Hypothyroidism in Pregnancy

(Low thyroid in pregnancy, High risk pregnancy, Underactive thyroid, Myxedema)

Human beings are becoming less and less active as the technology grows. With such a low level of activity, keeping the balance of body systems is difficult, as a result, thyroid diseases. Awareness about the disease and its diagnosis remains shockingly low. Hypothyroidism results from the withering or atrophy of the thyroid gland. The disease is more common in women who are overworked and who do not get sufficient rest and relaxation

Hypothyroidism is a clinical condition resulting. from decreased circulating levels of T4 and T3 by the thyroid gland irrespective of the cause. When the hypothyroidism is of severe degree and of long standing it is seen as myxedema which is characterized by deposition of mutinous material causing swelling of skin and the subcutaneous tissue.

Hypothyroidism is a condition marked by an underactive thyroid gland and may be present during pregnancy. Many symptoms of hypothyroidism are similar to pregnancy symptoms. For example, fatigue, weight gain, and abnormal menstruation are common to both.

Thyroid dysfunction is the commonest endocrine disorder in pregnancy apart from diabetes. The background prevalence of spontaneous hypothyroidism is between 1% and 2% in iodine-replete communities

Thyroid hormones are essential for fetal brain development in the embryonic phase. Maternal thyroid dysfunction during pregnancy may have significant adverse maternal and fetal outcomes such as preterm delivery, preeclampsia, miscarriage and low birth weight

Nearly 1 out of 50 women is diagnosed with hypothyroidism during pregnancy. 6 out of 100 miscarriages are associated with thyroid deficiencies during pregnancy.

“Stamina is controlled by Thyroid”

Thyroid Disorder

"Thyroid hormones are very important. They help control growth, cell repair, and metabolism — the process by which your body converts what you eat into energy. Your metabolism affects your body temperature and at what rate you burn calories. That is why people with hypothyroidism often feel cold and fatigued and may gain weight easily."

Introduction

Hypothyroidism, also known as an underactive thyroid, is a common endocrine disorder resulting in insufficient production of thyroid hormone. thyroid is a butterfly-shaped endocrine gland present in the front part of the neck, which plays an important role in metabolism and growth. In severe hypothyroidism in pregnancy serum TSH level > 20.0 mIU/L.

If you have thyroid problems, you can still have a healthy pregnancy and protect your baby's health by having regular thyroid function tests and taking medicines that your doctor prescribes.

Primary maternal hypothyroidism :

It is defined as the presence of an elevated TSH concentration during gestation in the absence of rare exceptions such as TSH-secreting pituitary tumor thyroid hormone resistance and a few cases of central hypothyroidism with biologically inactive TSH

Secondary hypothyroidism :

Other times, the thyroid gland doesn’t receive enough TSH. This happens when the pituitary gland is not working properly and is called secondary hypothyroidism.

Overt Hypothyroidism :

Overt hypothyroidism is increased TSH and decrease free T4 levels.. TSH level of 10 mU/L or greater, irrespective of the fT4 level . It affects 0.3–0.5% of pregnancies. It is often pre-existent although it can sometimes develop during pregnancy. Its commonest cause is chronic autoimmune (Hashimoto’s) thyroiditis. It can also result from previous surgery or radioactive iodine treatment for hyperthyroidism , goiter or thyroid cancer.

There is an increased incidence of obstetric complications in pregnant women with untreated hypothyroidism These include preterm birth, low birth weight (mostly related to preterm delivery), perinatal death, , pregnancy induced hypertension, pre-eclampsia, placental abruption, anaemia and post partum hemorrhage. Hypothyroidism has also been associated with adverse effects on intelligence quotient (IQ) and neuropsychological development Following the diagnosis of overt hypothyroidism, levothyroxine replacement should be commenced, aiming to achieve a TSH level within the trimester-specific pregnancy reference range. The majority of pregnant women with pre-existing hypothyroidism will need increments of their levothyroxine dose by 25–50%, often within four to eight weeks of gestation and the dose increment tends to plateau by 16 weeks of gestation Such a dose increment should take place immediately on confirmation of a missed cycle or a positive pregnancy test; one way of doing this is by increasing the 7 doses of levothyroxine per week to 9 doses The levothyroxine requirements usually plateau from 16–20 weeks of gestation until delivery.

