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INTRODUCTION
Prevalence
CLINICAL PRESENTATION
Hypothyroidism
can
affect
all
organ
systems
&
these manifestations are largely independent of the
underlying disorder but are a function of the degree of
hormone deficiency.
CAUSES OF HYPOTHYROIDISM
HASHIMOTOS THYROIDITIS
Hypothyroidism in Pregnancy
Convincing data suggest that pregnant women who are positive for Thyroid
autoantibodies (especially anti-TPO antibodies) leads to higher frequency of miscarriage
(13.8%) than is seen in pregnant women who lack anti-TPO antibodies (2.4%), and that T4
treatment of the anti-TPO antibody positive group reduces the risk of miscarriage to
approximately 3.5%.
Over Hypothyroidism (OH) in pregnancy is defined as an elevated TSH (>2.5 mIU/L)
in conjunction with a decreased FT4 concentration. Women with TSH levels of 10.0 mIU/L
or above, irrespective of their FT4 levels, are also considered to have OH.
Sub-clinical Hypothyroidism (SCH) in pregnancy is defined as a serum TSH between 2.5
and 10 mIU/L with a normal FT4 concentration.
Isolated Hypothyroxinemia (IH) is defined as a normal maternal TSH concentration
in conjunction with FT4 concentrations in the lower 5th or 10th percentile of the
reference range.
Prevalence
10%-20% of all pregnant women in the first trimester of pregnancy are Thyroid
Peroxidase (TPO) or Thyroglobulin (Tg) antibody positive and Euthyroid
16% of the women who are Euthyroid and positive for TPO or Tg antibody in the
first trimester will develop a TSH that exceeds 4.0 mIU/L by the third trimester,
and 33%-50% of women who are positive for TPO or Tg antibody in the first
trimester will develop postpartum Thyroiditis
2%3% of apparently healthy, non-pregnant women of childbearing age have an
elevated serum TSH. Among these healthy non-pregnant women of childbearing
age it is estimated that 0.3%-0.5% of them would, after having Thyroid function
tests, be classified as having OH, while 2%2.5% of them would be classified as
having SCH
An increased risk of premature birth, low birth weight, and miscarriage. Such
patients carry an estimated 60% risk of fetal loss when OH was not adequately
detected and treated
Negro and colleagues published data suggesting SCH also increases the risk
of pregnancy complications in anti-thyroid peroxidase antibody positive
(TPOAb+) women
Recommendations:
Women who are positive for TPOAb and have SCH should be treated with LT4
Women with SCH in pregnancy, who are not initially treated, should be
monitored for progression to OH with a serum TSH and FT4 approximately every 4
weeks until 16-20 weeks gestation and at least once between 26 and 32 weeks
gestation
Recommendations:
Recommendations:
Patients whose serum TSH levels exceed 10 mIU/L are at increased risk for heart
failure and cardiovascular mortality, and should be considered for treatment with
L-thyroxine.
Euthyroid women (not receiving LT4) who are TPOAb + require monitoring
for Hypothyroidism during pregnancy. In addition to the risk of Hypothyroidism, it
has been described that being TAb + constitutes a risk factor for miscarriage,
premature delivery, Perinatal death , post-partum dysfunction, and low motor and
intellectual development (IQ) in the offspring.
References:
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