1.Who is at higher risk of hypothyroidism during pregnancy?
-Those who are having inadequate iodine in the diet (need for iodine increases during pregnancy and breast-feeding)-Among women who have an adequate intake of iodine, the main cause of hypothyroidism during pregnancy is an autoimmune thyroid disease known as Hashimoto’s thyroiditis.(Autoimmune thyroid disease is caused by a woman’s own immune system attacking and destroying the thyroid).
-Prior treatment for hyperthyroidism and surgery for thyroid tumors
2.Why to treat hypothyroidism during pregnancy?
-It is important that a woman have normal thyroid hormone levels before and during pregnancy. -Hypothyroidism during pregnancy can have harmful effects like miscarriages, intrauterine deaths, mental defects in babies etc
3.What special considerations apply to the diagnosis and management of hypothyroidism during and after pregnancy?
-Women with a family history of thyroid disease or any autoimmune disease are at increased risk for hypothyroidism.-Typical symptoms of hypothyroidism include weight gain, feeling colder than usual, dry skin and
hair, and reduced energy levels. Any signs or symptoms of hypothyroidism should alert your physician to measure your TSH level.
-Women with postpartum depression should be tested for hypothyroidism and appropriately treated.
-Postpartum thyroiditis (PPT) is a thyroid inflammation that occurs in 7% of all women during the first year postpartum.Approximately 30% of women who have had PPT will develop permanent hypothyroidism within the next 10 years. Annual evaluation of thyroid hormone levels is, therefore, recommended.
4.What is the recommended treatment for hypothyroidism?
A woman beginning her prenatal care should have her thyroid function evaluated if she has: a) symptoms consistent with hypothyroidism
b) a history of hyperthyroid or hypothyroid disease
c) a history of postpartum thyroiditis
d) a history of previous thyroid surgery
e) a family history of thyroid disease
f) a goiter (an enlarged thyroid gland)
g) the known presence of thyroid antibodies,
type 1 diabetes or other autoimmune diseases
h) a history of head or neck irradiation
i) a prior miscarriage
j) a history of preterm delivery
-In a woman already diagnosed with hypothyroidism and being treated with thyroxine, thyroid hormone levels should be checked before attempting to conceive. This may alert her physician that an increase in the dose of thyroxine is needed even before she becomes pregnant.
-If a woman is diagnosed with hypothyroidism just before she wants to conceive, she should begin treatment with thyroxine to achieve normal thyroid hormone levels prior to becoming pregnant.
-Once a woman becomes pregnant, the thyroxine dose often needs to be increased, possibly by as much as
30% to 50% in the first 4 to 8 weeks of pregnancy.
-It is important to contact your physician immediately after pregnancy is confirmed so that a blood test can be
performed and the dose of thyroxine adjusted if needed.
-After delivery, most hypothyroid women need to decrease the thyroxine dosage they received during pregnancy.
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