Thyroid Dysfunction during Pregnancy

Maternal Hypothyroidism is known to have adverse effects on the fetus, so it should be avoided. If the diagnosis is made before pregnancy, preconception dose adjustment of levothyroxine [medication for hypothyroidism] to reach before pregnancy to a TSH (thyroid blood test] level not higher than 2.5 mIU/liter is recommended. All women taking levothyroxine should be counseled that they have to contact a physician if pregnancy is suspected or if they have a missed menstrual period, to check their TSH level.

Diagnosis:

As the dose requirements of levothyroxine increase during pregnancy, if the diagnosis of hypothyroidism is made during pregnancy, levothyroxine dose adjustment should be made, and the thyroid function tests should be normalized to the trimester specific ranges. Thyroid function tests should be again checked every 4-6 weeks. Most of the hypothyroid women need to decrease the levothyroxine dose to the pre-pregnancy dose after delivery.

Vitamin D deficiency:

Vitamin D deficiency is common in all age groups. Muscle weakness is a prominent feature. 25-hydroxy vitamin D level is a blood test to evaluate vitamin D status in patients who are at risk for vitamin D deficiency. Vitamin D deficiency is defined as a 25 [OH] D value below 20 ng/ml on the blood test. The major source of vitamin D is exposure to natural sunlight and inadequate exposure to sunlight is a major cause of deficiency. Few foods naturally contain or are fortified with vitamin D. Vitamin D treatment is given to achieve a blood level of 25[OH] D above 30 ng/ml[physician follow up]. Vitamin D deficiency can be treated with vitamin D2 or vitamin D3 [medications] to maximize bone health and muscle function.

 

 

Dr. M. Anuritha,

Endocrinologist, Apollo Health City, Hyderabad