Being Pregnant: Thyroid Disorder in Pregnancy, Dylipidemia and Depression
The Indian Thyroid Society (ITS) recently launched three guidelines for the Management of Thyroid Dysfunction in Pregnancy, Dyslipidemia and Depression at the 10th Annual Conference ‘ITSCON – 2013’. These guidelines are for managing thyroid dysfunction in Pregnancy to safeguard mother and child health, and for patients of Depression and Dyslipidemia to reduce the co-morbidities associated with thyroid disorders.
Thyroid disorders in India are characterized by a high prevalence (approx. 11% of adult population), minimal diagnosis, low awareness and low involvement of doctors in treatment.
The Thyroid Dysfunction and Pregnancy Guidelines recommend screening for hypothyroidism in pregnant women at the 1st antenatal visit by measuring TSH levels. In case overt hypothyroidism is diagnosed then expectant mothers should be treated with a full replacement dose of thyroxine to normalize thyroid function as rapidly as possible. It is also important to understand that; thyroid dysfunction by itself is not an indication for termination of pregnancy.
As per the Thyroid Dysfunction and Dyslipidemia Guidelines, overt hypothyroidism is associated with the risk of cardio vascular disease as it causes increased levels of LDL cholesterol and hypertension. It is therefore advised that doctors screen patients with dyslipidemia for abnormal thyroid levels and accordingly prescribe treatment.
According to the Thyroid Dysfunction and Depression Guidelines one of the co-morbidities associated with thyroid disorders is depression. It is important for doctors who are treating patients for depression to refer them to undergo a TSH test to detect hypothyroidism. This will help in correct diagnosis and treatment to prevent further damage.
Thyroid disorder is a medical condition that impairs the normal functioning of the thyroid gland causing abnormal production of hormones leading to hyperthyroidism or hypothyroidism. Multiple factors such as hereditary, environment and diet can trigger thyroid dysfunction. Thyroid disorders are commonly diagnosed between 20 – 40 years and research has shown that women are more commonly detected with thyroid disorders than men.
Speaking of thyroid disorders in women during pregnancy, Dr. Hema Divakar, President - Federation of Obstetric and Gynaecological Societies of India [FOGSI], Bangalore said “Hypothyroidism is emerging as one of the most common endocrine problem during pregnancy and often goes undetected. It increases the risk of miscarriage, stillbirth, premature birth and placental abnormalities that adversely affects the overall development of the foetus. In the best interest of the mother and baby, we encourage regular screening for thyroid disorders amongst pregnant women. The guidelines recommend screening at the 1st antenatal visit by measuring TSH levels.” Often symptoms such as anxiety, mood swings and poor concentration are ignored as signs of stress. These could have been triggered due to abnormal levels of thyroid hormone which can push people into depression.
According to Dr Sarita Bajaj, President Endocrine Society of India (ESI), Allahabad, “Thyroid hormones have a tremendous effect on body processes and can even impact cognitive function. There is little awareness that depression is a co-morbidity associated with hypothyroidism. All patients with depression should preferably be screened for thyroid function tests and be appropriately treated with thyroxine as judged by the physician.”
Hypothyroidism also leads to a co-morbid condition called dyslipidemia indicated with an increase in serum total cholesterol, low-density lipoprotein (LDL), apolipoprotein B, lipoprotein (a) levels, and possibly triglyceride levels. Dyslipidemia puts a patient at an increased risk for developing cardiovascular diseases, atherosclerosis and coronary artery disease.
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