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Hashimoto's thyroiditis
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=== Pregnancy === The [[Endocrine Society]] recommends screening in pregnant women who are considered high-risk for thyroid autoimmune disease.<ref>{{Cite web |date=26 March 2015 |title=Endocrine Experts Support Screening for Thyroid Dysfunction in Pregnant Women |url=https://www.endocrine.org/news-room/current-press-releases/endocrine-experts-support-screening-for-thyroid-dysfunction-in-pregnant-women |url-status=dead |archive-url=https://web.archive.org/web/20151008045642/https://www.endocrine.org/news-room/current-press-releases/endocrine-experts-support-screening-for-thyroid-dysfunction-in-pregnant-women |archive-date=8 October 2015 |access-date=4 October 2015 |website=Endocrine Society}}</ref> Universal screening for thyroid diseases during pregnancy is controversial, however, one study "supports the potential benefit of universal screening".<ref name="Lepoutre-2012">{{cite journal | vauthors = Lepoutre T, Debiève F, Gruson D, Daumerie C | title = Reduction of miscarriages through universal screening and treatment of thyroid autoimmune diseases | journal = Gynecologic and Obstetric Investigation | volume = 74 | issue = 4 | pages = 265–273 | date = 2012-01-01 | pmid = 23147711 | doi = 10.1159/000343759 | s2cid = 1646888 | doi-access = }}</ref> Pregnant women may have [[Antithyroid autoantibodies|antithyroid antibodies]] (5%–14% of pregnancies<ref name="Klubo-Gwiezdzinska-2022" />), poor thyroid function resulting in hypothyroidism, or both. Each is associated with risks:<ref name="Klubo-Gwiezdzinska-2022" /> ==== Anti-thyroid antibodies in pregnancy ==== The presence of Thyroid peroxidase antibodies at the outset of pregnancy are associated with a greater risk to the mother of hypothyroidism and thyroid impairment in the first year after [[Childbirth|delivery]].<ref>{{cite journal | vauthors = Caturegli P, De Remigis A, Rose NR | title = Hashimoto thyroiditis: clinical and diagnostic criteria | journal = Autoimmunity Reviews | volume = 13 | issue = 4–5 | pages = 391–397 | date = 2014-04-01 | pmid = 24434360 | doi = 10.1016/j.autrev.2014.01.007 | series = Diagnostic criteria in Autoimmune diseases }}</ref> The presence of antibodies is also associated with "a 2 to 4-fold increase in the risk of recurrent [[Miscarriage|miscarriages]], and 2 to 3-fold increased risk of [[preterm birth]]", however the reason why is unclear. Thyroid peroxidase antibodies are speculated to indicate other autoimmune processes against the placental-fetal unit.<ref name="Klubo-Gwiezdzinska-2022" /> Levothyroxine treatment in euthyroid women with thyroid autoimmunity does not significantly impact the relative risk of miscarriage and preterm delivery, or outcomes with live birth. "Therefore, no strong recommendations regarding the therapy in such scenarios could be made, but consideration on a case-by-case basis might be implemented."<ref name="Klubo-Gwiezdzinska-2022" /> ==== Hypothyroidism in pregnancy. ==== Women who have low thyroid function that has not been stabilized are at greater risk of complications for both parent and child. Risks to the mother include [[Gestational Hypertension|gestational hypertension]] including [[Pre-eclampsia|preeclampsia]] and [[eclampsia]], [[gestational diabetes]], [[placental abruption]], and [[Postpartum bleeding|postpartum hemorrhage]].<ref name="Klubo-Gwiezdzinska-2022" /> Risks to the infant include miscarriage, preterm delivery, [[low birth weight]], [[Infant respiratory distress syndrome|neonatal respiratory distress]], [[hydrocephalus]], [[hypospadias]], fetal death, infant intensive care unit admission, and [[Developmental disability|neurodevelopmental delays]] (lower child IQ, language delay or [[global developmental delay]]).<ref name="Lepoutre-2012" /><ref name="Gaberšček-2011">{{cite journal | vauthors = Gaberšček S, Zaletel K | title = Thyroid physiology and autoimmunity in pregnancy and after delivery | journal = Expert Review of Clinical Immunology | volume = 7 | issue = 5 | pages = 697–706; quiz 707 | date = September 2011 | pmid = 21895480 | doi = 10.1586/eci.11.42 | doi-access = free }}</ref><ref name="Klubo-Gwiezdzinska-2022" /> Successful pregnancy outcomes are improved when hypothyroidism is treated.<ref name="Gaberšček-2011" /> Levothyroxine treatment may be considered at lower TSH levels in pregnancy than in standard treatment.<ref name="Klubo-Gwiezdzinska-2022" /> Liothyronine does not cross the fetal blood-brain barrier, so liothyronine (T<sub>3</sub>) only or liothyronine + levothyroxine (T<sub>3</sub> + T<sub>4</sub>) therapy is not indicated in pregnancy.<ref name="Klubo-Gwiezdzinska-2022" /> Close cooperation between the [[endocrinologist]] and [[obstetrician]] benefits the woman and the infant.<ref name="Lepoutre-2012" /><ref>{{cite journal | vauthors = Budenhofer BK, Ditsch N, Jeschke U, Gärtner R, Toth B | title = Thyroid (dys-)function in normal and disturbed pregnancy | journal = Archives of Gynecology and Obstetrics | volume = 287 | issue = 1 | pages = 1–7 | date = January 2013 | pmid = 23104052 | doi = 10.1007/s00404-012-2592-z | url = https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/84394 | url-status = live | access-date = 16 January 2022 | s2cid = 24969196 | archive-url = https://web.archive.org/web/20220123170145/https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/84394 | archive-date = 23 January 2022 }}</ref><ref>{{cite journal | vauthors = Balucan FS, Morshed SA, Davies TF | title = Thyroid autoantibodies in pregnancy: their role, regulation and clinical relevance | journal = Journal of Thyroid Research | volume = 2013 | pages = 182472 | date = 2013 | pmid = 23691429 | pmc = 3652173 | doi = 10.1155/2013/182472 | doi-access = free }}</ref> ==== Immune changes during pregnancy ==== Hormonal changes and [[trophoblast]] expression of key [[Immunomodulation|immunomodulatory]] molecules lead to [[immunosuppression]] and fetal tolerance. The main players in regulation of the immune response are [[Tregs]]. Both [[Cell-mediated immunity|cell-mediated]] and [[Humoral immunity|humoral]] immune responses are attenuated, resulting in [[Immune tolerance in pregnancy|immune tolerance]] and suppression of autoimmunity. It has been reported that during pregnancy, levels of thyroid peroxidase and thyroglobulin antibodies decrease.<ref name="Weetman-2010" />
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