Best Home Remedy to Cure Hypothyroidism

The Hypothyroidism Revolution

During Phase 1 of the Hypothyroidism Revolution Program, the magic begins to happen as you begin to notice many positive changes occurring. You will begin your progressive transition towards the ideal thyroid healing diet that will give your thyroid the big boost that it needs to help your cells produce more than enough energy for you. By the end of Phase 1, your energy levels will be rapidly on the rise and you will feel amazingly satisfied with zero food cravings. You will feel in control again as your mood drastically improves and any sign of depression and anxiety begin to disappear. Your family and friends are going to notice some major positive changes in you. You will also begin to experience many of the outer changes that come with improved thyroid function. Youre skin will begin to clear up and glow while your hair and nails will begin to look healthy again. As you ease into the thyroid healing diet, you will progressively remove the foods that suppress your thyroid, disrupt your hormone pathways, cause digestive upset and irritation, and cause toxic byproducts that congest your liver. At the same time, you will be progressively adding the foods that will be supplying your cells with the right balance and combination of nutrients that they need to thrive and produce endless amounts of energy. More here...

The Hypothyroidism Revolution Summary

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2156 Hypothyroidism triiodothyronine T3 and thyroxine T4

Pregnant women with hypothyroidism have a higher risk of complications Glinoer 1997), and hypothyroidism during pregnancy can impair the mental development of the child. In particular in relation to iodine deficiency, this has been understood for a long time. According to a recent study on 60 hypothyroid women (whose disease was only diagnosed after 12 weeks of pregnancy), hypothyroidism impaired the mental and motor capacities of their children, who were tested at the age of 2 years compared to children of euthyroid or only discrete hypothyroid women during pregnancy (Pop 2003). Haddow (1999) draws similar conclusions from his study on 60 children aged 7-9 years. Their mothers only suffered from discrete hypothyroidism during pregnancy. Based on these results, hypofunction of the thyroid should be diagnosed and treated for the benefit of Lhe developing unborn child. Regarding the risk of neonatal hypothyroidism after maternal thyrostatic therapy during pregnancy, sec section 2.15.7....

Euthyroid chronic thyroiditis

Patients with Hashimoto's thyroiditis are at greater risk of developing hypothyroidism very early in pregnancy because of the increase demand in thyroid hormones if not properly managed they are at risk of developing the same complications as poorly treated hypothyroid mothers, mainly spontaneous abortions, preterm delivery, and pregnancy-induced hypertension (PIH). One recent study showed a significant decrease of miscarriages and preterm delivery in euthyroid chronic thyroiditis women treated with levo-thy-roxine in the first 10 weeks of gestation as compared to euthy-roid chronic thyroiditis mothers receiving no treatment and a control population.13 In the untreated women a significant number of them developed subclinical hypothyroidism. Therefore it appears reasonable to treat euthyroid and subclinical hypothyroidism mothers with levo-thyroxine before or very early in pregnancy to prevent the above complications.

Chronic autoimmune thyroiditis Hashimotos thyroiditis

Chronic autoimmune thyroid disease is more common in women with other autoimmune diseases, particularly Type 1 diabetes. The prevalence of positive TPO antibodies in women of childbearing age is between 3- and 5-fold higher in Type 1 diabetes.43 larger than the other, firm, rubbery consistency, and moving freely on swallowing. It is painless, although rapid growth of the gland may elicit some tenderness on palpation. Absence of goiter (atrophic thyroiditis) may be present in 30 of patients The importance of diagnosing chronic thyroiditis in women of childbearing age relates to the potential maternal and fetal complications. Women with chronic thyroiditis are at higher risk for spontaneous abortion, development of hypothyroidism for the first time in pregnancy, premature delivery and postpartum thyroiditis.44 Negro et al.13 recently studied a group of euthyroid women with chronic thyroiditis early in pregnancy. Of 984 pregnant women, 11.7 were TPO antibody positive. Fifty-seven of...

Hypothyroidism underactive thyroid

A woman with an underactive thyroid (hypothyroidism) can have a healthy pregnancy as long as her condition is adequately treated. If it's not, she stands a higher risk of developing certain complications, such as a low birth-weight baby. The condition is treated with a thyroid replacement hormone (Synthroid, for example). This medication is safe for the baby because very little of it crosses the placenta. If you have an underactive thyroid, your doctor may want to periodically check your hormone levels to see whether your medication needs to be adjusted.

Congenital Hypothyroidism

Hypothyroidism occurs when the thyroid, a butterfly-shaped gland located in the front of the neck, cannot produce enough thyroid hormones. These hormones control the rate at which many of the body's chemical functions (metabolism) take place. Thyroid hormones are necessary for bone growth and critically important for normal brain development in infants and young children. Congenital hypothyroidism meaning the child is born with an absent, underdeveloped, or inadequately functioning thy roid gland usually occurs in infants with no known family history of the condition. Approximately 1 in 3,000 infants born in this country have the disorder. Some (nearly 10 percent) of these infants have a hereditary disorder affecting the ability of the thyroid gland to produce hormones, but most are born with absent or underdeveloped thyroid glands. The developing thyroid gland of the fetus can be damaged or destroyed, resulting in congenital hypothy-roidism, if the mother herself is treated with...

