Thyroid Function Testing in Women Who Had a Stillbirth

During pregnancy, women tend to adapt to specific conditions, which cause a myriad of alterations in their bodies. These changes are mainly caused by the psychological demands of both the fetus and the mother. Mental changes exhibited during pregnancy are not limited to thyroid hormonal functioning alone but also to the change in metabolic processes. Hormonal changes occur during pregnancy to facilitate the cellular demands of maternal requirements. However, they also cause multiple outcomes on thyroid functioning. Thyroid dysfunction implies various perinatal outcomes. This literature review is intended to establish main points regarding thyroid function testing among women who have a stillbirth.

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Previous research has established that thyroid disorders are more prevalent in reproductive women. Also, the greatest ratio of women with stillbirths has explicit hypothyroidism in the general population of unselected women. However, the common disorders are relatively observed in groups of unselected pregnant women. According to (Nijkamp, et.al, 2016), stillbirths occur less frequently during early gestation periods and often during late gestation periods. Their research did not reveal a prevalence of antithyroid antibodies in their study subjects. Previous studies have established among many things that high TSH levels tend to fuel the risk of stillbirths among women. However, in this research, the only observations were estimations of the prevalence, which ranged between 10 and 15 percent. The presence of antithyroid antibodies highlights the presence of other diseases such as gestational diabetes and perinatal death. Evidently, most of the women who have suffered diseases associated with thyroid function previously also exhibit thyroid dysfunctions during stillbirth evaluations. Proper treatment of hypothyroidism during gestation has been proven to minimize pregnancy complications such as miscarriage. As a result, the trend observed in women with thyroid dysfunctions has been attributed to inadequate nursing and treatment of thyroid function through pregnancy.

Recently, the health sector in the US has been trying to establish the most efficient means of assessing thyroid function. As a result, relevant studies have shown significant differences in their ratios of stillbirths among hypothyroxinaemic women. Several pregnancy complications associated with thyroid dysfunction are known to cause perinatal death. Most studies on perinatal death have not been able to account for causes of fetal deaths. However existing literature suggests that women with subclinical hypothyroidism have increased the risk of contracting gestational diabetes and pre-eclampsia. Nevertheless, there may be an association between thyroid dysfunction and fetal death, which indicates the existence of a fundamental pathophysiological mechanism. Apparently, in hypothyroid women, fetal death is most likely caused by placental hypoplasia and added placental defects. Nonetheless, the placental defects present different patterns depending on the individual thereby making it difficult to relate placental hypoplasia with a particular hypothyroid state. Currently, no existing literature suggests that treatment of subclinical hypothyroidism reduces the risk of perinatal death.

The normal tests on thyroid function have shown no value in diagnostic studies of women with stillbirths. This can be attributed to routine observations, which have not highlighted any individual associations with fundamental causes of death. The only convincing observations are two essential mechanisms, which cause fetal deaths related to thyroid dysfunction. In hypothyroid women, however, there could be a primary mechanism, which causes placental hypoplasia and other placental abnormalities, which lead to fetal deaths. A subclinical hyperthyroid state, on the other hand, may result in fetal hydrops, which also cause fetal deaths. To control the outcome of maternal hypothyroidism, treatment is recommended for thyroid hormone replacement. To prevent hypothyroidism, it is essential that women maintain healthy thyroid hormone levels before and during pregnancy. For women already undergoing treatment for hypothyroidism, there is a need to check thyroid hormone levels before conceiving because if the TSH levels are too high, one may need to delay their pregnancy period until the disease has been well controlled. To control TSH levels, pregnant women are treated with doses of levothyroxine. However, in cases of women suffering from the disease, after pregnancy, they are required to increase their dose of levothyroxine. After pregnancy, the dosage should resume normal amounts to keep TSH levels balanced.

Even better, pregnant women who are at a high risk of contracting thyroid diseases should have thyroid function tests conducted. Typically, this screening process is recommended for the first prenatal visit or the ninth week of pregnancy. Women with higher levels of TPO antibodies require extra screening because they are at an increased risk of contracting hypothyroidism and other pregnancy problems. Also, they should get TSH blood tests before and during pregnancy. In its most stark form, hypothyroidism in newborns can be fatal. With adequate control, the consequences are usually temporary. However, it is important to note that even under the best conditions there may be permanent effects. This is because even for women who undergo treatment definitively, maternal antibodies may remain afterward posing a potential risk to the newborn. To monitor the health of a newborn child as well as the mothers, mothers are required to seek the help of endocrinologists to receive proper monitoring and treatment after pregnancy.

Therefore, adequate evaluation of thyroid function tests before, during, and after pregnancy is of great importance if the abnormalities associated with thyroid dysfunction are to be prevented.

Bibliography

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LEUNG, ANNA S., LYNNAE K. MILLAR, PAUL P. KOONINGS, MARTIN MONTORO, and JORGE H. MESTMAN. "Perinatal outcome in hypothyroid pregnancies." Obstetrics & Gynecology 81, no. 3 (1993): 349-353.

Nijkamp, Janna W., Fleurisca J. Korteweg, Henk Groen, Albertus Timmer, Gerrit Van Den Berg, Patrick M. Bossuyt, Ben Willem J. Mol, and Jan Jaap HM Erwich. "Thyroid function testing in women who had a stillbirth." Clinical endocrinology (2016).Shalev, Eliezer, Shlomo Eliyahu, M. Ziv, and Moshe Ben-Ami. "Routine thyroid function tests in infertile women: are they necessary?." American journal of obstetrics and gynecology 171, no. 5 (1994): 1191-1192.

Surks, Martin I., Eduardo Ortiz, Gilbert H. Daniels, Clark T. Sawin, Nananda F. Col, Rhoda H. Cobin, Jayne A. Franklyn et al. "Subclinical thyroid disease: scientific review and guidelines for diagnosis and management."Jama 291, no. 2 (2004): 228-238.

Tunbridge, W. M. G., D. C. Evered, R. Hall, D. Appleton, M. Brewis, F. Clark, J. Grimley Evans, E. Young, T. Bird, and P. A. Smith. "The spectrum of thyroid disease in a community: the Whickham survey." Clinical endocrinology 7, no. 6 (1977): 481-493.