Subclinical hypothyroidism :

Subclinical Hypothyroidism : Raised serum Thyroid stimulating hormone (TSH) levels. Normal Thyroid hormone levels. Subclinical hypothyroidism occurs in 10% of pregnancies. Hypothyroidism is defined as an elevated TSH level (TSH 2.5–10.0 mU/L) with normal levels of free thyroxine . It can affect 0.25–2.5% of all pregnancies.

Subclinical hypothyroidism during pregnancy has been associated with significantly increased risk of hypertension and pre-eclampsia, placental abruption, premature rupture of membranes, early pregnancy loss, neonatal death, and gestational diabetes. The risk of miscarriage has been confirmed in iodine-replete populations and the risk seems to apply with TSH increments above, but not within, the normal range. Neurodevelopmental deficits in the offspring have been reported..

Isolated hypothyroxinaemia (IH)

Maternal isolated hypothyroxinaemia (IH) is defined as TSH concentrations within normal range and fT4 levels below the reference range. The diagnosis of IH can indicate the early stages of thyroid insufficiency and rarely secondary hypothyroidism, which should always be considered. Some authors have reported increased rates of IH in areas of mild to moderate iodine deficiency and with advancing gestational age, reaching 25% in the third trimester. IH is associated with obstetric risks including placental abruption, low birth weight, neurodevelopmental impairment and pregnancy loss .

Untreated maternal hypothyroidism can lead to preterm birth, low birth weight, and respiratory distress in the neonate. Even minimal hypothyroidism can increase rates of miscarriage and fetal death and may also have adverse effects on later cognitive development of the offspring.

Iodine and pregnancy

Iodine is an essential component of thyroid hormones and requirements increase during pregnancy. Iodine deficiency is associated with thyroid dysfunction and subsequently with impaired fetal development.. It is nowadays accepted that severe maternal iodine deficiency can have adverse implications for the mother, including hypothyroidism and goitre; for the foetus, including miscarriage and stillbirth for the neonate, including neonatal mortality and for the child, including impaired neurological development, faltering growth and cretinism. Iodine supplementation is recommended as a treatment of maternal hypothyroidism in severely iodine deficient populations and there is good evidence that it improves clinical outcomes including cretinism and infant mortality rates.

What is the daily iodine recommendation during pregnancy?

During pregnancy, 250 micrograms of iodine is required daily. Since the fetus derives iodine from the mother, the intake is higher than that of a single individual.

“Your car runs on gasoline and your thyroid runs on iodine”

"Consult an Endocrinologist".

Hypothalamic-pituitary-thyroid axis and pregnancy

Basic Physiology

The Hypothalamus secretes Thyrotropin releasing hormone (TRH) a tripeptide, Which stimulates the production of Thyroid Stimulating Hormone (TSH), a polypeptide from the anterior Pituitary. TSH increases the production and the release of thyroxine.(T4) and triiodothyronine (T3).from the Thyroid.T3 and T4 reduce production of TSH. which is the basis of TRH test. The thyroid produce mainly T4 some of which is converted into T3 in the blood or tissue. 85% of T3 is produced this way, 15% is secreted from the thyroid. T3 is five times as active as T4. Most T3 and T4 in the in plasma is protein bound mainly to thyroxine binding globulin. (TBG). It is the unbound portion which is active. T3 and T4 increase much cell metabolism. They are vital to normal growth and mental development. They also increase the effect of catecholamines.

How does Hypothyroidism affect your metabolism?

The thyroid hormone helps control the speed of your metabolism. The faster your metabolism, the more calories your body burns at rest. People with hypothyroidism make less thyroid hormone. This means they have a slower metabolism and burn fewer calories at rest. Having a slow metabolism comes with several health risks. It may leave you tired, increase your blood cholesterol levels, and make it harder for you to lose weight.. you find it difficult to maintain your weight with hypothyroidism, try doing moderate or high intensity cardio. This includes exercises like fast-paced walking, running, hiking, and rowing. Moderate to high intensity aerobic exercise may help boost your thyroid hormone levels. In turn, this may help speed up your metabolism. with hypothyroidism might also benefit from increasing protein intake. Higher protein diets help increase the rate of your metabolism

"Alopecia areata is common with thyroid disease."

