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HYPOTHYROIDISM

IN

PREGNANCY

ALEKYA KALLEM

ROLL NO:-162

Topic

Hypothyroidism (underactive thyroid) refers to any state in which a person's thyroid hormone production is below normal during Pregnancy.

*Overall prevalence is 1-2 per 100 pregnant women. May be subclinical (elevated TSH and normal FT,) or overt (elevated TSH and low FT,).

Topic

ETIOLOGY:-

Primary hypothyroidism met in pregnancy is mostly related to thyroid autoimmunity (Hashimoto thyroiditis).

Myxedema rarely presents in pregnancy because they tend to be infertile.

(i) Autoimmune (Hashimoto thyroiditis)

(ii) Following thyroidectomy

(iii) Treatment with 131]

(iv) Drug induced (lithium, amiodarone, iodine excess

and ATDs).

Topic

TYPES:-

OVERT CLINICAL

SUBCLINICAL

It is defined as elevated levels of serum TSH with low serum T, or with serum TSH >10 mIU/L irrespective serum thyroxin level. The common complications of SCH are similar to that of overt clinical situation.

Serum TPO Abs (antimicrosomal antibodies) are elevated in almost 95% of cases with autoimmune hypothyroidism.

*It is defined as the state with elevated serum TSH in the presence of normal (trimester specific) FT4 values. TPO Abs are raised in 70%-80% of women of child bearing age.

*The recommended upper limit of serum TSH (gestation specific) is 2.5 mIU/L in the first trimester and up to 3 mIU/L into second and third trimesters.

INDICATIONS of thyroid hormone testing in pregnancy:-

  • Age >30 years.
  • Residing in an area of iodine deficiency.
  • Symptoms of thyroid dysfunction.
  • Family history of thyroid dysfunction.
  • Obesity (BMI ≥30).
  • Unexplained miscarriage/infertility.
  • Presence of goiter.
  • Presence of autoimmune disorders (Type-1 DM).

It is important that patient should be euthyroid at

the time of conception.

COMPLICATIONS

  • Pre-eclampsia (PE),
  • Placental abruption,
  • Cardiac dysfunction,
  • Anemia, LBW,
  • Still birth,
  • Miscarriage and deficient intellectual development of the child.

It is reasonable to estimate the serum TSH levels in the first antenatal clinic in these women with higher risk of thyroid dysfunction though universal testing is also recommended. Chronic autoimmune thyroid disease is more common in women with other autoimmune diseases (Type-1 diabetes).

  • Serum TSH should be repeated at an interval of 6-8 weeks as there is increased demand of thyroid hormone in the second half of pregnancy. If the patient is having substitution therapy in prepregnant state, the dose of levothyroxine need to be increased in pregnancy.

TREATMENT

  • It is started with levothyroxine 2-2.4 ug/kg/ day.
  • The maintenance dose for most patients is between 75 and 150 ug of L-thyroxin per day.
  • The serum TSH should be repeated every 4-6 weeks.
  • In order to keep serum TSH, serum FT, or FT,1 values within the normal range, the dose need to be increased in the second trimester of pregnancy.
  • After delivery, dose is reduced.

In India, routine screening for thyroid dysfunction is recommended (FOGSI, ITS, ESI).

REFERENCE:

DC DUTTA TEXTBOOK OF OBSTETRICS

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