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As thyroxine is essential for fetal neurodevelopment it is critical that maternal delivery of thyroxine to the fetus is ensured early in gestation. [5] In pregnancy, iodide losses through the urine and the feto-placental unit contribute to a state of relative iodine deficiency. [6] Thus, pregnant women require additional iodine intake.
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]
Levothyroxine is taken on an empty stomach about half an hour to an hour before meals. [21] As such, thyroid replacement therapy is usually taken 30 minutes prior to eating in the morning. [ 14 ] For patients with trouble taking levothyroxine in the morning, bedtime dosing is effective, as well. [ 14 ]
For patients taking levothyroxine, TSH may be boosted by discontinuing levothyroxine for 3–6 weeks. [5] 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 ...
Progesterone causes many changes to the genitourinary system. A pregnant woman may experience an increase in the size of the kidneys and ureter due to the increase blood volume and vasculature. Later in pregnancy, the woman might develop physiological hydronephrosis and hydroureter, which are normal. [33]
The thyroid hormones act on nearly every cell in the body. It acts to increase the basal metabolic rate, affect protein synthesis, help regulate long bone growth (synergy with growth hormone) and neural maturation, and increase the body's sensitivity to catecholamines (such as adrenaline) by permissiveness. [12]
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During pregnancy, the thyroid gland must produce 50% more thyroid hormone to provide enough thyroid hormone for the developing fetus and the expectant mother. [28] In pregnancy, free thyroxine levels may be lower than anticipated due to increased binding to thyroid binding globulin and decreased binding to albumin.