August is the month of raising awareness about 'thyroidism during pregnancy'. Significant changes occur in the thyroid gland, which vary depending on the periods during and after pregnancy.
The need for iodine increases in a pregnant woman. In areas with iodine deficiency (IE), both the mother's thyroid and the unborn baby are affected. A decrease in T4 level causes an increase in TSH. Normally, thyroid volume increases by around 20-30 percent in pregnant women. In case of IE, the goiter promoting effect will be greater due to the decrease in T4. The ideal dietary iodine content during pregnancy is recommended as 200-250 mcg. Therefore, in our country, which is a region with moderate to mild IE, iodine support should be given to pregnant women with either preparations containing only iodine or folic acid combinations.
Free T3 (ST3) to evaluate thyroid functions during pregnancy. , free T4 (ST4), Total T4 (TT4) and TSH should be measured. The upper limit of TT4 should be considered 1.5 times normal. Along with adequate iodine intake in pregnant women, ST4 values should be kept within the upper limits of the relevant trimesters. The target TSH value during pregnancy should be 2.5 mIU/L in the first three months and 3 mIU/L below the upper reference values in the following months. If these figures are exceeded despite adequate iodine intake, it means that the pregnant woman needs thyroid hormone.
Hypothyroidism: It means insufficiency in thyroid hormones. ST3 and ST4 are decreased and TSH is below normal. In women, it causes menstrual irregularities, excessive bleeding, breast milk discharge and increased hair growth. Although pregnancy can occur in mild hypothyroidism, it causes stillbirth, miscarriage and premature birth. If hypothyroidism is severe, pregnancy will not occur. The frequency of hypertension increases in hypothyroid pregnant women. It negatively affects the baby's intelligence development. Due to these negativities, a woman with hypothyroidism needs to be treated before pregnancy. When pregnancy is decided, TSH levels to be measured immediately after the end of menstruation should be between 0.5-2.5 mIU/L.
Hyperthyroidism: It is the excess of hormones of the thyroid gland. ST3 and ST4 are increased and TSH is below normal. If a woman of childbearing age with hyperthyroidism plans a pregnancy, the disease should be treated first and then the pregnancy should be planned. Extreme fatigue, weakness, palpitations, anxiety during pregnancy Shivering, heat intolerance, tremors, excessive irritability, and inability to gain the required weight every month despite having a good appetite should suggest hyperthyroidism. Sometimes it may be accompanied by enlargement of the eyes. Pregnant women diagnosed with hyperthyroidism should not take iodine supplements and should not use iodized salt.
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