How hypothyroidism arises in pregnant women: Upon entering pregnancy, the thyroid gland has to work overtime and expand its production capacity in order to meet the increasing metabolic demands of both the pregnant woman and the fetus. So the question arises, which is the best thyroid function? Is it possible to expand the production capacity just because you say so? 1, before pregnancy has been clearly diagnosed hypothyroidism The most common cause of hypothyroidism disease —- “Hashimoto’s thyroiditis” is originally preferred in women of childbearing age. Therefore, the treatment of hypothyroidism, while preparing for pregnancy and pregnancy of the mother-to-be is not a minority, so that a weak sick horse and then wearing heavy armor to run to the frontier, the result can be imagined. 2, a variety of reasons for the new onset of hypothyroidism during pregnancy This is also understandable, due to the existence of certain problems in the thyroid gland itself, although it can barely perform its daily work, not to show any abnormality, but can not withstand the high intensity of the load of the state of pregnancy. It is just like the Sino-Japanese War before the North Atlantic naval division, usually flaunted the first in East Asia, in fact, internal and external problems and crises, to the face of a powerful opponent in wartime, quickly collapsed and crumbled. Regardless of the situation, it needs to be clear: hypothyroidism in pregnancy must be corrected, otherwise it is likely to lead to the occurrence of many adverse pregnancy events, including miscarriage, preterm labor, pre-eclampsia, gestational hypertension, postpartum hemorrhage, low birth weight, stillbirth, and fetal mental and psychological developmental damage, and so on. First of all, let’s talk about the prevention of hypothyroidism in pregnancy: 1. For female compatriots who are being treated for hypothyroidism and plan to get pregnant, the doctor’s advice is: 1.1 Control serum TSH to <2.5miu/l level through treatment before getting pregnant, and the more ideal goal is to let tsh between 0.1~1.5miu/l;< strong=""> 1.2 Once pregnant, increase the dose of the medication by 25%-30% from the original level; 1.2 Increase the dose of medication by 25%-30% from the original level. The easiest way to do this is to increase the dose by an extra two days per week (a 29% increase), after which it has to be adjusted according to the target value. In other words, for all healthy pregnant women without a history of hypothyroidism, although due to national constraints, China has not yet carried out thyroid screening for pregnant women, doctors still recommend: 2.1 recommend that pregnant women who are in a position to do so should be screened for thyroid disease at an early stage of pregnancy, and that screening should include the following: serum TSH, FT4, and TPOAb; 2.2 choose the time for screening to be before the eighth week of gestation, and preferably before pregnancy. In the special state of “pregnancy”, many expectant mothers are afraid of the words “disease” and “medication”. In fact, as long as the timely diagnosis, “hypothyroidism in pregnancy” is not at all terrible. Its treatment can even be summarized in three words: effective, safe and economical. Don’t miss out on such a simple and inexpensive disease. As long as the following principles are grasped, there is no worry about the smooth passage: 1, “levothyroxine (LT4)” is currently the only correct treatment of hypothyroidism in pregnancy medication, if someone is still using thyroid tablets, LT3, or LT4/LT3 combined preparations, should be changed, change the doctor; 2, serum TSH is the most important therapeutic assessment indicators , the target value in various periods of pregnancy is not the same, specifically: early pregnancy (0-12 weeks) 0.1 ~ 2.5 mIU / L, mid-pregnancy (13-27 weeks) 0.2 ~ 3.0 mIU / L, second trimester (28-40 weeks) 0.3 ~ 3.0 mIU / L; (generally less than 2.5 is good) 3, after the end of pregnancy, the LT4 dose to be adjusted back to the pre-pregnancy level, and It is recommended to recheck the TSH level at 6 weeks postpartum for further dose adjustment. There are a bunch of specialized vocabulary and many figures, and you may be tired of reading them again. In fact, the actual clinical situation is much more complicated than the above understated sentences. For example, between “normal” and “hypothyroidism”, there is also the state of “subclinical hypothyroidism”. Subclinical hypothyroidism is a condition in which a pregnant woman’s serum TSH level is higher than the upper limit of normal for pregnancy, while her FT4 level remains normal. This is roughly the state in which the thyroid has worked overtime to complete its assigned task, but is tired and unloved. A growing body of research suggests that this state also increases the risk of pregnancy, but treatment is dependent on another important indicator: thyroid peroxidase antibodies (TPOAb). 1. if TPOAb is negative, treatment is controversial and non-committal due to insufficient evidence-based evidence; 2. if TPOAb is positive, LT4 treatment is recommended, with the same treatment goals as before; in addition, as long as TPOAb is positive, even if TSH and FT4 are normal, it is necessary to review thyroid function periodically, because it reflects that the thyroid gland is suffering from autoimmune damage, and that the transition from compensated to decompensated is only a matter of time. This is because it reflects that the thyroid is suffering from autoimmune damage, and it is only a matter of time from compensation to decompensation. In addition to normal, gestational hypothyroidism, and subclinical hypothyroidism, there is also a hypothyroxinemic state, in which the TSH level is normal and the FT4 is below the lower cut-off point. (voice-over sounds: Enough, are you done?!) Sentimentally, it seems that hypothyroxinemia should be corrected, but modern medicine does not rely on speculation but on empirical evidence, and for the time being, there is a lack of evidence in this regard, so again, I can only be non-committal.