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Managing Thyroid Disease During Pregnancy

The effects of pregnancy on the thyroid gland are profound. The gland is required to produce a 50% increase in thyroxine (T4) and triiodothyronine (T3). While a healthy thyroid should respond well to pregnancy, women with limited thyroidal reserve or iodine deficiency who become pregnant can develop hypothyroidism. “Women in high-risk groups need to be tested as early as possible for hypothyroidism during the first trimester.” Knowledge about the interaction between the thyroid gland and pregnancy has exploded over that last 15 to 20 years. In response to the emerging data, the American Thyroid Association (ATA) recently created clinical guidelines on the diagnosis and treatment of thyroid disease during pregnancy and postpartum. They were published in the October 2011 issue of Thyroid. Pregnancies At-Risk for Thyroid Disease According to the ATA guidelines, about 10% of pregnant women are thyroid peroxidase (TPO)-antibody positive but have normal thyroid function. These women have a two- to four-fold increased risk of miscarriage when compared with women who don’t have the antibody. Among women without the antibody but with slightly elevated thyrotropin (TSH) levels, the risk of miscarriage is increased by 60% when compared with women without hypothyroidism. Women with either the TPO antibody or mild hypothyroidism are also at risk for preterm delivery. The 10% of all women who are TPO-antibody positive have a 50% chance of developing postpartum thyroiditis. Thyroid Screening Recommendations Women in high-risk groups need to be tested as early as possible for hypothyroidism during the first trimester, according to the ATA guidelines. These groups include (but are not limited to) women: With a history of thyroid dysfunction or prior thyroid...
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