Maternal Demographic Characteristics And Thyroid Function
Maternal demographic characteristics of the case and control groups are shown in Table 1. No significant differences were observed between the two groups in the following parameters: median maternal age, gestational age, BMI, smoking history, alcohol consumption, history of miscarriage and family history of thyroid disease, high blood pressure. Serum TSH levels were significantly higher in the case group compared to the control group . In TPOAb-negative women, serum TSH levels were significantly higher in the case group compared to the control group . After additional exclusion of TgAb-positive women, TSH levels were also higher in the case group compared to the control group . No significant differences in FT4 levels, TPOAb and TgAb were observed between the two groups .
What Is Thyroid Disorder
The thyroid gland, located at the front of the neck just below the voice box, is part of the endocrine system, which produces all of the hormones in your body. The hormones your thyroid creates play a key role in regulating your metabolism the way your body uses energy along with your temperature, weight, cholesterol levels and other key body functions.
Production of thyroid hormones, in turn, is regulated by levels of thyroid-stimulating hormone , generated by your pituitary gland . The levels of thyroid hormones in your blood naturally fluctuate throughout the day usually, the pituitary gland responds by creating more or less TSH.
Hypothyroidism , can cause many of the bodys functions to slow down, or hyperthyroidism , can cause many of the bodys functions to speed up.
Association Of Miscarriage With Thyroid Autoimmunity
Miscarriage is defined as pregnancy failure before 24 weeks of gestation. Approximately 10 to 15% of all pregnancies end in early spontaneous miscarriage before 10 weeks of pregnancy. Chromosomal abnormalities, advanced maternal and paternal age, underweight or overweight, smoking, and high alcohol consumption are known to be associated with increased chance of miscarriage. It may also occur due to antiphospholipid syndrome, uterine abnormalities, endocrine abnormalities, and use of various drugs.28)
Liu et al.29) investigated the miscarriage frequency in pregnant women according to the presence of thyroid autoantibodies and serum TSH levels. They reported that the presence of autoantibodies increased the risk of miscarriage by 2.7 to 9.6 times irrespective of the serum TSH levels, and TSH level above 5.2 mU/L increased the risk of miscarriage by 3.4 to 9.6 times regardless of the presence of autoantibodies. They emphasized that the risk of miscarriage also increased 5-fold when autoantibodies were accompanied with a TSH within the range of 2.5-5.2 mU/L.
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Who Should Be Treated For Hypothyroidism During Pregnancy
Women found to have a TSH level greater than 10 mIU/L in the first trimester of pregnancy should be treated for hypothyroidism. Conversely, women with a TSH of 2.5 or less, do not need levothyroxine treatment. For women with TSH measured between these , ATA recommendations for treatment vary and may depend on whether or not the mother has TPO antibodies. When TPO antibodies are positive, treatment is recommended when the TSH is above 4 and should be considered when the TSH is between 2.5-4.0. However, when there are no TPO antibodies , current ATA recommendations are less strong and suggest that treatment may be considered when TSH is between 2.5-10.0 mIU/L. These recommendations are based on the degree of evidence that exists that treatment with levothyroxine would be beneficial.
How Should A Woman With Hypothyroidism Be Treated During Pregnancy
The goal of treating hypothyroidism in a pregnant woman is adequate replacement of thyroid hormone. Ideally, hypothyroid women should have their levothyroxine dose optimized prior to becoming pregnant. Levothyroxine requirements frequently increase during pregnancy, usually by 25 to 50 percent. Hypothyroid women taking levothyroxine should independently increase their dose by 20%30% as soon as pregnancy is diagnosed and should notify their doctor for prompt testing and further evaluation. One means of accomplishing the dose increase is to take two additional tablets weekly of their usual daily levothyroxine dosage. Thyroid function tests should be checked approximately every 4 weeks during the first half of pregnancy to ensure that the woman has normal thyroid function throughout pregnancy. As soon as delivery of the child occurs, the woman may go back to her usual prepregnancy dose of levothyroxine. It is also important to recognize that prenatal vitamins contain iron and calcium that can impair the absorption of thyroid hormone from the gastrointestinal tract. Consequently, levothyroxine and prenatal vitamins should not be taken at the same time and should be separated by at least 4 hours.