Diagnosis

● Thyroid Function Test : Normal values-

Blood test:

Normal TSH level for pregnant women be maintained between 0.2 to - 2.5 mU/L in the first trimester of pregnancy and between 0.3-3 mU/L in the remaining trimester.
Reduction in free and total T4 and rise in serum TSH ( usually more than15-29mu/l) indicates primary hypothyroidism. Elevated TSH with normal serumT4 is termed 'sub clinical hypothyroidism.
Note: Measurement of serum free or total T3 is usually unhelpful since T3 may not only slightly reduced, because of increased peripheral conversion of T4 to T 3.
Reduction in free and total T4 with TSH level within or below normal range, suggest secondary hypothyroidism.

● Serum cholesterol

Fasting cholesterol and triglycerides which may be raised

● ECG

Bradycardia, low voltage complexes and flattened or inverted T waves. Marked improvement occurs with thyroxine treatment.

● Tendon reflex duration

Tendon reflexes are prolonged.

● Thyroid antibodies

If positive may indicate the ethology ( Hashimoto 's thyroiditis)

● Blood Test

The blood may show a normochromic, macrocytic anemia

● FNAB Fine needle aspiration biopsy

Subclinical hypothyroidism, it is advisable that Thyroid function test TFTs should be performed regularly, particularly in the first half of pregnancy, and every time there is a change in treatment.

Causes

● PREDISPOSING CAUSES

a . Hereditary or genetic or constitutional factor occasionally.
b . Goitrous regions (prolonged iodine deficiency)
c . Females : male female ratio.1;6

● DIRECT CAUSES

Common

Hashimoto’s Disease: It is an autoimmune disorder of hereditary nature where your body produces antibodies that could attack and destroy your thyroid. It may also be caused by viral infection.
Radiation therapy in the neck region: Radiation therapy for cancer, especially in the neck region might cause damage to your thyroid cells making it difficult to produce hormones.
Radioactive iodine treatment: This destroy the cells in the thyroid making it less functional.
Medication: Use of certain medicines may hinder your thyroid’s ability to produce hormones. Medicines link lithium, amiodarone.
Iodine in the diet: Thyroid needs iodine for hormone production and lack of it would lead to hypothyroidism.
Pregnancy: Postpartum thyroiditis where there is a severe increase in thyroid hormone production followed by a sharp drop in the same.
Congenital Hypothyroidism: It is a condition in which some babies may be born with a thyroid that is not well developed or not functioning properly.
Pituitary & Hypothalamus

"Hypothyroidism causes high cholesterol."

Signs & Symptoms

Onset - Insidious with physical, mental and metabolic processes below normal.
1 . General
Tiredness, somnolence
Sudden weight gain, swelling of the body.
Cold intolerance
Goitre, The damaged and inflamed tissues of the thyroid don't produce enough hormones (hypothyroidism). When the pituitary gland detects the decline and prompts the thyroid to create more hormones, the thyroid can become enlarged.

BMR- Basal metabolism rate decreases below normal with the results the patient tends to be slow in his movement.

Pulse is slow and the patient often complains of vague pains in the back and stiffness in the joints.

2 . Skin and subcutaneous tissues
Coarse dry skin
Puffiness of face with malar flush
Baggy eyelids
Myxedema - Swollen edematous appearance of supraclavicular regions, neck, backs of hand and feet.
Minimal sweating
Alopecia, loss of hair
Vitiligo white spots
Carotenemia, yellow orange discoloration of skin.
Erythema abigne, damage to superficial blood vessels that subsequently leads to epidermal vascular dilation

3 . Cardio-vascular

Angina, Pain in heart.

Bradycardia, slow heart rate

Cardiac failure

Pericardial effusion

Plural effusion

4 . Psychiatric features
Depression, myxedema madness

5 . Neuromuscular
a . Carpal tunnel syndrome, swelling of the median nerve near to the wrist bone.
b . Polyneuritis, multiple joint pain.
c . Cerebellar syndrome with slurred speech and ataxia
d . Muscle cramps and stiffness
e . Myopathy and myotonia
f . Hoarseness
g . Deafness of perceptive type
h . Delayed relaxation of ankle reflexes.

6 . Gastrointestinal
a . Constipation
b .Ascites

7 . Hematological - one of the following types-
a . Iron deficiency anaemia due to blood loss from menorrhagia.
b . Macrocyclic due to associated vitamin B 12 deficiency or
c . Normochromic ( most common) which may respond to thyroxine alone.

