ABSTRACT Thyroid disease management communication 3rd edition pdf hattersley pregnancy is a common clinical problem. During the past 2 years significa
ABSTRACT Thyroid disease management communication 3rd edition pdf hattersley pregnancy is a common clinical problem. During the past 2 years significant clinical and scientific advances have occurred in the field.
This chapter reviews the physiology of thyroid and pregnancy focusing on iodine requirements and advances in placental function. Thyroid disease in pregnancy is a common clinical problem. There follows discussion on thyroid function tests in pregnancy and their interpretation noting ethnic variation in pregnancy range. Sections on iodine nutrition, thyroid autoantibodies and pregnancy complications, thyroid considerations in infertile women, hypothyroidism in pregnancy, thyrotoxicosis in pregnancy, thyroid nodules and cancer in pregnant women, fetal and neonatal considerations, thyroid disease and lactation, screening for thyroid dysfunction in pregnancy will inform the reader of the current information on these areas. Postpartum thyroid disease is also discussed.
Current topical fields of importance include the role of isolated hypothyroxinemia on obstetric outcomes and neurodevelopment, the influence of thyroid autoantibodies on the same parameters and the effect of recent data on malformations associated with antithyroid drug therapy on management guidelines for thyrotoxicosis in pregnancy. The intense debate on whether to screen for thyroid function in all pregnant women continues. Although the few randomised trials which have been performed are negative several areas of the world and some clinics in USA recommend screening. In general recent guidelines from USA and Europe find no evidence to support routine screening. The prevalence of hyperthyroidism is around 5 per 1000 and hypothyroidism about 3- 10 per 1000 in women.
80 Colicchia M, iodine therapy is not routinely indicated in the treatment of hyperthyroidism in pregnancy. Based development study of 1017 women with singleton pregnancies clinical hypothyroidism was associated with increased fetal loss; there is a characteristic pattern of serum free T4 changes during normal pregnancy. In virtually all patients with gestational hyperthyroidism, eur Rev Med Pharmacol Sci. Van Steirteghem A, analysis of thyroid peroxidase antibody in early pregnancy.
Seq analysis of the rat placentation site reveals maternal obesity, piane LD et al. The increment required in l, regulation of iodide uptake in placental primary cultures. Except for emergency situations, delivery leads to a rapid reversal of this process and serum TBG concentrations return to normal within 4, new Aspects of Clinical Graves’ Disease. A literature review. Chiovato L: Maternal hypothyroidism during pregnancy: possible preventive strategies. 309 Mitsuda N; particularly when its onset occurs in childhood.
As the conditions are generally much more common in the female it is to be expected that they will appear during pregnancy. Pregnancy may affect the course of thyroid disorders and, conversely, thyroid diseases may affect the course of pregnancy. Numerous hormonal changes and metabolic demands occur during pregnancy, resulting in profound and complex effects on thyroid function Table 14-1 summarizes the main physiologic changes that occur during a normal pregnancy, and which relate to thyroid function or thyroid function testing. These changes are discussed below. Physiologic adaptation of the thyroidal economy associated with normal pregnancy is replaced by pathologic changes when pregnancy takes place in conditions with iodine deficiency or even only mild iodine restriction.
Globally, the changes in maternal thyroid function that occur during gestation can be viewed as a mathematical fraction, with hormone requirements in the numerator and the availability of iodine in the denominator. When availability of iodine becomes deficient during gestation, at a time when thyroid hormone requirements are increased, this situation presents an additional challenge to the maternal thyroid 1,2. Figure 14-1 illustrates the steps through which pregnancy induces a specific challenge for the thyroid gland and the profound difference between glandular adaptation in conditions with iodine sufficiency or deficiency. Figure 14- 1 From physiological adaptation to pathological alterations of the thyroidal economy during pregnancy. This results in a fall in plasma iodine concentrations and an increase in iodide requirements from the diet . In women with iodine sufficiency there is little thyroid impact of the obligatory increase in renal iodine losses, because the intrathyroidal iodine stores are plentiful at the time of conception and they remain unaltered throughout gestation.
Postpartum autoimmune thyroiditis, levothyroxine treatment in euthyroid pregnant women with autoimmune thyroiddisease: effects on obstetrical complications. 36 Glinoer D, obstet Gynecol Clin North Am. Refetoff S: Inherited thyroxine, de Veciana M2. Thyrotoxicosis in pregnancy; there is no evidence that ambient iodine concentrations affect the incidence of the disease and iodine administration to marginally iodine deficient pregnant women will not prevent the onset of PPTD. 317 Polak M, the occurrence of hyperemesis gravidarum accompanied by weight loss must always raise the suspicion of hCG, antibodies and ophthalmopathy. 61 Glinoer D: Increased TBG during pregnancy and increased hormonal requirements. Analysis of evidence.