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How Is Hypothyroidism During Pregnancy Treated
The treatment for hypothyroidism is often referred to as thyroid hormone replacement therapy. It uses the medication levothyroxine to bring your thyroid hormone levels back up to normal. According to the Food and Drug Association , levothyroxine is safe to take in pregnancy. What is unsafe is having hypothyroidism.
Levothyroxine is available in different forms and brands, including:
As we mentioned, women who take thyroid medications will usually need a higher dose during pregnancy, but hyperthyroidism is also dangerous to an unborn baby. Just remember, never change the dose of your thyroid medication without your provider first.
If you have a history of thyroid issues, the sooner you see your doctor the better ideally, even before trying to conceive. This way, your doctor can make sure your hormone levels are normal as you prepare for pregnancy.
What Are The Risks Of Graves’ Disease/ Hyperthyroidism To The Mother
Graves disease may present initially during the first trimester or may be exacerbated during this time in a woman known to have the disorder. In addition to the classic symptoms associated with hyperthyroidism, inadequately treated maternal hyperthyroidism can result in early labor and a serious complication known as pre-eclampsia. Additionally, women with active Graves disease during pregnancy are at higher risk of developing very severe hyperthyroidism known as thyroid storm. Graves disease often improves during the third trimester of pregnancy and may worsen during the post partum period.
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What Are Clinical Trials And Are They Right For You
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.
How Does Pregnancy Affect Thyroid Function
Thyroid hormone levels increase during pregnancy to support you and your baby. While your babys own thyroid starts working in week 10 to 12 of pregnancy, it only fully matures in the third trimester. Until then, your baby relies on your supply of thyroid hormone for their brain development.
Good thyroid function is therefore important during pregnancy for both the mother and babys health.
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Management Of Hyperthyroidism During Pregnancy
Treatment for hyperthyroidism is very specific for each patient. The goal of treatment is to maintain normal levels of thyroid hormone. Treatment may include:
- Frequent monitoring of thyroid levels throughout pregnancy
- Use of anti-thyroid drugs that help lower the level of thyroid hormones in the blood
- Surgery to remove part of the thyroid
Symptoms Of Hypothyroidism In Pregnancy
Do any of the following sound familiar? While common in pregnancy, its still best to play it safe and mention them to your doctor:
- Extreme fatigue
- Rarely, congestive heart failure for the mother
Your doctor will discuss the symptoms youve been experiencing and then run a blood test to check for levels of TSH and T4 .
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What Are The Symptoms Of Postpartum Thyroiditis
The hyperthyroid phase often has no symptomsor only mild ones. Symptoms may include irritability, trouble dealing with heat, tiredness, trouble sleeping, and fast heartbeat.
Symptoms of the hypothyroid phase may be mistaken for the baby bluesthe tiredness and moodiness that sometimes occur after the baby is born. Symptoms of hypothyroidism may also include trouble dealing with cold dry skin trouble concentrating and tingling in your hands, arms, feet, or legs. If these symptoms occur in the first few months after your baby is born or you develop postpartum depression, talk with your doctor as soon as possible.
Inclusion Of Carrots And Eggs In The Diet
The thyroid gland functions properly when the quantity of vitamin A in the body is good enough. Any nutritional deficiency in that regard could affect the levels of thyroid hormones. Eggs are the best bet here since they are known to have good quantities of Vitamin A. If you are a strict vegetarian, the best option for you would be to consume carrots or even pumpkins, since both consist of vitamin A. However, it is recommended to not overdo with their consumption during pregnancy and keep it in moderation.
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Tips On How To Reduce Tsh Levels During Pregnancy Naturally
Aliya KhanIn this Article
Physical change is just one of the things a woman undergoes when she gets pregnant- there are hormonal changes within the body as well, and thyroid-related issues are faced by many women during pregnancy. The increase in weight, mood swings, hair fall, etc. are all signs that your body is not producing the thyroid hormone as much as normally required. This leads to an increase in the TSH levels.
