|
||||||||
 |
Send to a Colleague |
|
Doctor Profile |
Polycystic ovary syndrome (PCOS) is seen in 6-10% of women of reproductive age.
Approximately 7% of all pregnancies are complicated by gestational diabetes mellitus (GDM).
U.S. prevalence rates of GDM are higher in African-American, Hispanic, Native American and Asian women.
Skin cancer rates have doubled in people under 40 in the U.S. in just the past 10 years.
During pregnancy, there is an approximate doubling in thyroid binding globulin (TBG) and a 30-40% increase in plasma volume.
The pregnant woman is the sole source of thyroid hormone to the fetus until approximately 13 weeks gestation.
Primary hypothyroidism occurs in 3-10% of women.
Excluding pregnancy, hyperprolactinemia accounts for approximately 10-20% of cases of amenorrhea.
Thyroid Disease and Pregnancy
During pregnancy, there are several changes in a woman?s thyroid physiology. There is an approximate doubling in thyroid binding globulin (TBG) due to increases in estradiol concentrations; in addition, there is a 30-40% increase in plasma volume. The result of these changes is a significant increase in total thyroxine pool, especially in the first trimester. As a result, the TSH may briefly be low in the late first trimester in normal pregnancies, but for the remainder of the pregnancy, TSH stays in normal range, despite an estimated 30-50% increase in levothyroxine requirement. The pregnant woman is the sole source of thyroid hormone to the fetus until approximately 13 weeks gestation, when the fetal thyroid has developed. Pregnancy mimics thyroid disease. The diagnosis is often overlooked because there is significant overlap in symptoms: weight changes, heat intolerance, increased fatigue, change in bowel habits, and skin changes.
Hyperthyroidism
True hyperthyroidism complicates only 0.2% of all pregnancies. Although hyperthyroidism from any cause can complicate pregnancy, Graves? hyperthyroidism is the most common cause. This condition is associated with an increased risk of premature delivery. The diagnosis of hyperthyroidism in pregnant women should be based primarily on a serum TSH value <0.01 mU/L and also a high serum free T4 value. The treatment of hyperthyroidism is made difficult by pregnancy. It is often not possible to determine the cause of the hyperthyroidism during pregnancy, because radioiodine administration is contraindicated. As a result, most patients with symptoms severe enough to warrant treatment are given anti-thyroid medications throughout pregnancy and while nursing. The medication of choice in pregnancy is propylthiouracil, and it is generally used in relatively low doses with the goal of maintaining free T4 in the mildly hyperthyroid range. One of the dangers of inappropriate management of hyperthyroidism in pregnancy is often related to overtreatment, which results in maternal and fetal hypothyroidism. This comes with a separate set of risks, as discussed below.
Hyperthyroidism
Primary hypothyroidism occurs in 3-10% of women, often around childbearing years. 1-2% of all pregnant women receive levothyroxine therapy for hypothyroidism. Overt hypothyroidism is an unusual complication of pregnancy, mostly because most women with hypothyroidism are often anovulatory, and there is an increased risk of first-trimester miscarriage.