Congenital Hypothyroidism In Infants

Facial Puffiness Hypothyroidism

Left, radiograph of the long bones of the lower extremity in a term infant with congenital hypothyroidism. Note the lack of the ossification centers. The distal femoral ossification center usually appears at 36 weeks gestational age and the proximal tibial ossification center usually appears at 38 weeks gestational age. Right, lateral radiograph of the neck of the same infant showing the presence of a large congenital goiter which caused severe respiratory distress. Figure 5.2. Left, radiograph of the long bones of the lower extremity in a term infant with congenital hypothyroidism. Note the lack of the ossification centers. The distal femoral ossification center usually appears at 36 weeks gestational age and the proximal tibial ossification center usually appears at 38 weeks gestational age. Right, lateral radiograph of the neck of the same infant showing the presence of a large congenital goiter which caused severe respiratory distress. Figure 5.3. This 5-week-old...

71 Hypothyroidism

Women may be diagnosed with hypothyroidism at any stage of pregnancy and should be treated promptly. In pregnancies complicated by hypothyroidism the TSH rises, indicating a rising demand for thyroxine. The usual increase in dose is 25-50 . If previous intrauterine growth restriction associated with hypothyroidism has occurred, then serial fetal growth scans are indicated

Antithyroid Drugs

Treatment is usually started at a high dose, which reduces fT4 and fT3 to normal in approximately four weeks. Propranolol, a non-selective beta-blocker, may be prescribed to relieve symptoms during this phase, but is not required long term. In order to avoid iatrogenic hypothyroidism it is necessary either to reduce the dose of CBZ or PTU to that required to keep the concentration of fT4 in the normal range (dose titration) or to continue with high dose CBZ or PTU in combination with L-thyroxine (block and replace). After treatment for 12-18 months with dose titration, or 6-12 months with block and replace, medication is stopped.

Hypothyroidism

The incidence of maternal hypothyroidism is between 0.19 and 2.5 .35 Subclinical hypothyroidism (normal FT4 and elevated TSH) is more often encountered than clinical hypothyroidism (low FT4 and elevated TSH). Mild elevations in serum TSH are frequently detected in hypothyroid women on thyroid replacement therapy soon after conception because of the increased demand for thyroid hormones in the first weeks of gestation.11 The two most common etiologies of primary hypothyroidism are autoimmune thyroiditis (Hashimoto's or chronic thyroiditis) and post-thyroid ablation therapy, surgical or 131I induced. As in the case of hyperthyroidism, the most common complication in hypothyroid pregnant women are PIH, prematurity and low birth weight. No significant complications were seen in those women achieving euthyroidism before 24 weeks' gestation.36-38 The impact of maternal hypothyroidism on the intellectual development of the offspring has been the subject of several studies.7,39 In the study...

Musculoskeletal Disorders

Musculoskeletal Ribs

This figure shows the growth arrest lines in the long bones of a term infant with severe intrauterine growth retardation. Note the lack of the distal femoral and proximal tibial ossification centers, normally appearing at 36 and 38 weeks respectively, also caused by growth retardation. Hypothyroidism is also a consideration. Figure 1.4. This figure shows the growth arrest lines in the long bones of a term infant with severe intrauterine growth retardation. Note the lack of the distal femoral and proximal tibial ossification centers, normally appearing at 36 and 38 weeks respectively, also caused by growth retardation. Hypothyroidism is also a consideration.

Vasomotor Instability Infant

Vasomotor Instability Infant

Cutis marmorata is a common finding in normal infants. This fine reticulated mottled appearance is due to vasomotor instability and thus is more commonly seen in premature infants, but should also alert one to the possibility of sepsis, hypothyroidism, and central nervous system pathology. Figure 1.20. Cutis marmorata is a common finding in normal infants. This fine reticulated mottled appearance is due to vasomotor instability and thus is more commonly seen in premature infants, but should also alert one to the possibility of sepsis, hypothyroidism, and central nervous system pathology.

Dilated Cardiomyopathy DCM

Progressive loss or damage of cardiac myocytes leads to chamber dilatation, cardiac enlargement and reduced systolic function. This leads to venous stasis in the lungs, pulmonary oedema, breathlessness, and eventually reduced cardiac output becoming left heart failure. Right heart failure can also follow, with fluid accumulation in the soft tissues, ankle leg oedema, liver enlargement and ascites (abdominal fluid). The cause can be genetic in 25-30 of cases, with both autosomal dominant and recessive types. It can follow viral myocarditis, and be associated with other muscle diseases, collagen disorders, metabolic disorders, chemotherapy4, autoimmune disease (Chapter 11), haemoglobinopathies, hypothyroidism and hyperthyroidism2.