Hypothyroidism Treatment During Pregnancy
Your doctor will prescribe a synthetic hormone called levothyroxine which is not only safe during pregnancy, its vital to both you and your baby. Work with your endocrinologist and obstetrician to determine the right dose for you. If you had preexisting hypothyroidism, they will likely need to increase your levels, since the body requires more thyroid hormones when its in baby-growing mode.
During pregnancy and postpartum, your thyroid hormone levels will be monitored every six to eight weeks to see if your dose needs further adjustment.
In addition to medication, be sure to eat a healthy balanced diet and take a prenatal vitamin. Most likely your doctor will also suggest a supplement of 150 micrograms iodine a day during pregnancy , since iodine is important for thyroid health. Youll also find iodine in seafood and iodized salt, so opt for that over sea salt.
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Untreated Low Thyroid Function During Pregnancy Can Cause Trouble
With commentary by Spyros Mezitis, MD, PhD, an endocrinology consultant and clinical investigator for Lenox Hill Hospital, New York City
Treating pregnant women with low thyroid function severe enough to produce symptoms does help them avoid ill effects such as high blood pressure, according to a new study that evaluated thousands of women. Women not treated have more adverse effects, the researchers found. The researchers also found the threshold at which to treat women for this hypothyroidism, however, may be higher than some experts currently believe, the researchers say.
The researchers, from the University of Texas Southwestern Medical Center, evaluated the pregnancy outcomes of more than 26,000 women, publishing their results online July 8 in the American Journal of Obstetrics & Gynecology.
Women had been pregnant in the years 2000 to 2003. In all, 47 were confirmed to have hypothyroidism with symptoms, called overt hypothyroidism, and were treated. Another 182 women had an abnormal result indicating hypothyroidism on the first blood test but did not have the typical follow up test to confirm it and were not treated. Those untreated women who had levels above 4.5 on the initial test had higher rates of pregnancy-related high blood pressure than women with normal thyroid test results, lending further support to the value of treating low thyroid function during pregnancy, the researchers say.
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472679/
How Is Hypothyroidism Diagnosed
It can actually be difficult to diagnose hypothyroidism because the symptoms can be easily confused with other conditions. If you have any of the symptoms of hypothyroidism, talk to your healthcare provider. The main way to diagnose hypothyroidism is a blood test called the thyroid stimulating hormone test. Your healthcare provider may also order blood tests for conditions like Hashimotos disease. If the thyroid is enlarged, your provider may be able to feel it during a physical exam during an appointment.
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How Can Hyperthyroidism Affect Me And My Baby
Untreated hyperthyroidism during pregnancy can lead to
- preeclampsiaa dangerous rise in blood pressure in late pregnancy
- thyroid storma sudden, severe worsening of symptoms
- congestive heart failure
Rarely, Graves disease may also affect a babys thyroid, causing it to make too much thyroid hormone. Even if your hyperthyroidism was cured by radioactive iodine treatment to destroy thyroid cells or surgery to remove your thyroid, your body still makes the TSI antibody. When levels of this antibody are high, TSI may travel to your babys bloodstream. Just as TSI caused your own thyroid to make too much thyroid hormone, it can also cause your babys thyroid to make too much.
Tell your doctor if youve had surgery or radioactive iodine treatment for Graves disease so he or she can check your TSI levels. If they are very high, your doctor will monitor your baby for thyroid-related problems later in your pregnancy.
An overactive thyroid in a newborn can lead to
- a fast heart rate, which can lead to heart failure
- early closing of the soft spot in the babys skull
- poor weight gain
Sometimes an enlarged thyroid can press against your babys windpipe and make it hard for your baby to breathe. If you have Graves disease, your health care team should closely monitor you and your newborn.
