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TSH
Normal or
decrease
Normal
Normal
Free T4
Normal
Normal
Normal
Free T3
Normal
Normal
Normal
Total T4
High
High
High
Total T3
High
High
High
Postpartum
Hyperthyroidism
Hypothyroidism (TSH)
Thyr Antibodies [antiTPO]
PPTD
PP depression
PP Graves
0.24%
2-2.5%
10%
5-9%
30% [ vs 20%]
up to 40% of Graves
Number of reports
Number of pregnancies
Total number of pregnancies
Fetal death and stillbirth
Fetal and neonatal abnormality
11(1954-1983)
3 - 41
249
14 (5.6%)
15 (5%)
MATERNAL
Miscarriage
Placenta abruptio
Preterm delivery
Congestive Ht failure
Thyroid Storm
Pre-eclampsia
FETAL
Hyperthyroidism
Neonatal
hyperthyroidism
Prematurity
IUGR
Fetal death /stillbirth
Fetal abnormalities
Still suppressed
Normalizes
Hyperemesis Gravidarum
Confirm diagnosis
Generally safe
Take ATD dose just after breast-feeding
From AMINO
On T4 prior to gestation
Epidemiology
Prevalence :
Overt Hypothyroid (OH) : 0.3 % 0.5 %
TSH >10 and Free T4: Low
in Bangladesh)
Clinical features :
Usually not very prominent symptoms
May have wt gain, cold intolerance, lethargy,
constipation, edema etc.
Asymptomatic
Lab Investigations
Free T4
TSH
Antithyroid antibody : TPO (Thyroid peroxidase)
TG (Thyroglobulin)
Total T4 and T3 level is increased (~ 1.5 folds) due to
increased TBG. TBG is increased about 2 folds.
No change in Free T4 or FT3
Still controversial .
Trimester specific reference ranges1 of FT4 and TSH is
coming up.
TSH is Lowest in first trimester , highest in third trimester and
In between in the second trimester
Normal Ref. Range is 0.4 mIU/liter 4.0 mIU/liter
Evidence :
Repercussion of Hypothyroid: Maternal aspect
Infertility
Abortion
Anemia
Hypertension (Gestational)
Placental abruption
PPH
Therapeutic Aspects :
Levothyroxin
30 % - 50 % above preconception dose
Non Pregnant 1.7 2.0 g/kg/day, increased upto
2.0 -2.4 g/kg/day
New onset hypothyroid should be initiated with higher dose
100 150 g per day or titrate according to B.W.
Whom to screen ?
Universal screening not yet recommended except by AACE.
High risk subjects should be screened :
- H/O thyroid disease
- F/H of thyroid disorders
- Known case of TAI ( Antibody +)
-Other autoimmune disease
- High degree of suspicion
- Bad obstetric history
- Obese or Rapidly gaining weight
Recommendations:
Both OH and SCH should be treated
Treatment is very safe and Effective. Drug interaction
with Calcium and Ferrous Sulfate ( absorption)
Usually life long
New onset SCH subjects may be re-evaluated after
stopping the drug for 6 wks.
Neonatal screening
Procedure of screening
Period of
screen-ing
No. of
babies
screen-ed
No. of
positive
babies
No. of
babies
detected
Incidence of
CH
19992008
98314
1094
38
1:2587
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