function Tests. Report of the IFCC Working Group for standardization of thyroid function tests; part 2: free thyroxine and free triiodothyronine. Clinical Chemistry. 2010;56(6):912-920. https://doi.org/10.1373/clinchem.2009.140194
Wilson KL, Casey BM, McIntire DD, Halvorson LM, Cunningham FG. Subclinical thyroid disease and the incidence of hypertension in pregnancy. Obstetrics and Gynecology. 2012;119:315-320. https://doi.org/10.1097/AOG.0b013e318240de6a
Lazarus JH, Bestwick JP, Channon S, Paradice R, Maina A, Rees R, Chiusano E, John R, Guaraldo V, George LM, Perona M, Dall’Amico D, Parkes AB, Joomun M, Wald NJ. Antenatal thyroid screening and childhood cognitive function. New England Journal of Medicine. 2012;366(6):493-501. https://doi.org/10.1056/NEJMoa1106104
Casey BM, Thom EA, Peaceman AM, Varner MW, Sorokin Y, Hirtz DG, Reddy UM, Wapner RJ, Thorp JM Jr, Saade G, Tita AT, Rouse DJ, Sibai B, Iams JD, Mercer BM, Tolosa J, Caritis SN, VanDorsten JP; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal—Fetal Medicine Units Network. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. New England Journal of Medicine. 2017;376(9):815-825. https://doi.org/10.1056/NEJMoa1606205
Yassa L, Marqusee E, Fawcett R, Alexander EK. Thyroid hormone early adjustment in pregnancy (the THERAPY) trial. The Journal of Clinical Endocrinology and Metabolism. 2010;95:3234-3241. https://doi.org/10.1210/jc.2010-0013
Alexander EK, Marqusee E, Lawrence J, Jarolim P, Fischer GA, Larsen PR. Timing and magnitude of increases in levothyroxine requirements during pregnancy in women with hypothyroidism. New England Journal of Medicine. 2004;351(3):241-249. https://doi.org/10.1056/NEJMoa040079
Stagnaro-Green A, Rovet J. Pregnancy: maternal thyroid function in pregnancy — a tale of two tails. Nature Reviews Endocrinology. 2016;12:10-11. https://doi.org/10.1038/nrendo.2015.212
Andersen SL, Laurberg P, Wu CS, Olsen J. Attention deficit hyperactivity disorder and autism spectrum disorder in children born to mothers with thyroid dysfunction: a Danish nationwide cohort study. BJOG. 2014;121(11):1365-1374. https://doi.org/10.1111/1471-0528.12681
Troshina EA. Iodine deficiency disorders and pregnancy. Contemporary aspects of prevention. Trudnyj pacient. 2012;10(8-9):16-20. (In Russ.)