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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.
Levothyroxine is safe to use during pregnancy and necessary for the health of the baby. [4] Women with Hashimoto's disease or an underactive thyroid who are taking levothyroxine before pregnancy may need a higher dose to maintain normal thyroid function. Clinicians may check thyroid function every 6 to 8 weeks during pregnancy.
The recommendation is stronger in pregnant women with subclinical hypothyroidism (defined as TSH 2.5–10 mIU/L) who are anti-TPO positive, in view of the risk of overt hypothyroidism. If a decision is made not to treat, close monitoring of the thyroid function (every 4 weeks in the first 20 weeks of pregnancy) is recommended.
As such, pregnant women are recommended to increase to nine doses of levothyroxine each week, rather than the usual seven, as soon as their pregnancy is confirmed. [14] Repeat thyroid function tests should be done five weeks after the dosage is increased.
For patients taking levothyroxine, TSH may be boosted by discontinuing levothyroxine for 3–6 weeks. [6] This long period of hormone withdrawal is required because of levothyroxine's relatively long biological half-life, and may result in symptoms of hypothyroidism in the patient. The shorter half-life of liothyronine permits a withdrawal ...
Recognizing and evaluating hyperthyroidism in pregnancy is a diagnostic challenge. [58] Thyroid hormones are commonly elevated during the first trimester of pregnancy as the pregnancy hormone human chorionic gonadotropin (hCG) stimulates thyroid hormone production, in a condition known as gestational transient thyrotoxicosis. [8]
Menopause typically occurs between 44 and 58 years of age. [8] DNA testing is rarely carried out to confirm claims of maternity at advanced ages, but in one large study, among 12,549 African and Middle Eastern immigrant mothers, confirmed by DNA testing, only two mothers were found to be older than fifty; the oldest mother being 52.1 years at conception (and the youngest mother 10.7 years old).
They recommend levothyroxine as the preferred treatment. Some practitioners refuse to use desiccated thyroid. [9] Each 64.8 mg (one grain) of thyroid extract contains approximately 38 μg and 9 μg of measurable levothyroxine (T4) and liothyronine (T3), respectively. [1] Arguments against desiccated thyroid include:
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