Women who are under-treated before the pregnancy are likely to require both increased thyroxine dose and further thyroid function assays. They can generally be easily detected, biochemically, at the first hospital visit.9 Complications Hashimoto's thyroiditis is associated with an increased risk of miscarriage. The patient may be left hypothyroid in the long term.
Thyroxine dose adjustment during pregnancy A Dawson1, JM Ng1, A Wakil1, R Krishnan2, Y Igzeer2, EA Masson1, BA Allan1 indow2. Author affiliations 1Department of Diabetes and Endocrinology, Hull, UK; 2Department of Womens and Child Health, Hull, UK.Patients and methods: Retrospective audit of all pregnant women with pre-existent hypothyroidism who delivered between May and August 2008. Seventeen patients were included. Results: At antenatal booking there were 8 patients with TSH above 2 mU/l of whom only one had the dose of thyroxine increased.
How was the study done? The women were randomly assigned to take either two (Saturday and Wednesday) or three (Monday, Wednesday and Friday) extra tablets a week of levothyroxine once pregnancy was confirmed, resulting in a 29 or 43 increase in their weekly dose of levothyroxine.Levothyroxine dose will need to be returned to pre-pregnancy levels after delivery and the TSH checked 6-8 weeks postpartum. Postpartum thyroid dysfunction (PPTD ) occurs in 50 of women found to have thyroid peroxidase antibodies in early pregnancy.
Printing leaflets directed to hypothyroid women of child bearing age with the intent to become pregnant or those who have just become pregnant may be beneficial.Chronic thyroiditis : more than 50 of women with Hashimoto's thyroiditis require an increase in thyroxine in the postpartum period. 8 Reidel's thyroiditis may require rescue surgery for severe compression symptoms on the trachea or oesophagus.
These women had a mean early pregnancy TSH of 12.3 mU/l, which decreased by 95 to 1.3 mU/l (P less than 0.01). CONCLUSIONS : Most of the hypothyroid patients presenting to an antental booking clinic are well controlled in early pregnancy and will remain so throughout pregnancy.Abalovich and colleagues write. "By taking this approach, patients will promptly attain the euthyroid state, avoiding additional increments and, probably, obstetric risks they conclude. Thyroid. Published online November 11, 2013. Abstract.
TFT normal ESR raised Leukocytosis Associations Hashimoto's disease may be associated with other autoimmune diseases - eg, Addison's disease, pernicious anaemia. Patients with Hashimoto's disease also have an increased incidence of mitral valve prolapse.Thyroid hormone requirement increases during pregnancy by approximately 50 in the first trimester. We audited our practice of increasing thyroid hormone dose at booking and thereafter in pregnant women attending our combined obstetric medical clinic.
They recommend checking the serum TSH levels every 4 weeks through the second trimester. How does this compare with other studies? Other studies have shown that the dose of levothyroxine must be increased during pregnancy.The major factor that predicted excessive suppression of the TSH was a dose of levothyroxine of at least 100 g per day before pregnancy. The study authors concluded that an increase of two levothyroxine tablets at the time pregnancy is confirmed significantly reduces the risk of hypothyroidism occurring in the mother during the first trimester.
For example, the latest Endocrine Society guidelines "say that for the treatment of subclinical hypothyroidism diagnosed during pregnancy, a dose of 50 g or more could be enough Dr. Abalovich explained to.The full article title: Yassa et al. Thyroid hormone early adjustment in pregnancy (The THERAPY Trial). J Clin Endocrinol Metab 2010; May 12 Epub ahead of print. What was the aim of the study?
Rarely, autoantibodies cross the placenta to cause thyroiditis in the fetus. Management Subacute thyroiditis : this usually resolves spontaneously. Patients may need treatment if there is prolonged hypothyroidism. Postpartum thyroiditis : this does not usually require treatment, and may benefit from yearly reassessment.Guidance from the local laboratory/thyroid specialist should be sought as to the normal range. 6 Management 5 6 Thyroxine at increasing dosages until TSH is brought to a normal-low range. The starting dose is usually mg/day and should be adjusted according to TSH levels every four weeks.
CLINICAL THYROIDOLOGY FOR PATIENTS A publication of the American Thyroid Association. Summaries for Patients from Clinical Thyroidology (June 2010) Table of Contents. PDF File for Saving and Printing. THYROID AND PREGNANCY Thyroid hormone replacement in pregnancy ABBREVIATIONS DEFINITIONS.Iodine deficiency. Infiltrative diseases. Pituitary or hypothalamic disease. Presentation Dry skin with yellowing especially around the eyes. Weakness, tiredness, hoarseness, hair loss, intolerance to cold, constipation, sleep disturbance. Goitre, delayed relaxation of deep tendon reflexes.
Prognosis Prognosis for mother and fetus is excellent with appropriate treatment. However, there is a small increase in stillbirth rate and fetal assessment in the third trimester is necessary. Recent research has suggested an increased risk of neurocognitive difficulties in children of women with hypothyroidism, even with a euthyroid fetus, as maternal thyroid hormone is.The researchers retrospectively identified 77 women seen at their center who were aged 18 to 45 years and had hypothyroidism that was newly discovered during pregnancy. A total of 64 women had subclinical hypothyroidism: The remaining 13 women had overt hypothyroidism (group 2).