What Is The Link Between Iodine Deficiency And Thyroid Function In Pregnancy
Having too little iodine in your body is a common cause of low thyroid hormone levels. A study found that, on average, Australian women consume 100 micrograms of iodine a day. However, the World Health Organization recommends a daily intake of least 250 micrograms of iodine during pregnancy and breastfeeding.
Australian guidelines recommend that pregnant and breastfeeding women take a supplement containing 150 micrograms of iodine each day .
Check with your antenatal health provider if you are concerned about your iodine levels, particularly if you are taking supplements such as pregnancy or pre-natal vitamins and minerals.
What Are The Treatment Options For A Pregnant Woman With Graves’ Disease/ Hyperthyroidism
Mild hyperthyroidism often is monitored closely without therapy as long as both the mother and the baby are doing well. When hyperthyroidism is severe enough to require therapy, anti-thyroid medications are the treatment of choice, with PTU being preferred in the first trimester. The goal of therapy is to keep the mothers free T4 in the high-normal to mildly elevated range on the lowest dose of antithyroid medication. Addition of levothyroxine to ATDs is not recommended. Targeting this range of free hormone levels will minimize the risk to the baby of developing hypothyroidism or goiter. Maternal hypothyroidism should be avoided. Therapy should be closely monitored during pregnancy. This is typically done by following thyroid function tests monthly.
In patients who cannot be adequately treated with anti-thyroid medications , surgery is an acceptable alternative. Surgical removal of the thyroid gland is safest in the second trimester.
Radioiodine is contraindicated to treat hyperthyroidism during pregnancy since it readily crosses the placenta and is taken up by the babys thyroid gland. This can cause destruction of the gland and result in permanent hypothyroidism.
Effects Of Hyperthyroidism On Fertility
Hyperthyroidism is a condition where the body produces too much of a hormone called thyroxine. Women in particular are at risk for this type of disorder. Unlike hypothyroidism, hyperthyroidism can manifest itself in a myriad of different symptoms, including but not limited to:
Â· Rapid or irregular heartbeat
Â· Changes in menstrual cycle
It can be difficult to pinpoint whether or not these symptoms are a byproduct of an overactive thyroid, as they can mimic symptoms that are common in many other health issues as well. If you suspect you may be suffering from hyperthyroidism, and are actively trying to conceive, speak to your healthcare provider to see what steps to take next.
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Is An Underactive Thyroid Preventing You Getting Pregnant
This series of articles is looking at fertility and how naturopathic medicine can help improve it if you are having difficulty conceiving. This time, I want to look at the role the thyroid gland can play in infertility. If you have missed any of the previous articles in this series and would like to catch up you can find them here:
- Sowing a Seed: Improving Fertility with Seeds and Oil
- Fertility & Folic Acid: Why Taking Folic Acid May Not Be Enough
- Wanting To Get Pregnant? Dont Forget About Sperm Health
- What Is PCOS And How Does It Affect My Fertility?
The primary function of the thyroid gland is to produce hormones to regulate your metabolism, however it also plays an important role in female and male fertility and pregnancy by:
- Thickening the uterine lining for the fertilized egg to attach to
- Increasing body temperature to aid ovulation
- Helping with cell differentiation which is needed for a rapidly developing fetus
- Facilitating brain development in the fetus
- Helping to maintain healthy testosterone levels in males
- Helping with the production of the right quantity of high quality sperm
When thyroid hormone levels are too high or too low the following pregnancy risks can occur:
- Increased risk of miscarriage
- Increased risk of premature birth
The Thyroid and Fertility
How Can I Tell if I have a Thyroid Imbalance?
Signs of an Underactive or Overactive Thyroid
- Female Infertility
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What Is Graves Disease
Graves disease is a condition where the thyroid gland makes too much thyroid hormone. This is called hyperthyroidism or overactive thyroid. Graves disease is the most common cause of hyperthyroidism during pregnancy. Having too much thyroid hormone speeds up the way the body uses energy and controls growth.