Autoimmune gestational diabetes as a clinical entity

Autoimmune destruction of the beta cells is determined by multiple genetic susceptibility and modulated by undefined environmental factors. The autoimmune response may be detected for months or years before the clinical onset. Patients with Type 1 diabetes have an increased risk of other autoimmune disorders, including Graves disease, thyroiditis, Addison disease, celiac disease, and pernicious anemia. A minority of patients with Type 1 diabetes have no known

13 The Differential Diagnosis

In addition, organic causes such as thyroid dysfunction must be ruled out. Approximately 5 of all postpartum women (11) and 50 of the 10 of women who have thyroid peroxidase antibodies during early gestation develop thyroid dysfunction during the first 9 mo after delivery (12,13). One-third of these women will develop permanent hypothyroidism (14), and findings from several studies suggest that women who are thyroid peroxidase antibody-positive during early gestation are at increased risk of PPD regardless of postpartum thyroid function (15-18).

Preconception Issues And Care

Women with hypothyroidism may have anovulation and may present with infertility. Pregnancy induced hypertension - this is 2-3 times as common in overt or subclinical hypothyroidism Reduced psychomotor development - associated with hypothyroidism in early pregnancy Lower IQ in children at age eight years - associated with untreated maternal hypothyroidism fetal thyroid starts to produce hormones at 10-12 weeks and early fetal brain development depends on small amounts of maternal thyroid hormone that cross the placenta3 Women who are known to have hypothyroidism should be informed of the above issues, but can be reassured that adequate treatment with thyroxine will reduce the risks to a minimum. They should be reminded to take their thyroxine regularly throughout the pregnancy. Women with recently-diagnosed hypothyroidism should be advised to delay conceiving until their TSH is restored to a normal level. Women with subclinical hypothyroidism, who are contemplating pregnancy, should be...

Primary adrenal insufficiency in pregnancy

Isolated autoimmune adrenalitis is the most common cause of primary AI in developed countries. Although the glands are small in autoimmune primary adrenal disease, they are large in tuberculous or fungal infection, bilateral metastases, hemorrhage, or infarction. Less common causes of AI, autoimmune polyglandular syndrome type 2 (APS-2) and Schmidt's syndrome (primary autoimmune hypoadrenalism, type 1 diabetes mellitus, thyroid autoimmune disease), were reported in at least seven pregnancies 27 . In APS-2, the appropriate management of hypothyroidism and diabetes during gestation poses a particular challenge beyond that of isolated hy-poadrenalism 27 .

Newborn Screening for Hereditary and Metabolic Diseases

Two of the most commonly performed newborn screening tests are for congenital hypothyroidism and PKU, conditions that can result in severe mental retardation if not recognized and treated within the first few weeks of life. (To learn more about these conditions, see Chapter 32, Health Problems in Early Childhood.) These tests, as well as other tests that may be offered in your state, are performed by taking a small amount of blood from your baby (usually by a heel prick) and sending it to a laboratory for analysis. The blood specimen is usually drawn before your baby leaves the nursery.

Pregestational diabetes

A complete anamnesis is imperative before planning for pregnancy. This should include, but not be limited to, questioning for duration and type of diabetes (Type 1 or Type 2), acute complications, including history of infections, ketoaci-dosis, and hypoglycemia, chronic complications, including retinopathy, nephropathy, hypertension, atherosclerotic vascular disease, and autonomic and peripheral neuropathy, diabetes management, including insulin regimen, prior or current use of oral glucose-lowering agents, SMBG regimens and results, medical nutrition therapy, and physical activity, concomitant medical conditions and medications, thyroid disease in particular for patients with Type 1 diabetes, menstrual pregnancy history contraceptive use and support system, including family and work environment.70 To minimize the occurrence of malformations, standard care for all women with diabetes who have child-bearing potential should include Measurement of serum thyroid stimulating hormone and...

Explanation Of Condition

Addison's disease refers to primary adrenal insufficiency. Of all cases, 70-90 are due to autoimmune destruction of the adrenal cortex (either alone or associated with other organ-specific autoimmune conditions, e.g. type 1 diabetes, autoimmune thyroid disease). Of the remainder, most cases are due to tuberculosis. Autoantibodies to the enzyme 21-hydroxylase are often present in autoimmune Addison's disease.

