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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.
Radioactive iodine (iodine-131) alone can potentially worsen thyrotoxicosis in the first few days after treatment. One side effect of treatment is an initial period of a few days of increased hyperthyroid symptoms. This occurs because when the radioactive iodine destroys the thyroid cells, they can release thyroid hormone into the blood stream.
The absolute indications are a large goiter (especially when compressing the trachea), suspicious nodules or suspected cancer (to pathologically examine the thyroid), and people with ophthalmopathy and additionally if it is the person's preferred method of treatment or if refusing to undergo radioactive iodine treatment. Pregnancy is advised to ...
Subclinical hyperthyroidism in pregnancy is associated with an increased risk of pre-eclampsia, low birth weight, miscarriage and preterm birth. [50] Propylthiouracil is the preferred treatment of hyperthyroidism (both overt and subclinical) in the first trimester of pregnancy as it is associated with less birth defects than methimazole. [50]
Thyroid scintigraphy, in which the thyroid is imaged with the aid of radioactive iodine (usually iodine-123, which does not harm thyroid cells, or rarely, iodine-131), [31] is performed in the nuclear medicine department of a hospital or clinic. Radioiodine collects in the thyroid gland before being excreted in the urine.
It is recommended that breastfeeding be stopped at least six weeks before radioactive iodine treatment and that it not be resumed, although it can be done in future pregnancies. It also shouldn't be done during pregnancy, and pregnancy should be put off until at least 6–12 months after treatment. [49] [50]
Molar pregnancy: Trauma (i.e. hip fracture) Burns Myocardial infarction: Pulmonary embolism: Stroke: Heart failure: Radioactive iodine treatment Medication side effect (anesthetics, salicylate, pseudoephedrine, amiodarone) Exposure to iodinated contrast: Withdrawal of antithyroid treatment Emotional stress Intense exercise
While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality. [1] [2] [3] Common complications of pregnancy include anemia, gestational diabetes, infections, gestational hypertension and pre-eclampsia.