What Causes Hypothyroidism In Pregnancy
Hypothyroidism in pregnancy is usually caused by Hashimotos disease and occurs in 2 to 3 out of every 100 pregnancies.1 Hashimotos disease is an autoimmune disorder. In Hashimotos disease, the immune system makes antibodies that attack the thyroid, causing inflammation and damage that make it less able to make thyroid hormones.
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What Does Your Tsh Mean
Weve been talking a lot about the TSH so far but I havent really explained what it is and why it is important.
The TSH stands for Thyroid Stimulating Hormone and it is one of the lab tests used to assess thyroid function in both pregnant and non-pregnant women.
Your body produces TSH to stimulate the thyroid gland to produce thyroid hormone.
It sounds simple to understand, and it is, but its a little bit counterintuitive.
A low TSH is usually an indication of hyperthyroidism while a high TSH is usually indicative of hypothyroidism.
In pregnancy, a high TSH is an indication that your body is not producing enough thyroid hormone which means you may need to use thyroid medication.
As you take thyroid medication your TSH will begin to lower.
So, if you become pregnant and find that your TSH is 5.0 that is an indication that you need to take thyroid medication to help supplement the hormone that your body is producing.
As you take thyroid medication your TSH will fall to a lower level.
Doctors use TSH to help determine how much thyroid medication you may need.
Following the example illustrated above it may look something like this:
This is generally how TSH is used both in pregnancy and outside of it.
Even though we are discussing TSH in this article, its still important to know that they are other tests that can also be used to test your thyroid.
These other tests include the free thyroid hormones free T3 and free T4.
Symptoms Of Hyperthyroidism In Pregnancy
- Irregular or increased heartbeat
- Weight loss or less weight gain than a typical pregnancy
The good news: If you had preexisting Graves Disease, you may actually see an improvement and even remission in symptoms in the second and third trimesters, since the body suppresses the immune system during pregnancy. And if your condition was linked to hyperemesis gravidarum, it will likely disappear along with nausea and vomiting in the second trimester due to lower levels of hCG.
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How Can You Avoid The Complications Of Hypothyroidism In Pregnancy
Several medical associations and organizations have made recommendations on screening for thyroid disease.
Some of the recommendations are:
The management of each woman’s situation is considered individually after consultation with her physician. The benefits of treatment extend not only to pregnant women with hypothyroidism but also to their children.
How Can Hypothyroidism Affect Me And My Baby
Untreated hypothyroidism during pregnancy can lead to
- preeclampsiaa dangerous rise in blood pressure in late pregnancy
- congestive heart failure, rarely
These problems occur most often with severe hypothyroidism.
Because thyroid hormones are so important to your babys brain and nervous system development, untreated hypothyroidismespecially during the first trimestercan cause low IQ and problems with normal development.
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Womens Wellness: Pregnancy And Thyroid Disorders
It is estimated that more than 20 million Americans take some form of thyroid hormone replacement for thyroid disease.
The thyroid a butterfly-shaped gland at the base of the throat controls the metabolism of many of the bodys systems. An underactive thyroid can cause a number of health problems if left untreated, including unexplained fatigue, weight gain, difficulty with memory, constipation and depression. An overactive thyroid can cause weight loss, rapid heartbeat, excessive sweating and tremors.
Women are at greater risk of developing thyroid disorders. Dr. Robert Smallridge, a Mayo Clinic endocrinologist, says about 80% of all thyroid conditions occur in women. We do not understand fully why that might be, but its well established, he says. We also know women suffer from hypothyroidism in particular more often than men.
Journalists: Broadcast-quality sound bites with Dr. Smallridge are in the downloads at the end of the post. Please “Courtesy: Mayo Clinic News Network.”
Hypothyroidism is a condition in which the thyroid gland doesn’t produce enough thyroid hormone.
Although the conditiontends to be more common in someone in their 50s, 60s and 70sthan early in life, Dr. Smallridge says that, for a small subset of adultwomen, pregnancy also can cause low levels of thyroid hormone, known as thyroxineor T4.
Women are also at riskafter delivery as well.