2173 Antiseptics and disinfectants

When povidone iodine is used as a local disinfectant on intact skin, on wounds and on the mucosa as well as in body cavities, iodine transfer to the fetus must be assumed. This can lead to functional disturbances in the fetal thyroid gland. The intake of iodine from a vaginal douche during labor can lead to a temporary TSH-increase in the newborn's blood - a sign of transient hypothyroidism (Weber 1998). This should be considered in the interest of the undisturbed thyroid status necessary for central nervous system differentiation. Retrospective evaluation of children born to mothers who applied iodine vaginal douching did not show indications of teratogenic effects (Czeizel 2004). However, this study did not identify the time of exposure or usage during pregnancy.

Checking In Babys First Doctor Visit

When the pediatrician examines your baby, he checks the baby's general appearance, listens for heart murmurs, feels the fontanelles (the openings in the baby's skull where the various bones come together), looks at the extremities, checks the hips, and generally makes sure that the baby is in good condition. The pediatrician orders a variety of standard blood tests and newborn screening tests. The specific screens that are required vary from state to state but often include tests for thyroid disease, PKU (a condition in which a person has trouble metabolizing some amino acids), and other inherited metabolic disorders. The results of these screening tests usually don't come back until after you take your baby home. The pediatrician gives you the results at your baby's first office visit. If any of the tests come back positive, the state also notifies you by mail. Be sure to ask the pediatrician upon discharge when your baby should be seen again.

Mary Frances Picciano and Michelle Kay McGuire

Summary National surveys indicate that as many as 97 of women living in the United States are advised by their health care providers to take multivitamin, multimineral (MVMM) supplements during pregnancy, and 7-36 of pregnant women use botanical supplements during this time. Although there is evidence of benefit from some of these preparations, efficacy has not been established for most of them. This chapter reviews some of the most commonly used prenatal supplements in terms of the evidence for their need, efficacy, and safety. Specifically, MVMM, folate, vitamin B6, vitamin A, vitamin D, iron, zinc, magnesium, and iodine are discussed, as are several botanicals. Data indicate that, in general, evidence for benefit gained from taking prenatal MVMM supplements is not well established except for women who smoke, abuse alcohol or drugs, are anemic, or have poor quality diets. Because of folate's well-established effect on decreasing risk for neural tube defects, it is recommended that...

2201 Xray examinations

These effects are a function of the dose administered and of the stage of development of the embryo. Embryo fetai death may also occur during the first 5 days after conception (i.e. in the all-or-none period) the lowest lethal dose is 10 rads (0.1 Gy). During embryogenesis, the lowest lethal dose for the embryo increases to 25-50 rads and later to more than 100 rads (lGy) (Brent 1999). Severe CNS malformations are to be expected with exposures above 20 rads during early gestation (18-36 days after conception). Microcephaly and mental retardation were observed only after exposures above 20 rads between weeks 8 and 15 after conception. The conclusion from most studies is that for doses lower than 0.05 Gy (i.e. 5 rads) there is no significant increase of the malformation rate in humans, and the risk clearly is increased above 20-50 rads (Brent 1999. Sternberg 1973). A common and important finding is the absence of visceral, limb or other malformations unless there is...

2205 Iodinecontaining contrast media

The amount of free iodine in the contrast medium is less than 0.1 of the total. The amount of the free iodide depends on the compound, and can increase during storage. The Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature and developed guidelines (Webb 2005). Free iodide can reach the fetal thyroid and be stored there. The danger with iodine in excess is transient fetal hypothyroidism, particularly from the twelfth week of

Thyroid function tests

The determination of TSH receptor antibodies (TRAb) is indicated in very special circumstances during pregnancy (Box 46.1). These antibodies are immunoglobulins, usually of the IgG subclass, having different functional activity thyroid stimulating antibodies (TSI) in most patients with Graves' disease or blocking antibodies, in some patients with Hashimoto's thyroiditis, particularly in those without goiter. They do cross the placental barrier and when present in high titers may affect fetal thyroid function.9 The chances for the offspring to be affected by these maternal antibodies are very low (up to 2 of mothers with autoimmune thyroid disease). However, if mothers with high titers are not properly identified, the consequences for the infant could be irreversible neurologic and metabolic sequelae. A value of TSRAb five times greater than normal is considered predictive of neonatal or fetal thyroid dysfunction. Thyroid peroxidase antibodies (TPO) or antimicrosomal antibodies (AMA),...

Prepregnancy counseling

The physician may be faced with different clinical situations when counseling a woman with thyroid disease contemplating pregnancy. Hyperthyroidism on antithyroid drug treatment If the woman decides to continue antithyroid drug therapy, PTU is the drug of choice in view of rare cases of methimazole embri-opathy (see section on hyperthyroidism). She should be made aware of the importance of frequent testing during gestation to achieve target serum thyroxine levels and the potential side effects on the fetus. Alternative therapies, 131I ablation or thyroidectomy should be discussed. If the patient opts for ablation therapy, there is no long-term effect of 131I therapy on the offspring. However, it is customary to wait 6 months after the therapeutic dose is administered before pregnancy is contemplated. Regardless of the form of therapy chosen, it is important for the patient to be euthyroid at the time of conception.

