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Hypothyroidism is common in pregnancy with an estimated prevalence of 2-3% and 0.3-0.5% for subclinical and overt hypothyroidism respectively. [8] Endemic iodine deficiency accounts for most hypothyroidism in pregnant women worldwide while chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world.
At 10 to 12 weeks of pregnancy, the baby's thyroid begins to work on its own. But the baby still depends on the mother for iodine, which the thyroid uses to make thyroid hormone. Pregnant women need about 250 micrograms (mcg) of iodine a day. Some women might not get all the iodine they need through the foods they eat or prenatal vitamins ...
Even with appropriate treatment, it may pose risks not only to the mother, but also to the fetus. Thyroid hormones, T4 and TSH, diffuse across the placenta traveling from the mother to fetus for 10–12 weeks before the fetus’s own thyroid gland can begin synthesizing its own thyroid hormones. [2]
These normal hormonal changes often make pregnancy look like a hyperthyroid state but may be within the normal range for pregnancy, so it necessary to use trimester specific ranges for TSH and free T4. [23] [24] True hyperthyroidism in pregnancy is most often caused by an autoimmune mechanism from Graves' Disease. [23]
[2] [12] According to newer theories, [2] elevated concentrations of TSH and thyroid hormones in type 2 allostasis result from an up-regulated set point of the feedback loop, which ensues from increased TRH expression in the basolateral amygdala and the paraventricular nucleus of the hypothalamus in response to stress. [13] [14]
Women with type I diabetes mellitus have a threefold increase in the prevalence of postpartum thyroiditis than non-diabetic women in the same region. [3] According to Johns Hopkins, 3 in 100 women develop postpartum thyroiditis. Some risk factors include antithyroid antibodies, type 1 diabetes, history of thyroid problems, and family history of ...
The therapeutic target range TSH level for patients on treatment ranges between 0.3 and 3.0 μIU/mL. [18] For hypothyroid patients on thyroxine, measurement of TSH alone is generally considered sufficient. An increase in TSH above the normal range indicates under-replacement or poor compliance with therapy.
The elevation is usually a marked increase over the normal range. [13] TSH is the preferred initial test of thyroid function as it has a higher sensitivity to changes in thyroid status than free T 4. [64] Biotin can cause this test to read "falsely low". [21]