8 . Reproductive system
a . Infertility
b . Menorrhagia
a . Hyperprolactemia and gal actor Rhoda

9 . Miscellaneous
a . Impairment of smell, taste and hearing may be present
b. Hoarse husky voice due to thickening of vocal cords.
c . Nails striated and tend to break;
d . Hypotonia of muscles.
e . Generalized aches and pains
f . Hyperlipidemia
g . Xanthelasma

10 . Miscellaneous

Can't stop feeling cold : Do you feel cold when it is not? The sickness can leave you feeling tired and depressed and may be a sign of invisible condition - Hypothyroidism. Or an underactive thyroid. It makes the metabolism slow down.

Effect of Hypothyroidism during pregnancy

● Anemia
● Preeclampsia
● Low birth weight (smaller than 5 pound)
● Miscarriage
● Stillbirth

● Problem with baby's growth and brain development.

Complications

In pregnant women Hypothyroidism untreated can lead to both maternal and fetal complications.
● Maternal complications include gestational Hypertension, gestational Diabetes, abruptio Placenta, and PostPartum Hemorrhage.
● Fetal complications include Abortions, Premature births, stillbirths and low birth weight.

Risk

●  Age 30 years.
●  A personal history of thyroid disease.
●  Family history of thyroid disease.
●  History of thyroid dis-function or surgery.
●  Goiter.
●  Thyroid antibody positive.
●  Symptoms suggestive pf hypothyroidism.
●  Type 1 Diabetes.
●  History of miscarriage preterm delivery.
●  Autoimmune disorder associated with autoimmune thyroid disfunction.
●  History of head or neck irradiation.
●  History of infertility.
●  Morbid obesity.
●  Treatment with antibiotics, lithium, or levothyroxine.
●  Recent exposure to iodinated radiological contrast agent.
●  Current residence with the region with presumed iodine deficiency.

● Trauma to neck.

Lifestyle

● Wake up early in the morning before sunrise
● Morning walk to keep fit
● Drink sufficient water to flush out toxins
● Dinner should be taken between 7 - 8 PM
● No sleeping in the day
● Do not sleep more than 6-7 hours in night
● Ensure proper evacuation of bowel
● Practice pranayama and yoga asanas in your daily routine
● Exercise should be a part of daily routine
● Eat lots of salads, vegetables and fruits
● Use iodized salt
● Have buttermilk with lunch
● To plan pregnancy only, when the patient is euthyroid
● Take one tsp of Triphala at night before sleeping with warm water
● Massage with oil once or twice a week
● Include light food and avoid fried food
● Great care must be taken never to allow the body to become exhausted
● And any irritation is likely to cause emotional upset should be avoided

● Jeevan Bindis for iodine deficient women. Jeevan bindis : Packets of iodine-coated bindis to women in rural areas are given, which will provide users with their daily dose of the essential element through the skin on their foreheads. The stickers, which are coated with 150-200 microgames of iodine, are supposed to work like a nicotine patch. What is required in a day is only 150-200 micrograms. When there is a deficiency, only then the absorption takes place.

Exercise

● Regular physical activity ensures the proper functioning of vital body organs, regulates endocrine gland functions, uplifts mood, improves metabolism, flushes body toxins and maintains a healthy weight. Few thyroid-related symptoms like fatigue, loss of appetite and osteoporosis, can be combated through a regular 30-minute exercise regime.

Yoga

● ● Cow Face Pose GomukhAsana ( गोमुखासन )

Bhujanga Asana

Hala asana

Setubanda

Sarvanga Asana

Matsya Asana

Pranayama
Ujjayi Pranayama
●    Sit in any meditative pose. Contract the muscles of the throat  as much as possible. Bend the neck so that chin touches the sternum . Inhale air through both nostrils. On doing so the air should touch muscles of the contracted throat. While inhaling a sound of snoring is produced.
Kapal  Bhatti
●     Kapal-  means forehead. Bhati- means light. So with this pranayama one becomes luminous and lustrous. In this  normal inspiration and forceful expiration is done. In doing so, the abdominal area gets inward and outward movements.
B Bhastrika   Sit in comfortable  Asana. Breath in through both nostrils forcefully, till the lungs are full and till the diaphragm is stretched.
●     Then breath out forcefully
Bhramari
●     Breath in till the lungs are full of air. Close the ears with the thumbs and eyes with the middle fingers. Press forehead with both the index fingers lightly close the eyes. Then press the eyes and nose bridge with remaining fingers.
● Udgeet Pranayama Concentrate on Ajna Chakra. Close the mouth. Begin slowly exhaling making humming sound like a bee while reciting OM mentally.