Previous ablation treatment for Graves disease

Women treated with ablation therapy and on thyroid replacement therapy will need to increase levothyroxine doses soon after conception to avoid hypothyroidism.11 In spite of remaining euthyroid on replacement hormonal therapy, in a subgroup of patients, high maternal titers for TSI or TSHRAb may be present, with the fetus being at risk of developing hyperthy-roidism despite the mother being euthyroid (Box 46.1). Close follow-up during pregnancy and communication between the obstetrician and endocrinologist is essential.

Maternalplacentalfetal interactions

Studies in the last two decades have shown an important role of maternal thyroid hormones in embryogenesis.14 Maternal thyroxine crosses the placenta in the first half of pregnancy at the time when the fetal thyroid gland is not functional. Maternal TSH does not cross the placenta. TRH does cross the placental barrier, but its physiologic significance is unknown. Methimazole (MM) and propylthiouracil (PTU), cross the placenta, and if given in inappropriate doses may produce fetal goiter and hypothyroidism.15

Transient hyperthyroidism of hyperemesis gravidarum

One of the most clinically recognized forms of gestational thyrotoxicosis is transient hyperthyroidism of hyperemesis gravidarum (THHG). It is characterized by severe nausea and vomiting, with onset between 4 and 8 weeks' gestation, requiring in many cases frequent visits to the emergency room and sometimes repeated hospitalizations for intravenous hydration. Weight loss of at least 5 kg, ketonuria, abnormal liver function tests, and hypokalemia are common findings, depending on the severity of vomiting and dehydration. Free thyroxine levels are elevated, sometimes up to four to six times the normal values, whereas FT3 is elevated in up to 40 of affected women, values not as high as serum FT4. The T3 T4 ratio is less than 20, as compared with Graves' hyperthyroidism, where the ratio is over 20. Serum TSH concentrations are very low or suppressed.17 TPO antibodies are negative. In spite of the significant biochemical hyperthy-roidism, signs and symptoms of hypermetabolism are mild or...

Universal screening vs casefinding cases

Universal vs. case-finding case screening for thyroid disease in pregnancy is controversial.46 Those women at risk (Box 46.2) should be screened before or early in pregnancy, with the determination of serum TSH and TPOAb. If the serum TSH is elevated a free thyroxine tests should be added. In a recent publication, 40 women out of 1560 consecutive pregnant women (2.6 ) had an elevated serum TSH, and 70 of them were in the high-risk group, while 30 of them had no risk factors based on medical history. This study along with a previous one7 appears to support universal thyroid screening early in pregnancy.

Postpartum thyroid dysfunction

Thyroid dysfunction, hyper- and hypothyroidism, affects 5-10 of women in the 12 months following delivery, or following spontaneous or medically induced abortions.48 Most of the cases are due to intrinsic thyroid disease, with a few due to hypothalamic or pituitary lesions Patients with autoimmune thyroid disease, chronic thyroiditis, and Graves' disease are most frequently affected. Postpartum thyroiditis rarely develop in women with negative antibodies.47 In about one-third of the cases, mild symptoms of hyperthyroidism develop between 2 and 4 months postpartum. A goiter is felt in the majority of cases, firm and nontender to palpation. Thyroid tests are in the hyperthyroid range and thyroid antibodies, anti-TPO antibody titers, are elevated. Spontaneously, without specific therapy, hyperthyroidism resolves, followed in a few weeks by hypothyroidism, with spontaneous recovery and return to a euthyroid state by 7-12 months following delivery. Antibody titers have a tendency to...

Fetal Risk Summary

A prospective controlled study published in 1997 evaluated the teratogenic risk of cetirizine and hydroxyzine (see also Hydroxyzine) in human pregnancy (2). A total of 120 pregnancies (2 sets of twins) exposed to either cetirizine (N 39) or hydroxyzine (N 81) during pregnancy were identified and compared to 110 controls. The control group was matched for maternal age, smoking, and alcohol use. The drugs were taken during the 1st trimester in 37 (95 ) of the cetirizine exposures and in 53 (65 ) of the hydroxyzine cases for a variety of indications (e.g., rhinitis, urticaria, pruritic urticarial papules and plaques of pregnancy, sedation, and other nonspecified reasons). Fourteen spontaneous abortions (cetirizine 6, hydroxyzine 3, controls 5) and 11 induced abortions (hydroxyzine 6, controls 5) occurred in the three groups. Among the live births, there were no statistical differences among the groups in birth weight, gestational age at delivery, rate of cesarean section, or neonatal...

