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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.
During pregnancy, immunologic suppression occurs which induces tolerance to the presence of the fetus. [5] Without this suppression, the fetus would be rejected causing miscarriage. [ 5 ] As a result, following delivery, the immune system rebounds causing levels of thyroids antibodies to rise in susceptible women.
An anti-NTIS phenotype is observed in some circumstances, wherein TSH, T3, and T4 are generally elevated rather than suppressed. This can occur during pregnancy, obesity, cold adaptation, stay in high altitudes, endurance exercise, acute psychosis, and post-traumatic stress disorder. [2] [12]
Symptoms of normal pregnancy, like fatigue, can make it easy to overlook thyroid problems in pregnancy. [1] Thyroid hormone is vital during pregnancy. The unborn baby's brain and nervous system need thyroid hormone to develop. During the first trimester, the baby depends on the mother's supply of thyroid hormone. At 10 to 12 weeks of pregnancy ...
[8] [60] [59] [61] Nonetheless, high maternal FT4 levels during pregnancy have been associated with impaired brain developmental outcomes of the offspring and this was independent of hCG levels. [62] Propylthiouracil is the preferred antithyroid medication in the 1st trimester of pregnancy as it is less teratogenic than methimazole. [8]
Successful pregnancy outcomes are improved when hypothyroidism is treated. [129] Levothyroxine treatment may be considered at lower TSH levels in pregnancy than in standard treatment. [15] Liothyronine does not cross the fetal blood-brain barrier, so liothyronine (T 3) only or liothyronine + levothyroxine (T 3 + T 4) therapy is not indicated in ...