The systematic screening and management of hypothyroidism and hyperthyroidism during pregnancy

Altogether, thyroid function abnormalities during pregnancy can affect up t o 10% of all women. The high prevalence of both hypo- and hyperthyroidism, the obstetrical repercussions associated with thyroid dysfunction in the mo thers, as well as the potential role of maternal thyroid dysfunction as an influence on fetal development constitute solid arguments for a further inc rease of our knowledge of the pathophysiological processes underlying the a lterations of thyroid function related to the pregnant state. In this revie w, the focus will be on the most clinically relevant aspects associated wit h hypothyroidism [autoimmune thyroid disorders (AITDs), subfertility, risk of miscarriage, risk of hypothyroidism in women with AITD and treatment of hypothyroid women] and with hyperthyroidism (clinical presentations during pregnancy, Graves' disease and its management, fetal hyperthyroidism in wom en with antithyroid-stimulating hormone receptor antibodies and gestational transient thyrotoxicosis associated with human chorionic gonadotropin stim ulation of the maternal thyroid gland). I also propose a global strategy fo r the systematic screening of hypo- and hyperthyroidism in the pregnant sta te.