Endocrine and Metabolic Disorders

Midline neck mass in an infant with congenital goiter. Goiter may occur in the newborn period as a result of maternal iodine deficiency, drug ingestion (e.g., iodide during pregnancy for treatment of maternal asthma), maternal thyrotoxicosis, or inborn errors of thyroxine synthesis. The pressure effect of the enlarged thyroid on the trachea may result in respiratory distress. Medical treatment depends on whether the infant has hypothyroidism or hyperthyroidism. Figure 5.1. Midline neck mass in an infant with congenital goiter. Goiter may occur in the newborn period as a result of maternal iodine deficiency, drug ingestion (e.g., iodide during pregnancy for treatment of maternal asthma), maternal thyrotoxicosis, or inborn errors of thyroxine synthesis. The pressure effect of the enlarged thyroid on the trachea may result in respiratory distress. Medical treatment depends on whether the infant has hypothyroidism or hyperthyroidism.

Photos Of Infants With Marfan

Infants With Marfan Syndrome

This is another example of long feet and toes in an infant with Marfan syndrome. Note the bilateral congenital curly toes. This infant had a birth length of 53 cm and an upper lower segment ratio of 1.41. The normal upper lower segment ratio at birth is 1.69 to 1.70. In short-limbed dwarfism and hypothyroidism it averages 1.8 or more, and in Marfan syndrome it averages 1.45.

4114 Thyroid hormones and thyroid receptor antibodies

L-thyroxine is used as a substitute in cases of hypothyroidism (at least 1 ng kg daily for adults), and, for this reason, is not problematic. The normal thyroid content of mother's milk is approximately 1 ng 1. An infant takes in about 0.15 ig kg in 24 hours this represents about 1 of a substitution dosage at this age (lOpg kg daily). This amount does not influence the thyroid function of a healthy infant. The same applies for treatment (substitution) of a maternal hypoparathyroidism. Of course, this also means it lias no therapeutic effect in case of a congenital hypo- or athyroidism. This has to be taken into account in case of extremely premature newborns with a higher risk for hypothyroidism. Neither breast milk nor formula contains enough thyroxine for substitution (van Wassenaer 2002). Thyroid receptor antibodies (TRAb) can result in transient neonatal thyroid disease by transfer through milk from mothers treated for thyrotoxicosis, Serum TRAb concentration in neonates decrease...

Single nodule of the thyroid gland

Nodular thyroid disease is clinically detectable in 10 of pregnant women. In most cases, it is discovered during the first routine clinical examination or detected by the patient herself. The chances for a single or solitary thyroid nodule to be malignant are between 5 and 10 , depending on risk factors such as previous radiation therapy to the upper body, rapid growth of a painless nodule, patient age, and family history of thyroid cancer. Papillary carcinoma accounts for almost 75-80 of malignant tumors, and follicular neoplasm for 15-20 a few percent are represented by medullary thyroid carcinoma. There is a paucity of information in the literature regarding the management and timing of the work-up in the presence of thyroid nodularity.40,41 It is generally agreed that elective surgery should be avoided in the first trimester and after 24 weeks' gestation because of the potential risks of spontaneous abortion and premature delivery, respectively.

Respiratory Disorders

Tonacchera M, Chiovato L and Pinchera A 2002 Clinical assessment and systemic manifestations of hypothyroidism in Wass JAM and Shalet SM (Eds) Oxford Textbook of Endocrinology and Diabetes. Oxford Oxford University Press 491-502 2. Girling JC and DeSwiet M 1992 Thyroxine dosage during pregnancy in women with primary hypothyroidism. British Journal of Obstetrics and Gynaecology, 99 368-370 4. Franklyn J 2002 Subclinical hypothyroidism in Wass JAM and Shalet SM (Eds) Oxford Textbook of Endocrinology and Diabetes. Oxford Oxford University Press 518-522 5. Hershman JM 2002 Thyroid disease during pregnancy in Wass JAM and Shalet SM (Eds) Oxford Textbook of Endocrinology and Diabetes. Oxford Oxford University Press 522-524 4. Hershman JM 2002 Thyroid disease during pregnancy in Wass JAM and Shalet SM (Eds) Oxford Textbook of Endocrinology and Diabetes. Oxford Oxford University Press 522-524

2157 Hyperthyroidism and thyrostatics

An uncontrolled hyperthyroidism of a pregnant woman is a risk for the outcome of pregnancy and the fetus fetal growth retardation, pre-eclampsia, prematurity, and intrauterine death or stillbirths occur more often (Glinoer 1997). In cases of Graves' disease or Hashimoto thyroiditis - the latter usually results in hypothyroidism - the maternal auto-antibodies should be tested at the beginning of pregnancy and early in the third trimester. A high concentration, especially of TSH-receptor antibodies (TRAb), is often correlated with a diaplacental transfer of these antibodies. It is estimated that 1-2 of pregnancies with Graves' disease result in a transient hyperthyroidism of the fetus or newborn, respectively (Carrol 2005). A recently published prospective study on 115 pregnant women reports a much higher rate of 12.6 of fetal neonatal hyperthyroidism (Rosenfeld 2005). 9.5 of in utero PTU-exposcd children developed hypothyroidism and 5.4 also developed goiter. Not all hypothyroid...