Meditation

"Meditation is a practice of sitting still and doing nothing."

Omkar Jap

● Meditation on the sacred Mantra OM. The body and the universal cosmic body are filled with this mantra. Om is a divine energy. It is more beneficial to start asanas and Pranayama practices with OM Japa. Breath in and out very slowly with Omkar Japa in mind. The breath is to be so slow that inhalation and exhalation is to be limited to one minute. The breath should be felt deep inside. This state lead to concentration. Gayatri Mantra also can be chanted in the same way.

Bandha

Jalandhara Bandha

● Jal means net, and Dhara means flow. Jalandhara Bandha is the lock which controls the network of Nadis (channels) in the neck. The physical manifestation of these Nadis are the blood vessels and nerves of neck. Where the thyroid gland is situated.

● Sit in any comfortable meditative Asana Padmasana, Sukhasana or Vajrasana. The head is bent forwards so that chin is pressing the neck. The awareness is concentrated on vishudha chakra. Which is located at the region of thyroid gland.

Mudra

Surya Mudra

●     Formation- The tip of the ring fingers is to be placed at the base of the thumb and thumb is to be placed gently on the back of ring finger.
Surya means the sun, Surya Mudra generates heat in the body like the sun.
It is also beneficial for the patient of High cholesterol in the blood.
SuSurya mudra is good for Hypothyroidism and slow metabolism.
Shankha Mudra
●     In Sanskrit Shankha means Conch
●     Place a thumb of the left hand at the base of the right thumb
●     This is the point of Thyroid gland in the palm
●     Fold the fingers of the right hand covering the left thumb
●     Join the index finger of the left hand with the thumb tip of the right hand. The other three fingers of the left hand are to be placed on the back of the right palm.

Marma

● Marma of Neck For Thyroid stimulate Marma of neck region i .e 8 Matrika and 4 Nila Manya.

● Take deep breath and take your tongue out

● Take deep breath with open mouth, hold back in chest and blow cheeks and exhale through nose.

● Clenching of teeth

Reflexology

● Base of thumb should be massaged by another hand round and round.

Chakra

● Vishudha Chakra. Concentrate on Vishuddha chakra. It is located in the region of throat.

Acupressure point

●

A Press the upper part of the palm below the thumb. Also pressing the fleshy webbing present between the thumb and index finger helps in the treatment of hyperthyroidism. This point is termed the Union Valley. below the thumb over thinner eminence is the thyroid point.

Diet

"Thyroid Diet Plan: How to Lose Weight, Increase Energy, and Manage Thyroid Symptoms".

● Iodized Salt :

● Whole wheat products, pulses, unpolished rice, Whole Grains Help Ease Constipation, A whole grain is a grain of any cereal and pseudo-cereal that contains the endosperm, germ, and bran, in contrast to refined grains, which retain only the endosperm. As part of a general healthy diet, consumption of whole grains is associated with lower risk of several diseases. Examples of whole grains include: Barley, Brown rice, Buckwheat., Bulgur (cracked wheat), Millet,. Oatmeal, Popcorn, .Whole-wheat bread, pasta or crackers.

● Dairy adds essential Vitamin D to your diet.

● Beans help maintain energy.

● Oily fish : Higher (especially oily) fish intake in pregnancy. Although such a favourable effect has been attributed to the omega-3 fatty acid content of oily fish, it is possible that the high iodine content of oily fish is the cause for the beneficial effects on thyroid physiology and function. Balancing the level of omega 3 to omega 6 fatty acids in your hypothyroidism diet can reduce inflammation and can support healthy thyroid and neurological functions. Wild fish like salmon, mackerel and sardines are some of the best sources.

A piece of Salmon

● Sushi

● Probiotic rich food : Probiotic helps t create a healthy gut environment by balancing microflora bacteria. These include kefir (a fermented dairy product) or yogurt, kimchi, kombucha, natto, sauerkraut, and other fermented veggies.

● High fiber food : High fiber food helps with digestive health. Aim for 30-40 grams of fiber daily. Eat more fresh vegetables berries, beans, lentils and seeds .Additionally, high fiber intake can ease constipation which is common in hyperthyroidism.

● Ginger : Ginger contains zinc, magnesium, potassium. Its anti-inflammatory properties help improve thyroid functioning.