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How Does Hyperthyroidism Affect Pregnancy
Uncontrolled hyperthyroidism has many effects. It may lead to preterm birth and low birth weight for the baby. Some studies have shown an increase in pregnancy-induced hypertension in women with hyperthyroidism.
A severe, life-threatening form of hyperthyroidism, called thyroid storm, may complicate pregnancy. This is a condition in which there are extremely high levels of thyroid hormone that can cause high fever, dehydration, diarrhea, rapid and irregular heart rate, shock and death, if not treated.
It is always best to plan for pregnancy and to consult with your physician to ensure your thyroid status and treatment are optimized prior to becoming pregnant and monitored throughout your pregnancy. However, if this does not happen and you find out you are pregnant, you should contact your physician immediately to arrange for increased testing of your thyroid functions and a potential change in your medication.
Thyroid Autoimmunity And Fertility
Thyroid autoimmunity is the most common cause of thyroid disorders.
Hashimotos thyroiditis is the most common cause of hypothyroidism while Graves disease causes hyperthyroidism. Thyroid autoimmunity occurs when the bodys immune system starts attacking healthy cells and tissues, in this case, thyroid.
Women with thyroid autoimmunity can experience fertility problems too. Poppe et al found that prevalence of thyroid autoimmunity is significantly higher in infertile women than their fertile counterparts. Although having an autoimmune thyroid condition does not interfere with normal embryo implantation, the risk of miscarriage in early stages of pregnancy is high.
The connection between thyroid autoimmunity, endometriosis, and ovarian failure has been identified in some studies. Endometriosis is a condition that occurs when bits of the tissue that lines the uterus grow on the pelvic organs like fallopian tubes and ovaries.
The condition has been an association with various immunological changes such as the presence of autoantibodies to endometrial antigens, the decline in the concentration of natural killer cells, complement deposits, among others.
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Your Tsh And Your Fertility
When we think about classic hypothyroidism, we often think about the thyroid completely shutting down and our TSH scores going through the roof and the free hormones plummet. The thing we need to know today is that you definitely do not need to be in that dire state in order to have your thyroid impact your fertility2.
Key Insight: Your thyroid does not need to be completely shut down to affect your fertility. When your TSH is greater than 2.0, that alone might just be a factor in impairing your fertility.
Thankfully, more and more fertility specialists are aware of this issue. So, many women who are struggling with fertility need to know how important it is to screen your thyroid function .
It might even be a situation where you consider thyroid replacement treatment. Even in the short-term, where you might not have had a strong need for it otherwise. This will help keep your TSH below that target, where you might not have to worry about it so much.
Bottom Line: Your TSH score can have an effect on your fertility, and not only when it shoots through the roof. Have a good idea of where you stand with your score, which starts with effectively screening your thyroid function.
Risk Factors For An Overactive Thyroid
- A family history of Graves’ disease or autoimmune disorders
- Women are more likely to develop hyperthyroidism compared to men
- A personal medical history of specific chronic illnesses, including type 1 diabetes, pernicious anemia, or primary adrenal insufficiency
- Common viral infections
- Excess iodine intake
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Thyroid Treatment During Pregnancy
Thyroid hormones play a very important role during pregnancy. Theyre essential for a healthy pregnancy and for normal development of the embryo, especially neurodevelopment .
Pregnancy has a dramatic effect on thyroid hormone production, especially during the first trimester.
During these first 3 months of pregnancy, the growing fetus depends on maternal thyroid hormone for its growth and development. It contributes its own thyroid hormone later on in pregnancy.
Its extremely important that you maintain healthy levels of T4 and T3 during pregnancy because too much or too little thyroid hormone can increase the risk of complications to the pregnancy and the baby.
This includes preterm delivery, pre-eclampsia, growth restriction and neurodevelopmental delay in the baby, and still birth.
