Thyroid disease is the second most important endocrine disorder affecting pregnant women after diabetes.
Physiological changes seen during pregnancy can also mimic thyroid disease. Pregnancy may cause changes in the clinical
status of the disease, and pregnancy may also affect thyroid function tests.
Is there any importance of dietary iodine during pregnancy?
Dietary iodine intake during pregnancy normal thyroid function. In a woman with iodine deficiency, changes occur that cause permanent thyroid stimulation and eventually the development of goiter. When iodine supplementation is given in the range of 200 to 300 mcg per day (WHO recommendation), many of these changes are improved.
There is definitive evidence that hypothyroxinemia due to severe iodine deficiency has harmful effects on the fetus. available. Goiter formation, mental retardation, and neurological abnormalities may occur in the fetus (cretinism). Therefore, iodine deficiency must be prevented.
Pregnancy and Hypothyroidism:
It is seen in 0.1-2.5% of pregnancies. Symptoms of hypothyroidism can often be masked due to the increase in
metabolism during pregnancy. Findings such as constipation, hoarseness, hair loss, easy breaking of nails, dry skin and goiter may be observed.
Hypothyroidism during pregnancy:
p>Significant hypothyroidism or; It may appear as subclinical hypothyroidism.
• Subclinical hypothyroidism: It is a condition in which the TSH value is high and free thyroid hormones are normal.
• However, in cases where TSH > 10 mIU/L, even if fT4 is within the normal range, the patient has Marked Hypothyroidism< br />.
What are the complications that may occur in pregnant women diagnosed with hypothyroidism?
• Preeclampsia and gestational hypertension
• Placental complications
• Fetal cardiac complications
• Birth before 32 weeks (very early birth) and preterm birth
• Low birth weight
• Increased frequency of cesarean section
• Increased perinatal morbidity and mortality
• Neuropsychiatric and cognitive dysfunctions
Pregnancy and Hyperthyroidism:
The incidence is 0.05-0.2% and the reasons are;
• Graves' Disease(85-90)
• Toxic multinodular goiter
• Toxic adenoma
• Thyroiditis
• Transient subclinical hyperthyroidism
• Hyperemesis gravidarum
• Trophoblastic hyperthyroidism (hydaditiform mole and choriocarcinoma). Although pregnant women may have hyperthyroidism for various reasons, Graves' Disease is the most common cause.
What are the complications that may be seen in pregnant women with hyperthyroidism?
• Stillbirth - miscarriage
• Premature birth
• Low birth weight
• Preeclampsia
• Heart failure
• Thyroid storm
What are the symptoms that may be seen in pregnant women diagnosed with hyperthyroidism?
• Irritability< br /> • Tremors
• Palpitations
• Increased sweating
• Heat intolerance
• Weight loss or inability to gain weight
• Insomnia
• Defecation increase in the number
• Goiter
For Which Pregnant Women Routine Screening is Recommended?
• Any history of thyroid disease
• Family history of thyroid disease
• Goiter on examination Presence or laboratory findings suggestive of hypo-hyperthyroidism
• Presence of autoimmune disease
• History of miscarriage or premature birth
• Routine screening is recommended for pregnant women with a history of radiation exposure.
Pregnancy and Thyroid Cancer
The most common thyroid cancer among young women is papillary cancer, and in 10% of these cancers, patients are pregnant or in the postpartum period at the time of diagnosis. Although the incidence of thyroid papillary cancer is high among pregnant women, the first diagnosis is usually made in the postpartum period. Diagnosis and management of thyroid cancer during pregnancy pose serious risks to both the patient and the fetus. The fact that the thyroid gland can generally secrete more hormones in the early stages of pregnancy
may be responsible not only for hormone secretion but also for the increase in the
differentiated thyroid cancer rate during pregnancy. In this process, treatment of thyroid cancer includes
surgical treatment, use of levotrix and follow-up until birth.
If a malignant thyroid nodule is detected in the pregnant woman in the first or early second trimester. Pregnancy
is not terminated, but surgery is recommended in the second trimester. When papillary thyroid cancer or follicular neoplasm, which is thought to have a good prognosis, is detected, the postpartum period can be waited for surgery.
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