having a supra-normal TSH value at delivery.

Because the risk of TSH elevation is increased in

this population, increased surveillance of euthyroid thyroid antibody positive women should
occur.

TPO antibodies are able to cross the placenta. At the time of delivery, cord blood
TPOAb levels strongly correlate with third-trimester maternal TPOAb concentrations (148).
However, maternal passage of either TPOAb or TgAb is not associated with fetal thyroid
dysfunction.
ART: Assisted Reproductive
Techniques
BMC Res Notes. 2009 Nov 26;2:237. doi:
10.1186/1756-0500-2-237.
Pregnant women with normal antibody values
according to gestational age had values for FT4
and TSH, but not for FT3, that differed to a
statistically significant degree. The values we
describe can be used as reference values for the
Aragon region of Spain.
In hyperthyroid patients not tolerating or non-responsive to
antithyroid drug therapy, preparation for surgery with beta-
blocking agents and a short course of potassium iodide solution
(50-100 mg a day) are recommended (381 =ao 1992). Potassium
iodide preparation before surgery is also recommended in patients
with other signs of active disease to reduce bleeding during
surgery.
A maternal TRAb serum concentration > 5 IU/L (approximately 3X the
upper limit of normal for the assay) in the 2 nd and 3rd trimester predicted
neonatal hyperthyroidism with 100 % sensitivity and 43 % specificity.
 In pregnancy, a major difference from GD is that no TRAb is produced by the mother, and
consequently the fetal thyroid is not stimulated as it is in GD. Therefore, ATD therapy to
make the mother euthyroid would significantly increase the risk of hypothyroidism and
goiter in the fetus. Acknowledging limited data on this subject, if ATDs are required in this
setting, careful monitoring of the fetus should occur. Furthermore, the dose of ATD should
be kept low, and maternal surgical therapy with removal of autonomous nodule(s)
considered if signs of fetal hypothyroidism develop. Generally, if possible, ablative therapy
should be considered before
conception for hyperthyroidism caused by thyroid autonomy in women seeking future
pregnancy.
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A trial which screens women pre-conception and then randomizes women with subclinical
hypothyroidism, isolated hypothyroxinemia and isolated thyroid autoimmunity (with
normal TSH) to either a treatment or no treatment arm is needed. The task force is aware of
the difficulties inherent in performing such a trial, and the ethical challenges to be faced.
Nevertheless, we believe that such a trial is feasible, can be ethically performed with
appropriate study design and safeguards, and will yield invaluable information related to
the
optimal care of the pregnant women and the developing fetus.