If you have Graves Disease its important that you consult your doctor before getting pregnant, to ensure that your thyroid hormone levels are in the healthy range. If they arent, you may need treatment before you get pregnant.
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What Is The Difference Between An Overactive And An Underactive Thyroid
During pregnancy, some women may experience thyroid dysfunction where their thyroid becomes:
- An underactive thyroid , which can be due to having too little iodine in their body, a pre-existing immune disorder, or previous damage to the thyroid gland or
- An overactive thyroid , which is usually a result of a condition that stimulates the thyroid gland too much, such as Graves disease.
Thyroid dysfunction affects 2 to 3 in every 100 pregnant women. Either an overactive or underactive thyroid dysfunction should be monitored and treated if necessary.
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Thyroid And Fertility In Men:
When discussing about thyroid disease, it is commonly showcased as a womens problem. But the fact is that one-third of hypothyroidism cases arise in men. Treating thyroid problem may completely address fertility issues in men if no other causes are suspected.
Low thyroid hormone levels in men leads to poor semen quality, low sperm count, reduced testicular function, erectile dysfunction and a drop in libido. If not treated, an underactive thyroid can lead to male infertility. Once hypothyroidism is diagnosed in a man with fertility problems, restoring the hormone levels to normal and it solves the erectile dysfunction problem. In most cases, problems related to sperm quantity and quality also improve over time. Even though discussed less, hyperthyroidism in men is also linked to fertility issues. High thyroid levels can lead to higher testosterone and gonadotropin hormones, which may lead to sperm damage.
Estrogen Tends To Get All The Attention But Balanced Thyroid Hormones Are Equally Important For Conception
With Elena Christofides MD and David Unuane MD PhD
Thyroid hormone imbalances can affect both female and male fertility, making it difficult for the sperm to enter the egg for implantation.
Your thyroid gland is the butterfly-shaped organ in the front of your neck that produces hormones that regulate your bodys metabolism and affect vital functions. Fertility refers to a couples ability to conceive and bring a baby to term. The relationship between your thyroid health and fertility is an important and sometimes complex part of conception.
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What Can Be Done To Fix A Thyroid Problem
For people with hypothyroidism, physicians will prescribe the missing hormone to correct the low levels. Levothyroxine is the medicine most commonly prescribed to correct the problem. Patients can suffer a myriad of symptoms while their thyroid levels equilibrate, but most will feel their symptoms resolve. Levothyroxine has no major side effects on its own. Hyperthyroidism is a more complex endocrine problem to treat. Options include medication like methimazole and propylthiouracil, surgery to remove the thyroid and radioactive iodine, amongst other modalities.
Normal Range Tsh Levels And Unexplained Fertility Problems
In one study conducted between 2000 and 2012, women with unexplained infertility were found to have TSH levels on the higher end of normal than the control population which is indicative of subclinical thyroid disorder, though not of full-blown hypothyroidism.
What this means: Even less-dramatically elevated, within-range levels of TSH can result in difficulty conceiving.
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Hyperthyroidism And The Risk Of Pregnancy Loss
Even more important than infertility, women with hyperthyroidism who do conceive must be wary of pregnancy loss. Pregnant women with hyperthyroidism are more likely to have a miscarriage during the first trimester. Getting the condition treated prior to pregnancy is essential for the health of the mother and the baby.
What Is Postpartum Thyroiditis
Postpartum thyroiditis is an inflammation of the thyroid that affects about 1 in 20 women during the first year after giving birth1 and is more common in women with type 1 diabetes. The inflammation causes stored thyroid hormone to leak out of your thyroid gland. At first, the leakage raises the hormone levels in your blood, leading to hyperthyroidism. The hyperthyroidism may last up to 3 months. After that, some damage to your thyroid may cause it to become underactive. Your hypothyroidism may last up to a year after your baby is born. However, in some women, hypothyroidism doesnt go away.