● Coconut oil : Coconut oil contains medium chain fatty acids that helps improve thyroid functioning. and supports a healthy metabolism, increase energy and fight fatigue. It also nourishes the digestive system and has anti microbial and anti oxidant and antibacterial properties that suppress inflammation. One must always prefer extra virgin, cold compressed and organic coconut oil in order to benefit from its health-promoting properties.

● Sprouted seeds : Flax, hemp and chia seeds provide ALA a type of omega 3 fat that is critical for proper hormonal balance and thyroid function.

Hemp, chia, flax seeds

● Clean water : Water helps in hydration and digestive function while preventing fatigue and moodiness, Drink at least 2 liters per day

● Iron Supplements

● Apple Cider Vinegar : Apple cider vinegar helps regulate hormones and improve their energy metabolism. Apple Cider Vinegar: Apple cider vinegar is good for hormone regulation and detoxification of the body. It helps lose weight, improve metabolic fats and carbohydrates and maintain a proper alkaline acid balance in the body. It is beneficial in controlling other chronic diseases like high cholesterol, blood pressure and diabetes. A spoonful of organic apple cider vinegar with honey in Luke-warm water will help improve thyroid activity and control the symptoms.

● Vitamin B : B vitamins are vital for healthy thyroid functions, Take adequate amount of vitamin B1,B2, B3, B5,B7, B9 and B12.

● Sea Weeds : Some of the best natural sources of iodine, which is essential for thyroid function.. These help prevent deficiencies. which disturb thyroid functions, dried kelp, nori, dulse are the best choice. Luckily, iodine is readily available in most varieties of seaweed. Other sources of iodine include seafood, dairy products, and iodized salt

Nori. This is a red algae commonly sold in dried sheets and used to roll sushi.
Sea lettuce. This is a type of green nori that looks like lettuce leaves. It is commonly eaten raw in salads or cooked in soups.
Kelp. This brown algae is usually dried into sheets and added to dishes during cooking. It can also be used as a gluten-free alternative to noodles.
also be cooked in stews and soups.
Dulse. This is a red algae with a softer, chewier texture. It is used to add flavor to a variety of dishes and may also be eaten as a dried snack.

● Bone Broth : Chicken stock contains the amino acids 1-proline and 1-glycine which can help repair the digestive lining and help hypothyroidism. Bone broth is made from a variety meaty joints and bones, simmered for an extensive period of time, and typically sipped one its own as a restorative tonic.

● Eat a Balanced Natural Diet: A balanced diet is the prerequisite to help with the symptoms of hypothyroidism. An underactive thyroid diet must contain all necessary nutrients that improve total body functions and help combat the symptoms of hypothyroidism. Most importantly, the diet should be natural without processed, canned and preserved foods or ingredients.

● Organic food consumption is most advisable. A natural diet with whole grains, vegetables and fruits help boost the immune system and reduce effects of hypothyroidism.

● Fresh fruits and vegetables help manage weight gain.: These are rich in vitamins, minerals, and antioxidants that are neccessary for combating free radical damage and lowering inflammation.

● Eating Fiber rich foods and including nuts in your diet may help eliminate hypothyroidism symptoms and improve overall health.

● Increase protein intake : Proteins help in better distribution of thyroid hormone all over the body. Protein rich diet helps in improving the reduced production of thyroid hormone by regulating the function of the thyroid gland. Nuts, green vegetables, eggs, meat and legumes are rich in protein that may help combat the symptoms of hypothyroidism.

● Go for Natural Iodine: Iodine is needed for the proper functioning of the thyroid gland. Adding the right amount of iodine helps maintain the thyroid hormone levels in the body. Reduced thyroid gland activity might be due to low iodine in diet or due to greater than required iodine content. It is best to eat foods that are naturally rich in iodine like seafood and seaweeds. Kelp is a good choice to replenish the lost iodine in the body. Avoid artificial iodine supplementation as they may increase the iodine levels than required and hamper thyroid production.

● Food rich in Selenium : Eggs, chicken, brown rice, mushrooms oatmeal's, Cashew and spinach.

● Include Probiotics in Diet: Curd, yogurt, buttermilk, lassi, probiotic are gut friendly bacteria that help better digestion and improve metabolism. Thyroid function highly depends on how healthy is your digestive system. Improper digestion and low level of good bacteria in stomach. may reduce thyroid hormone production.

