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Thyroid hormone requirements increase during and last throughout pregnancy. [14] As such, pregnant women are recommended to increase to nine doses of levothyroxine each week, rather than the usual seven, as soon as their pregnancy is confirmed. [14] Repeat thyroid function tests should be done five weeks after the dosage is increased. [14]
Blood free thyroxine and TSH levels are monitored to help determine whether the dose is adequate. This is done 4–8 weeks after the start of treatment or a change in levothyroxine dose. Once the adequate replacement dose has been established, the tests can be repeated after 6 and then 12 months, unless there is a change in symptoms. [8]
Hypothyroidism is common in pregnancy with an estimated prevalence of 2-3% and 0.3-0.5% for subclinical and overt hypothyroidism respectively. [8] Endemic iodine deficiency accounts for most hypothyroidism in pregnant women worldwide while chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world.
When pregnant, a woman with a low-functioning thyroid will also need to increase her dosage of thyroid hormone. [16] One exception is that thyroid hormones may aggravate heart conditions, especially in older patients; therefore, doctors may start these patients on a lower dose and work up to a larger one to avoid risk of heart attack. [17]
Drug titration is the process of adjusting the dose of a medication for the maximum benefit without adverse effects. [ 1 ] When a drug has a narrow therapeutic index , titration is especially important, because the range between the dose at which a drug is effective and the dose at which side effects occur is small. [ 2 ]
Thyroid disease is a medical condition that affects the structure and/or function of the thyroid gland.The thyroid gland is located at the front of the neck and produces thyroid hormones [1] that travel through the blood to help regulate many other organs, meaning that it is an endocrine organ.