Brief Answer:
Treatment should be started as soon as possible

Detailed Answer:
Hi XXXX,

I have gone through your wife's reports. According to them, she is overtly hypothyroid with Thyroid peroxidase antibodies (TPO) levels greatly increased. Another report is of platelet count, which is normal.

In pregnancy, the protein levels are altered and hence the thyroid function is measured by TSH, free T3 and free T4 values. T3 and T4 do not give the correct picture as they are protein bound and hence levels are altered. That is why T3 and T4 levels are normal in her reports, despite TSH being so high depicting hypothyroidism and hence decreased thyroid function.

With such high levels of TPO antibodies, she is having autoimmune thyroiditis, and is at risk of other autoimmune diseases especially diabetes mellitus, developing due to damage of pancreatic cells by the autoantibodies. She is also at high risk of developing post partum thyroiditis, in which there is greatly decreased thyroid activity post delivery.

I would suggest you to consult your OBGYN specialist and get her started on appropriate doses of replacement therapy of levothyroxine tablets.

Moreover, I would suggest you to get her blood sugar levels checked (oral glucose tolerance test with 75 gm glucose preferred; she can get fasting and post prandial levels checked if she is having nausea and vomiting and cannot tolerate 75 gm glucose) so that diabetes can be detected early and treated in time preventing complications to both mother and fetus.

Her TSH and free T4 levels should be repeated after 2 weeks of starting levothyroxine; the two weekly test to be repeated and dose adjusted till the TSH and FT4 levels are normal for that trimester of pregnancy. When the levels become normal, the tests are to be repeated monthly till delivery.

Special attention should be given during delivery and especially if there is a caesarean section, as TSH and FT4 levels effect the anesthetic drugs.

After the childbirth, TSH and FT4 levels should be repeated 6 weeks and 6 months after delivery and dose has to be adjusted accordingly.

Urgent treatment should be initiated now as the fetus is dependent on mother for its thyroid hormone in first 3 months, and decreased levels can lead to adverse consequences.

Hope you found the answer helpful. Please do get back for further queries.
Wishing you both good health.
Regards,
Dr Deepti Verma

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Brief Answer:
Urine culture should be done

Detailed Answer:
Hi XXXX, thanks for responding.The report of the hemogram is normal.
The urine report shows 8-9 pus cells per high power field, which can be due to urinary tract infection , which is common in pregnancy. I would suggest you to get her urine culture and sensitivity test done so that the bacteria responsible for infection can be found out and appropriate antibiotics can be given.
The obstetric scan is normal showing single live intrauterine fetus of 8 weeks with good trophoblastic reaction and regular gestational sac margins. All these are good signs of a normal pregnancy.
By OBGYN specialist, I mean an obstetrician and gynaecologist (OBGYN).
Hope you found the answer helpful. Please do get back for further queries.
Wishing you both good health.
Regards,
Dr Deepti Verma

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Brief Answer:
Caesarean section not mandatory

Detailed Answer:
Hi XXXX, thanks for responding.
Yes, she should start the levothyroxine tablets given by her doctor.
Caesarean section will be required in case of any obstetric or fetal complication. I have mentioned that the thyroid hormone levels should be maintained in normal range so that if caesarean section is required, due to any complication, then it may not pose any problem in anaesthesia. Caesarean section has no role in treatment of hypothyroidism in pregnancy, neither caesarean section is mandatory in patient with hypothyroidism. She can very well have a normal vaginal delivery, if all other conditions are favourable.
Hope you found the answer helpful. Please do get back to me with the reports.
Wishing you both good health.
Regards,
Dr Deepti Verma

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