● Natural fats in avocado, nuts, walnuts and animal products maintain a hormonal balance in the body. One must always prefer extra virgin, cold compressed and organic coconut oil in order to benefit from its health-promoting properties.

● Vitamin D

Avoid

● Cruciferous Vegetables Like Broccoli and Cauliflower

Cruciferous vegetables, such as broccoli and cabbage, are full of fiber and other nutrients, but they may interfere with the production of thyroid hormone.

Cabbage

Broccoli

Avoid intake alcohol, gluten based products

● Avoid Soy:

Foods With Soy, Including Edamame, Tofu, and Miso
Soy Bean

Soy Products

Tofu

Phytoestrogens in soybeans and soy-rich foods may inhibit the activity of an enzyme that makes thyroid hormones. Soy products and soybeans contain goitrogenic compounds that interfere with thyroid hormone levels in the body and make it worse for a person with hypothyroidism. Soy reduces thyroid production and causes hormonal imbalance in the body promoting the formation of goiters This may aggravate the symptoms of hypothyroidism and cause a higher deficiency in levels of thyroid hormones.

Miso Soup : basic, miso is a fermented paste that's made by inoculating a mixture of soybeans with mold called Koji that's been cultivated from rice, barley, or soybeans

Miso Soup

● High-fat food slows down the already sluggish metabolism and offers additional weight gain

● Dump Caffeine and Sugars: Caffeine and carbohydrates can disrupt the malfunctioning thyroid gland. Reduce your coffee intake and eliminate high-calorie starchy foods from your diet. Starchy foods reduce body metabolism and increase the adverse effects of hypothyroidism. Beverages like coffee, tea, and alcohol can irritate thyroid tissues and hamper thyroid production. Hence these should be completely avoided.

Sugary loaded food : Sugary food like sweets, doughnuts, and chocolates will accelerate weight gain in patients with hypothyroidism. Extra sugar also contributes to mood swings, depression and fatigue like symptoms.

● Hydrogenated oils,, white flour and artificial colors and flavors must be eliminated from the diet.

● Pine nut, and peanuts:

These are goitrogenic foods which inhibit iodine absorption and should be completely avoided in case of iodine deficiency.

Key Pointers for Hypothyroidism during Pregnancy

Avoid feasting out regularly.
Avoid soy in any form.
You will need more iodine when you are pregnant.
Do not miss out on antioxidants.
Fruits are you best in-between snack.
Sprouts are healthy addition too.
Avoid other foods that might hurt your thyroid.

"Although hyperthyroidism can be serious if you ignore it, most people respond well once hyperthyroidism is diagnosed and treated."

Prevention

Simple solution for thyroid is activity. Keep on moving
“Just imitate a grasshopper”.

Treatment

The patient’s age, weight, the severity of hypothyroidism etc. need to be monitored.

Most satisfactory endocrine therapy
Replacement therapy

● Thyroxine (T4)- is the treatment of choice. In patients over age of 50 initial dose should not exceed 0.05 mg. daily, increasing the dose every every four weeks by 0.05 mg/ day until patient is euthyroid. The optimal maintain dose varies between 0.1 - 0.2 mg of thyroxine daily.

Caution must be exercised in any patient with ischemic heart disease in whom it may be difficult to attain full replacement dosage because of angina pectorals.

Thyroid Hormone) : Thyronorm 25mcg Tablet is a medicine used to treat an underactive thyroid gland (hypothyroidism). It replaces the hormone which is not being produced by your thyroid gland in sufficient quantity and helps regulate your body’s energy and metabolism.

Before you start taking Thyronorm 25mcg Tablet, your doctor will do a blood test to see what dose you need. Once you start taking the medicine, you will have regular blood tests to see how well it is working, and the dose may be adjusted from time to time. It is best taken on an empty stomach before your first meal of the day. You should take this medicine regularly to get the maximum benefit. It may take several weeks before your symptoms start to improve. You may need to take it for the rest of your life. If you stop taking it, your symptoms are likely to come back.

"For most people, this is a lifelong medication and should not be discontinued without talking to your doctor."

The most common side effects of this medicine are caused by taking a higher dose than you need. Possible side effects include palpitations (irregular heartbeat), vomiting, anxiety, diarrhea, weight loss, nervousness, or restlessness. Most side effects will disappear once you are on the right dose. Call your doctor straight away if you have a very high temperature, fast or irregular heart rate, low blood pressure, yellowness in the eye/skin, confusion, or fits.

