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Thyroid Dysfunction in Pregnancy: The Basic Science and Clinical Evidence Surrounding the Controversy in Management

Gyamfi, Cynthia MD; Wapner, Ronald J. MD; D’Alton, Mary E. MD

doi: 10.1097/AOG.0b013e3181996fe5
Current Commentary

Maternal hypothyroidism is known to result in neurodevelopmental disorders in offspring, but whether subclinical hypothyroidism results in lower intelligence quotient (IQ) performance in progeny is an area of debate. Animal studies have shown that fetal thyroxine and triiodothyronine are primarily maternally derived before mid gestation. Other animal data reveal that fetal brain damage at a time that is analogous to the first trimester in humans can be linked to irreversible future brain damage. A large study conducted on an unselected population of pregnant women, both with known diagnosis of hypothyroidism and those who were screened but not diagnosed, found a four-point difference in the IQ levels of the offspring, raising the question of clinical significance. The endocrine community has accepted that subclinical hypothyroidism causes a significant decrease in IQ scores and has advocated for routine screening of pregnant women. However, obstetric authorities have cautioned that more research is needed before a causal relationship between subclinical hypothyroidism and lower IQ performance can be verified. Consequently, the American College of Obstetricians and Gynecologists has stated that routine screening and treatment of subclinical hypothyroidism cannot be recommended. We will review the basic science and clinical evidence for the neurodevelopmental effects of thyroid dysfunction in pregnancy.

Clinical evidence has not substantiated the suggestion that subclinical hypothyroidism affects pediatric neurodevelopment.

From the Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York.

Corresponding author: Cynthia Gyamfi, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, 622 West 168th Street, PH-16, New York, NY 10032; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2009 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.