Thyroid disorders in pregnancy
Journal Title: Medpulse International Journal of Medicine - Year 2019, Vol 9, Issue 2
Abstract
Background: Pregnancy is an important milestone in the life of every female. Thyroid disorders are observed 4 to 5 fold more frequently in women and often during the child bearing period. In patients with thyroid dysfunction prior and during pregnancy, maintenance of hormone levels to physiological levels is essential for good maternal and foetal outcome. Aims and Objectives: The present study was undertaken to monitor Patients on treatment for thyroid disorders till term and evaluation of maternal and foetal outcome. Methodology: It was prospective observational study conducted over 1 year. 40 patients were included who were pregnant and have deranged thyroid function test. They were further divided into 2 groups as hypothyroidism with pregnancy (28 patients with TSH>4mlU/l) and hyperthyroidism with pregnancy(12 patients with TSH<0.5mlU/l and FT4> 0.7ng/dl). These patients one diagnosed were started on appropriate medication and followed up every 6 weekly with Thyroid function test till they deliver and 7 days post-partum. Primary end point was to achieve and maintain Thyroid profile in a pregnancy suitable range and the secondary end point was to assess the maternal and foetal outcome at the end of pregnancy. Results: Out of 28 patients in hypothyroid group only 27 patients had received treatment as 1 patient came in labour directly. Only 4 out of 27 patients were maintained on 50mcg of thyroxine supplement till term, rest all 23 required escalation in doses such as up to 150 mcg of thyroxine in 5 patients, 100mcg of thyroxine in 15 patients and 75 mcg of thyroxine in 3 patients. The adequate TSH response was seen in 7 patients (TSH<2.5) and intermediate response was seen in 9 patients (TSH 1.5 to 4.5) and unsatisfactory response was seen in 12 patients (TSH>4.5) owing to their poor follow up. Out of 12 hyperthyroid patients only 3 were started on treatment in 1st trimester, 2 patients were started in 2nd trimester and 7 patients were started on treatment in 3rd trimester. Incidence of maternal and foetal complications were high in hyperthyroid group as compare to hypothyroid group. Discussion: In spite of giving treatment and optimization of doses of drugs in hyperthyroidism, their were significantly high number of complications as compare to hypothyroidism group. In hypothyroidism group good follow up leads to adequate control of TSH levels owing to lesser complications. Conclusion: Profound alterations occur in thyroid function during pregnancy. Exact interpretation of these alterations as depicted by laboratory reports is very important for timely diagnosis of hypo or hyperthyroidism during pregnancy and should be treated accordingly.
Authors and Affiliations
Namita Padwal, Sonal Honrao, Sachin Patil
Keywords
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- EP ID EP516495
- DOI 10.26611/10219215
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