Thyronorm 25mcg Tablet may cause weight loss but should not be prescribed or taken to treat obesity. If you become pregnant while taking this medicine, inform your doctor right away as the dose may have to be increased/readjusted. Many other drugs affect the way this medicine works. Ask your doctor for advice if you are taking any other medications.

"Thyroxine given to elderly may precipitate angina."

Precaution

Leave a gap of at least 4 hours before taking any antacids, calcium or iron supplements, and multivitamins, as these may interfere with the effect of the medicine.

Get your hormone levels checked regularly and inform your doctor if you notice a significant change in your body weight. The dose may need to be adjusted.

SIDE EFFECTS OF THYRONORM TABLET

Most side effects do not require any medical attention and disappear as your body adjusts to the medicine. Consult your doctor if they persist or if you’re worried about them

Common side effects of Thyronorm
Nervousness
Restlessness
Anxiety
Diarrhea
Palpitations
Vomiting
Flushing (sense of warmth in the face, ears, neck and trunk)
Weight loss
HOW TO USE THYRONORM TABLET
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Thyronorm 25mcg Tablet is to be taken empty stomach.
HOW THYRONORM TABLET WORKS
Thyronorm 25mcg Tablet is a synthetic version of a hormone produced by the thyroid gland. It works by replacing the thyroid hormones that your thyroid gland cannot produce in a sufficient quantity, and relieves the symptoms of hypothyroidism (tiredness, weight gain, and depression).
SAFETY ADVICE
Alcohol
SAFE
Consuming alcohol with Thyronorm 25mcg Tablet does not cause any harmful side effects.
Pregnancy
SAFE IF PRESCRIBED
Thyronorm 25mcg Tablet is safe to use during pregnancy. Most studies have shown low or no risk to the developing baby.
Breast feeding
SAFE IF PRESCRIBED
Thyronorm 25mcg Tablet is safe to use during breastfeeding. Human studies suggest that the drug does not pass into the breastmilk in a significant amount and is not harmful to the baby.
Driving
SAFE
Thyronorm 25mcg Tablet does not usually affect your ability to drive.
Kidney
CONSULT YOUR DOCTOR
There is limited information available on the use of Thyronorm 25mcg Tablet in patients with kidney disease. Please consult your doctor.
Liver
CONSULT YOUR DOCTOR
There is limited information available on the use of Thyronorm 25mcg Tablet in patients with liver disease. Please consult your doctor.
WHAT IF YOU FORGET TO TAKE THYRONORM TABLET?
If you miss a dose of Thyronorm 25mcg Tablet, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

●  Treat by stopping drugs : Drug induced : Anti thyroid drugs, amiodarone, lithium ,iodine( in expectorants), para amino salicylic acid. PAS antitubercular drug,(treat by stopping drug.)

●  Levothyroxine is a medicine used to treat an underactive thyroid gland (hypothyroidism). The thyroid gland makes thyroid hormones which help to control energy levels and growth. Levothyroxine is taken to replace the missing thyroid hormone thyroxine. Levothyroxine is only available on prescription. Women with subclinical hypothyroidism who have elevated titers of thyroid peroxidase antibody (T.P.O. Ab)  should be treated with levothyroxine

●  Iodine supplementation is recommended as a treatment of maternal hypothyroidism in severely iodine deficient populations.  Iodine deficiency mountainous area; if supplementation with one dose of 400 mg iodized oil to the mother rather than 100 mg directly to the nursing infant was more effective in terms of reducing the frequency of infant thyroid hypofunction.

"On the other hand, excessive iodine supplementation should be avoided".

supplementation of 150 μg daily during pregnancy and lactation. It is important to note that these guidelines were based on urinary iodine concentration which is a population assessment of iodine status, but not so useful as a tool for the assessment of the iodine status of an individuals.

Following childbirth, it is common practice to reduce the levothyroxine dose to pre-pregnancy levels immediately post-delivery, although some authors advocate that the dose should be reduced to the pre-pregnancy levels two weeks post-partum, followed by repeated TFTs

One dose of 400 mg Iodized oil to the mother rather than 100 mg directly to the nursing infant was more effective in terms of reducing the frequency of infant thyroid hypofunction

Ayurveda

● Guggul

● Consume Ashwagandha (Indian Ginseng).

https://madhuchhandacdmo.blogspot.com/2022/02/hypothyroidism-in-pregnancy.html

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