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Thyroid function should be normalised prior to conception in women with pre-existing thyroid disease. Once pregnancy is confirmed the thyroxine dose should be increased by about 30-50% and subsequent titrations should be guided by thyroid function tests (FT4 and TSH) that should be monitored 4-6 weekly until euthyroidism is achieved.
[8] [60] [59] [61] Nonetheless, high maternal FT4 levels during pregnancy have been associated with impaired brain developmental outcomes of the offspring and this was independent of hCG levels. [62] Propylthiouracil is the preferred antithyroid medication in the 1st trimester of pregnancy as it is less teratogenic than methimazole. [8]
During pregnancy, immunologic suppression occurs which induces tolerance to the presence of the fetus. [5] Without this suppression, the fetus would be rejected causing miscarriage. [ 5 ] As a result, following delivery, the immune system rebounds causing levels of thyroids antibodies to rise in susceptible women.
Human chorionic gonadotropin is a glycoprotein composed of 237 amino acids with a molecular mass of 36.7 kDa, approximately 14.5kDa αhCG and 22.2kDa βhCG. [4]It is heterodimeric, with an α (alpha) subunit identical to that of luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), and a β (beta) subunit that is unique to hCG.
High follicle-stimulating hormone levels and low estradiol might indicate menopause, but of course, if you’re younger than typical menopause age, you should also rule out pregnancy with a ...
During pregnancy, there is also an increase in estrogen which causes the mother to produce more thyroxine binding globulin, which is what carries most of the thyroid hormone in the blood. [24] 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 ...
During pregnancy the plasma volume increases by 40-50% and the red blood cell volume increases only by 20–30%. [22] These changes occur mostly in the second trimester and prior to 32 weeks gestation. [24] Due to dilution, the net result is a decrease in hematocrit or hemoglobin, which are measures of red blood cell concentration.
Thyroid disease also has a marked effect on BMR, since thyroid hormones regulate the rate of cellular metabolism. [3] Hyperthyroidism —in which there is an increase in the production of thyroid hormones—leads to a high BMR, while hypothyroidism —in which thyroid hormones are depleted—causes a low BMR.
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