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HYPOTHYROIDISM
IN
PREGNANCY
ALEKYA KALLEM
ROLL NO:-162
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,).
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).
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.
It is important that patient should be euthyroid at
the time of conception.
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).
In India, routine screening for thyroid dysfunction is recommended (FOGSI, ITS, ESI).
REFERENCE:
DC DUTTA TEXTBOOK OF OBSTETRICS