Hyperthyroidism due to Graves disease

The goal of treatment is normalization of thyroid tests as soon as possible and to maintain euthyroidism with the minimum amount of antithyroid medication. Patients should be monitored at regular intervals and the dose of their medications adjusted to keep the FT4 or preferable the FT4I in the upper one third of the range of normal.20 For this purpose, thyroid tests should be performed every 2 weeks at the beginning of treatment and every 2-4 weeks when euthyroidism is achieved. Patients with small goiters, short duration of symptoms, and on minimal amounts of antithyroid medication will be able to discontinue antithyroid drugs by 34 weeks' gestation or beyond and remain euthyroid. In the USA, the two antithyroid drugs available are PTU and methimazole (Tapazole). Both drugs are effective in controlling symptoms. Aplasia cutis, an unusual scalp lesion, occurred in a small group of patients taking methimazole. A few reports have described a specific embryopathy in infants from mothers...

Conception During Breast Feeding References

A 1991 report described the use of amiodarone in one woman with a history of symptomatic ventricular arrhythmia, and mitral and tricuspid valve prolapse through two complete pregnancies (12). She also had a history of right upper lobectomy for drug-resistant pulmonary tuberculosis. She was treated with 400 mg day of amiodarone during the first 12 weeks of gestation of one pregnancy before the dose was reduced to 200 mg day. She continued this dose during the remainder of this pregnancy and through a successive pregnancy. One of the newborns was growth retarded, a 2500-g female delivered at 38 weeks' gestation. The second infant, a 2960-g male, was delivered prematurely at 35.5 weeks' gestation. Except for the growth retardation in the one infant, the newborns were physically normal and had no clinical or biochemical signs of hypothyroidism (12). The concentration of amiodarone and its metabolite, desethylamiodarone, were < 0.3 pg mL in the first-born infant (not determined in the...

Neonatal hyperthyroidism

Neonatal hyperthyroidism is infrequent, with an incidence of less than 1 of infants born to mothers with Graves' disease, therefore affecting 1 in 50,000 neonates. The disease is caused by the placental transfer of stimulating thyroid antibodies (TSIs) from mother to fetus. High serum maternal TSI titers (a 3- to 5-fold increase over baseline), in the third trimester of pregnancy are predictors of neonatal hyperthyroidism.30 If the mother is treated with antithyroid medications, the fetus benefits from maternal therapy, remaining euthyroid during pregnancy. However, the protective effect of the antithyroid drug is lost after delivery, and neonatal hyperthyroidism may develop within a few days after birth. If neonatal hyperthyroidism is not recognized and treated properly, neonatal mortality may be as high as 30 . Since the half-life of the antibodies is only a few weeks, complete resolution of neonatal hyperthyroidism is the rule.28

123 Minerals

Iodine needs increase during pregnancy for the synthesis of thyroid hormones. Maternal iodine deficiency during pregnancy can result in the enlargement of a woman's thyroid gland, development of goiter, and hypothyroidism. Maternal hypothyroidism increases the risk of a variety of poor fetal outcomes including stillbirth, spontaneous abortion, congenital anomalies, mental retardation, deafness, spastic dysplegia, and cretinism 3 . To avoid risk of harm to the fetus, maternal iodine deficiency should be corrected prior to conception.

Marfan Syndrome

Asymmetric Gluteal Folds

In infants with neonatal Marfan syndrome, the thumb may extend beyond the fifth finger when the infant fists its hand. This infant with Marfan syndrome had an upper lower segment ratio of 1.52. The normal upper lower segment ratio in the neonate is 1.69 to 1.7. It is much reduced in Marfan syndrome and increased in short-limbed dwarfism and hypothyroidism. Note that the fingers are long, tubular, and relatively slender.

921Anorexia Nervosa

Characterized by extreme voluntary weight loss due to self-starvation or binge eating followed by purging, AN occurs in 0.5-3 of the female population 3, 4 . Clinical signs and symptoms of AN include an emaciated appearance, prepubertal features, lethargy, lanugo, alopecia, acrocyanosis, hypothermia, swollen joints, pitting edema, and bradycardia and hypotension. Biochemical evaluation often shows fluid and electrolyte disturbances and hypercarotenemia as well as endocrine and hematologic abnormalities such as hypothyroidism and anemia, respectively. Several cardiovascular irregularities develop along with a host of gastrointestinal complications, particularly in those with the binge eating-purging type of AN. Osteoporosis and skeletal fractures are common in persons with AN. Some may experience peripheral neuropathy and seizures. Mortality is as high as 22 in women with long-term AN 5 .

