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The Regulation of Thyroid Function in Pregnancy: Pathways of Endocrine Adaptation from Physiology to Pathology

Hospital Saint-Pierre, Department of Internal Medicine, Thyroid Investigation Clinic, Université Libre de Bruxelles, Belgium

I. Introduction

II. The Regulation of Thyroid Function in Normal Pregnancy

A. The thyroid hormone transport proteins

B. The thyroid hormones

1. Total thyroid hormones

2. Free thyroid hormones

3. Peripheral metabolism of thyroid hormones

C. The serum levels of thyroglobulin (TG)

D. The metabolism of iodine

E. The hypothalamic-pituitary control of thyroid function and the role of hCG

1. Hypothalamic-pituitary-thyroid axis (HPTA)

2. Regulation of serum TSH

3. Thyrotropic action of hCG

F. A global view of thyroidal economy in pregnancy

III. Pathological Alterations of Thyroidal Regulation Associated with Pregnancy

A. IDD

1. Consequences of iodine deficiency during pregnancy

2. Assessment of increased thyroidal stimulation

3. Gestational goitrogenesis and its prevention by iodine supplementation

4. Consequences of iodine deficiency for the offspring

B. Hypothyroidism and pregnancy

1. Fertility and pregnancy outcome in hypothyroid women

2. Thyroid hormone replacement in the hypothyroid pregnant woman

3. Subclinical hypothyroidism in pregnancy

4. Euthyroid autoimmune thyroid disorders (AITD) and pregnancy

5. AITD and the risk of miscarriage

C. Hyperthyroidism and pregnancy

1. GD in the pregnant woman

2. GTT

3. Hyperemesis gravidarum and hyperthyroidism

IV. Conclusions and Perspectives