Obstetric & Gynaecology Malaysia


What is thyroid disease?

The thyroid gland is located at the base of your neck in front of your trachea (or windpipe). The thyroid gland makes, stores, and releases two hormones—T4 =thyroxine(normal FT4 level 7.5-21 pmol/L )and T3 =triiodothyronine.

Certain disorders can cause the thyroid gland to make too much or too little hormone. Women at risk of thyroid disease include those who have or have had an autoimmune disease (such as diabetes mellitus).


What is the function of the thyroid gland?

Thyroid hormones control your metabolism, which is the rate at which every part of your body works.

The thyroid gland is controlled by the pituitary gland (a gland in your brain). The pituitary gland makes thyroid-stimulating hormone (TSH=0.5-5 mUI/mL). TSH tells the thyroid gland to make more hormone if needed.

 How is thyroid disease diagnosed?

Thyroid disease is diagnosed by your symptoms, an exam, and tests. Symptoms of thyroid disease can be much like symptoms of other health problems especially pregnancy.

Your health care professional will examine your neck while you swallow. The thyroid gland moves when you swallow. This makes it easier for your health care professional to feel.

What tests are used to diagnose thyroid problems?

The following tests may be used to help find the exact cause of a thyroid problem:

Blood tests & ultrasound exam of the thyroid


What is hypothyroidism?

Hypothyroidism occurs when the thyroid gland does not make enough of the thyroid hormones to maintain your normal body metabolism.

What causes hypothyroidism?

The most common cause of hypothyroidism is a disorder known as thyroiditis—an inflammation of the thyroid gland. In this disease, the immune system—mistakes cells in the thyroid gland for harmful invaders. The pituitary gland then releases TSH to tell the thyroid gland to make more thyroid hormone. This demand on the thyroid gland can cause it to enlarge. This enlargement is called a goiter. Hypothyroidism also can result from a diet that does not have enough iodine. Accordingly, in November 2018, the whole of Malaysia has been gazetted to use iodine salt mandatory for household use and will take effect from 30 September 2020.

What are the symptoms of hypothyroidism?

The symptoms of hypothyroidism are slow to develop. Common symptoms of hypothyroidism include the following:

  • Fatigue or weakness , loss of sex drive
  • Weight gain, decreased appetite
  • Constipation, muscle aches
  • Feeling cold when others do not, puffiness around the eyes, brittle nails, hair loss
  • Change in menstrual periods-heavy menses


What treatment is available for hypothyroidism?

In most cases, hypothyroidism is treated with medication that contains thyroid hormone. The dosage of the medication is increased slowly until a normal level of thyroid hormone has been reached in the blood.

Can I be treated for thyroid disease if I am pregnant?

Yes, it is important to be treated for thyroid disease when you are pregnant.

Thyroxine in Pregnancy

Levothyroxine (Class A) has not been shown to increase the risk of congenital abnormalities or miscarriage.

Maternal hypothyroxinemia, (less than FT4 12pmol/L), however, can be associated with adverse effects in the mother and fetus, including spontaneous abortion, stillbirth, premature birth, low birth weight, impaired neurocognitive development in the off-spring, abruptio placentae, gestational hypertension, and preeclampsia.

Thyroid replacement therapy minimizes the risk of adverse pregnancy outcomes in females with overt hypothyroidism and treatment is recommended during pregnancy. Levothyroxine is the preferred treatment of maternal hypothyroidism; other agents should not be used in pregnant females.

Levothyroxine is also recommended in some cases of subclinical hypothyroidsim (TSH>5 mUI/mL) during pregnancy, and overt hypothyroidism in females with postpartum thyroiditis. Due to alterations of endogenous maternal thyroid hormones, hypothyroid patients treated with levothyroxine prior to pregnancy require a dose increase as soon as pregnancy is confirmed. Close monitoring of pregnant patients is recommended.

Some breastfeeding mothers with hypothyroxinemia struggle to make a full milk supplyThyroid hormones play a role in normal breast development and helping breasts to make milk. When not enough of the thyroid hormones are made, a mother's milk supply may be affected.

Goitrogenic Food

Cruciferous Vegetables-Bok choy, broccoli, cabbage, cauliflower, mustard greens, spinach.

Fruits and Starchy Plants-Bamboo shoots, cassava, corn, peanuts, pears, sweet potatoes, strawberries

Soy-Based Foods-Tofu, tempeh, edamame, soy milk=phytoestrogen

What is hyperthyroidism?

Hyperthyroidism results when the thyroid gland makes too much thyroid hormone. This causes your metabolism to speed up.

What are the causes of hyperthyroidism?

The most common cause of hyperthyroidism is a disorder known as Graves disease. It most often affects women between the ages of 20 years and 40 years. Hyperthyroidism also may result from medication. Taking too much thyroid hormone when being treated for hypothyroidism can lead to symptoms of an overactive thyroid. Lumps in the thyroid called hot nodules are another cause. These lumps produce excess thyroid hormone.

 What are the symptoms of hyperthyroidism?

Common symptoms of hyperthyroidism include the following:

  • Rapid heartbeat, feeling hot when others do not, increased sweating, tremors
  • Weight loss, more frequent bowel movements
  • Nervousness or
  • Reduction in menstrual flow.


What treatment is available for hyperthyroidism?

Anti-thyroid medication can be used to reduce the amount of thyroid hormone your body is making. Medications known as beta-blockers control rapid heart beat.

 What are thyroid nodules?

A nodule is a lump in the thyroid gland. When a thyroid nodule is found, it will be checked to see if it is benign (not cancer) or malignant (cancer). Your health care professional may use an ultrasound exam to examine the nodule. Nodules may be further examined by a procedure known as fine-needle aspiration or biopsy.

If no cancer cells are found, your health care professional may either prescribe medication to decrease the size of your nodule or suggest surgery to remove it. If cancer cells are found, further treatment will be needed. Thyroid cancer usually can be treated with success.