Investigations

Investigation consists of the measurement of circulating thyroid hormones with thyroid function tests. In primary hypothyroidism thyroid stimulating hormone (TSH) will be raised, free thyroxine (fT4) will be reduced, as will fT3, although this is not always measured. In central hypothy-roidism the TSH will also be low. TPO antibodies are usually positive in autoimmune thyroiditis. Up to 5 of women have positive antibodies in early pregnancy. Myxoedema coma is a rare complication that occurs in undiagnosed or chronically untreated hypothyroidism. There is loss of consciousness with hypothermia, hypoventilation and bradycardia.

1455Iodine

Severe maternal iodine deficiency during pregnancy has long been known to increase risks for stillbirths, abortions, and congenital abnormalities 104 . In its more serious condition, prenatal iodine deficiency causes cretinism, which is characterized by stunting, difficulty in hearing and speaking, and sometimes-profound mental retardation 105 . In fact, iodine deficiency is considered the world's most frequent cause of preventable mental retardation. In addition to detrimental effects of iodine deficiency on infants and children, maternal postpartum thyroid dysfunction is relatively common and related to chronic iodine deficiency as well 106 . The complications of both maternal and infant iodine defi-ciency collectively known as iodine deficiency disorders are complex, and the etiology of these deficiency characteristics is owed to iodine's critical role as a component of the quaternary structures of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Aside from marine...

1574Iodine

Vegetarians who do not use iodized salt may be at increased risk of developing iodine deficiency because, in general, plant-based diets are relatively low in iodine 36-39 . This is of special concern in pregnancy because of the effects of iodine deficiency on the developing brain 27 . Use of iodized salt (0.75 teaspoon) in cooking and at the table will provide enough iodine to meet the iodine RDA for pregnancy of 220 mcg day. Other alternatives include iodine supplements and sea vegetables. Some, but not all prenatal supplements contain iodine. Sea vegetables like nori and hiziki can provide iodine but their iodine content is quite variable 40 . Excessive maternal iodine (2,300-3,200 mcg day) from sea vegetables has been linked to hypothyroidism in newborn infants in Japan 41 and to postpartum thyroiditis in China 42 .

Radiation

Radioiodine (131I) can cause fetal hypothyroidism (298), is considered a category X drug, and is contraindicated in pregnancy. Uptake is minimal before 12 weeks of gestation (299), however. Sodium iodide delivers less than 10 mrad to the fetal thyroid, and its uptake into the fetal thyroid may be blocked by administering stable iodide to the mother, making administration during pregnancy feasible.

4165 Nicotine

As well as nicotine and cotinine, other toxic and carcinogenic chemicals and cadmium (Radisch 1987) also appear in the milk of smokers (Radisch 1987). Among 50 smoking mothers, a lower iodine content of the milk was found compared to a control group of 90 non-smokers. According to the authors, this could cause iodine deficiency in the infants requiring supplementation (Laurbcrg 2004).

72 Thyrotoxicosis

Overtreatment of maternal thyrotoxicosis will cause fetal hypothyroidism and goitre. If ultrasound scans show a fetal goitre the differential diagnosis is fetal hypothyroidism or fetal thyrotoxicosis. This is an indication for cordocentesis to measure fetal TSH and fT42. Block and replace regimens are contraindicated in pregnancy because, while CBZ and PTU cross the placenta, relatively little thyroxine does and this would cause fetal hypothyroidism Serial measurements of fT4 and TSH every four weeks will usually allow withdrawal of antithyroid drugs in the third trimester If large doses of CBZ or PTU appear to be required to treat maternal thyrotoxicosis, it is worth considering referral for subtotal thyroidec-tomy after the first trimester to avoid fetal hypothyroidism Management of neonatal thyrotoxicosis Neonatal thyrotoxicosis, caused by placental transfer of maternal TSIgs, is self-limiting, but gets worse transiently when the maternally-transferred antithyroid drugs disappear....

Lithium

Additional risks of lithium use later in pregnancy include reported neonatal toxicity in offspring exposed to lithium during labor and delivery. These reports include several cases of muscular hypotonia with impaired breathing and cyanosis, often referred to as floppy baby syndrome (see Ananth 1976 Schou and Amdisen 1975 Woody et al. 1971 Yonkers 1998). Isolated cases of neonatal hypothyroidism and nephrogenic diabetes insipidus have also been described (Ananth 1976 Yonkers 1998). A naturalistic survey of women who were treated with lithium found no direct evidence of neonatal toxicity in newborns whose mothers had received lithium either during pregnancy or during labor and delivery (Cohen et al. 1995). A limited amount of data are available regarding behavioral outcomes of children exposed to lithium in utero. A 5-year follow-up investigation of children exposed to lithium during the second and third trimesters of pregnancy (n 60) found no significant behavioral problems (Schou...

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