Thyroid disorders and pregnancy.

During pregnancy physiologic changes in thyroid function occur which should not be misinterpreted as pathological. Thyroid disorders may complicate pregnancy and need thorough investigation and treatment in order to ensure a favourable pregnancy outcome. The incidence of hyperthyroidism in pregnant women has been reported to be approximately 0.2%. The leading cause is Graves' disease. Treatment of hyperthyroidism includes antithyroid drugs or surgery to avoid adverse effects on the neonate such as prematurity, intrauterine growth retardation and fetal or neonatal thyrotoxicosis. Use of radioactive iodine is contraindicated. Hypothyroidism during pregnancy is associated with gestational hypertension and low birth weight. Women on thyroid replacement therapy before pregnancy may require an increase in dosage during pregnancy. Pregnant women with chronic autoimmune thyroiditis have a higher incidence of spontaneous miscarriage. Nodular disease demands meticulous investigation to rule out a toxic adenoma or malignancy. Surgery in the case of cancer can be postponed under certain circumstances. Within one year following delivery, about 5-10% of women may exhibit postpartum autoimmune thyroid dysfunction, which may result in hypothyroidism.

Reproductive health in patients with beta-thalassemia.

Homozygous transfusion-dependent beta-thalassemia patients manifest cardiac, hepatic, endocrine, and metabolic disorders attributable to chronic anoxia and iron overload. Short stature, delayed sexual maturation, diabetes mellitus, hypothyroidism, hypoparathyroidism, and metabolic bone disease can and should be diagnosed as early as possible so that the intervention can be fruitful. Primary or secondary amenorrhea is due primarily to pituitary gonadotrope hemosiderosis, as attested by pathology data and the demonstration in vivo of nonstimulable follicle-stimulating hormone and luteinizing hormone release and secretion after the exogenous administration of gonadotropin-releasing hormone or its agonistic analogs. Ovulation can be achieved with the use of exogenous gonadotropins provided that the ovary has no siderosis (as seen in neglected patients) or damage induced by drugs used for bone marrow transplantation. Once pregnancy is achieved, it should be considered high risk and be dealt with or cared for by an expert team to ensure a successful outcome.