Thyroid Physiology and Pregnancy

• Significant changes in thyroid physiology take place during pregnancy that can make the interpretation of thyroid function tests challenging.
• Tyroxine binding globulin (TBG) levels:
  • Increase by 50% by the end of the first trimester of pregnancy:
    • Which greatly increases the protein-bound levels of T4 and T3:
      • Resulting in an apparent elevation of measured T4 and T3.
  • The changes in TBG are thought to be due to:
    • The direct effect of estrogen:
      • With an increase in the liver production and glycosylation of TBG.
  • Despite the elevation of protein-bound thyroid hormones during pregnancy:
    • The active or free levels of T4 and T3 remain normal in euthyroid patients:
      • As reflected by a normal serum TSH level.
• During the first trimester:
  • The placental human chorionic gonadotropin (hCG) increases:
    • And peaks at approximately 12 to 14 weeks of pregnancy and then decreases to a lower plateau in the second and third trimesters in the euthyroid individual.
  • hCG has a weak TSH-like activity:
    • Resulting in a small increase in free T4:
      • Which usually remains in the normal range, and a concomitant decrease in TSH.
• Up to 13% of women during the first trimester have unmeasurable TSH levels (< 0.1 mud/L) with a normal or slightly elevated FT4I and are clinically euthyroid:
  • This suppression of TSH usually normalizes after the first trimester of pregnancy.

 

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

• He is an expert in the management thyroid cancer

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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http://www.cirugiatiroides.com

http://www.sociedadquirurigca.com

http://www.hiperparatiroidismo.info