Hyperthyroid/Hypothyroid and associated tests

Can someone knowledgeable about this please share how these two states affect women during pregnancy and what testing is required. more  

Well explained, Dr. Arpan. more  
Thyroid Problems during Pregnancy:

Hypothyroidism during Pregnancy: Hypothyroidism is more common during pregnancy as compared to hyperthyroidism. If untreated, it can result in goiter in the fetus and even malformations. However, if it is detected at the right time, the condition can be easily treated with thyroid hormone tablets, thus preventing any adverse consequences.

Hyperthyroidism during Pregnancy: Hyperthyroidism can also have serious consequences on the mother as well as the baby if it is untreated. In pregnancy, a drug calle propylthiouracil is preferred for its treatment.

Unfortunately, there is no consensus whether thyroid function should be carried out in all pregnant women. However, it is definitely recommended for women who are at a higher risk for developing thyroid disease, which includes all women over the age of 30 years. Tests used to detect thyroid dysfunction in pregnancy are:

TSH: Measurement of TSH levels is a common test done for screening thyroid disease in pregnancy. A high level indicates hypothyroidism, while a low level indicates hyperthyroidism. It should however be remembered that both the upper and lower limits of TSH are lesser during pregnancy as compared to the non-pregnant state. The levels also vary according to the trimester.

Other tests are usually done if the TSH levels are abnormal. These include:

Free T4 Levels: The T4 hormone is present in two forms, the free form and bound to protein. Since the protein levels in the blood increase during pregnancy, the total amount of the T4 hormone is higher. It is therefore necessary to measure the free T4 level, which gives a more accurate picture of the thyroid status during pregnancy.

Thyroid Antibodies: The presence of thyroid peroxidase antibodies along with slightly high TSH levels and normal free T4 levels can result in complications like miscarriage. These cases therefore should be treated with thyroid hormone.

Free T3 Levels: The level of this hormone is also altered in hyper and hypothyroidism, though this test is not commonly done in pregnant patients.

Reference:

1. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum

Regards
Dr Arpan Gandhi more  
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