Not all women who have postpartum thyroiditis go through both phases. Some only go through the hyperthyroid phase, and some only the hypothyroid phase.
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Does Thyroid Function Return To Normal After The Baby Is Born
Most pregnant women recover their regular thyroid function following the birth of their baby. However, 1 in 20 women may experience ongoing irregular thyroid activity . In some cases, your doctor may continue your thyroid hormone treatment until you have completed your final pregnancy. If you are taking medicines or supplements for thyroid dysfunction, check with your post-natal health provider after your baby is born be sure to let them know if you are breastfeeding or bottle feeding your baby.
Overactive Thyroid Problems And Fertility
Having an overactive thyroid is referred to as hyperthyroidism . Hyperthyroidism is less likely to prevent you from getting pregnant than hypothyroidism, but it has been linked to fertilisation and implantation problems. What is more serious is that once you are pregnant, hyperthyroidism will interfere with the normal progression of pregnancy by increasing risk of miscarriages, premature births, and intrauterine growth restriction .
As many as 5% of women of reproductive age may experience thyroid problems and the chance getting problems increases the older you get.
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How Is The Thyroid Related To Fertility
For a brief refresher in human anatomy, the thyroid is a key organ involved in the endocrine system, which is a group of glands that regulates hormones, sexual function, reproduction, and mood . The integral role it plays in hormonal function makes it necessary for successful conception in women of reproductive age. Therefore, disorders of the thyroid can make it difficult for women to conceive. A study done in the United Kingdom shows that one in five women who suffered from miscarriages or had problems conceiving also suffered from mild thyroid dysfunction. There are two primary types of thyroid issues: hyperthyroidism, or an overactive thyroid, and hypothyroidism, an underactive thyroid.
Thyroid Testing Is Critical
If youre a man dealing with unexplained infertility, have your thyroid checked out to see where you stand.
A complete thyroid panel for men should include:
- blood levels of TSH
- free and total T3 .
- free and total T4
- reverse T3
Your endocrine system is a unique symphony of glands that work together. TSH testing measures the pituitary glands response to the thyroid. A high level of TSH means hypothyroidism, as the pituitary is releasing more TSH to stimulate an underactive thyroid to release more T3 and T4. Low TSH means the pituitary is reducing its TSH hormone production to help control and lower the secretion of T3 and T4 from an overactive thyroid.
What thyroid values are optimal for men?
In 2002, the Society of Endocrinologists revealed that the reference ranges most used for thyroid levels were inaccurate. As a result, many men with hypothyroidism went undiagnosed. Unfortunately, some labs still use this outdated range.
According to the revised standards, 0.3 to 3.3 mIU/L is considered the normal range of TSH in adults. A knowledgeable physician will look for other important clues. For instance, many physicians think that your free circulating thyroid, T3 and T4, should be at the midpoint of the reference range, if not higher. The presence of thyroid antibodies is also important. Antibody presence can indicate Hashimotos disease or Graves disease.
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So Whats The Bottom Line With All This
Well, for starters, even though the thyroid is a pretty tiny gland, its important. Because it isnt always checked regularly, being aware of the symptoms of thyroid imbalance can be incredibly useful. If your periods are irregular or youre experiencing something unusual that resembles any of the above symptoms, pay a visit to your doctor. They can help you get to the bottom of it and treat the problem before it makes getting pregnant more difficult.
Last but not least: If all of this has got you thinking about your own thyroid levels, or your fertility as a whole, take the Modern Fertility test to complete a few pieces of the reproduction puzzle. Because even teeny glands like the thyroid and short, three-letter acronyms like TSH can give you a big-picture perspective of your health.
For more info, you can watch our Q& A with Dr. Cindy Duke below.
This article was medically reviewed by Dr. Eva Marie Luo, an OB-GYN at Beth Israel Deaconess Medical Center and a Health Policy and Management Fellow at Harvard Medical Faculty Physicians, the physicians organization affiliated with the Beth Israel-Lahey Health System.