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.
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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What Is The Thyroid
The thyroid is a tiny, butterfly-shaped gland in your neck. A gland is an organ that makes substances that help your body work. The thyroid makes hormones that play a big role in your health. For example, thyroid hormones can affect your heart rate and your metabolism .
Sometimes the thyroid gland makes too much or too little of certain hormones. When this happens, you have a thyroid disorder. Some women have a thyroid disorder that begins before pregnancy . Others may develop thyroid problems for the first time during pregnancy or soon after giving birth.
With treatment, a thyroid condition may not cause any problems during pregnancy. But untreated thyroid conditions can cause problems for you and your baby during pregnancy and after birth.
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Is Hyperthyroidism During Pregnancy A Problem
Thyroid hormone levels that are just a little high are usually not a problem in pregnancy. However, more severe hyperthyroidism that isnt treated can affect both the mother and the baby. If you have hyperthyroidism, be sure your disease is under control before becoming pregnant. Learn more about causes, diagnosis, and treatment of hyperthyroidism during pregnancy.
Diet And Thyroid Disorders
Once again, we come back to the cornerstone of PCOS Diet Support. Your diet can impact on your thyroid health, as well as your PCOS. Here are some suggestions to support your thyroid function and improve your PCOS:
Avoid soy: Soy products contain phytoestrogens that have been shown to increase the risk of developing subclinical hypothyroidism. Soy can also cause delayed ovulation which is why I dont recommend soy products as part of a good PCOS Diet.
Give up Gluten: There is a protein in gluten that is very similar in structure to a thyroid hormone. So, if you have a gluten sensitivity, your body not only attacks the gliadin, it can also attack your thyroid in an autoimmune response.
Avoid sugar: Research has shown that hypothyroidism can make insulin resistance worse. And, eating sugar or highly refined carbs causes your body to release more insulin. Remember that all of this insulin is also causing your ovaries to release more testosterone. So, by avoiding highly processed and sugary foods, you are managing your PCOS and supporting your thyroid function.
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Hyperthyroidism And Getting Pregnant
Many women planning to expand their family worry that their overactive thyroid might negatively affect their fertility and lower their odds of getting pregnant. Although hyperthyroidism in pregnancy requires thorough treatment and close monitoring to prevent serious complications, the good news is that most women with thyroid disease go on to have safe pregnancies.
Keep on reading to find out what to include in your pre-pregnancy action plan that can help you get pregnant and bring your baby to term without difficulties.
Thyroid Problems And Infertility: Reducing Your Risk
The best thing you can do to maintain fertility and reduce your risk of health complications is to get your thyroid condition under control as soon as possible. Once hyperthyroidism or hypothyroidism is successfully treated, you should no longer experience infertility, as long as thyroid problems were the only cause.
Infertility can have many different culprits, and a thyroid problem can certainly be one of them. If you have a thyroid condition, talk to your doctor before trying to get pregnant or if you’re having trouble conceiving. And if you’re having problems conceiving and are otherwise healthy, your doctor may want to run some screening tests to be sure that a thyroid problem isn’t the cause.
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How Are Thyroid Conditions Treated During Pregnancy And While Breastfeeding
Many medicines used to treat thyroid conditions during pregnancy are safe for your baby. Thyroid medicines can help keep the right level of thyroid hormones in your body. Your provider gives you blood tests during pregnancy to check your TSH and T4 levels to make sure your medicine is at the right amount . T4 is a hormone made by your thyroid.
If youre taking medicine for a thyroid condition before pregnancy, talk to your provider before you get pregnant. Your provider may want to adjust or change your medicine to make sure its safe for your baby. If youre already taking thyroid medicine when you get pregnant, keep taking it and talk to your provider about it as soon as possible.
Treating hyperthyroidism. If you have mild hyperthyroidism, you may not need treatment. If its more severe, you may need to take an antithyroid medicine. This medicine causes your thyroid to make less thyroid hormone.
Providers sometimes use radioactive iodine to treat hyperthyroidism. Pregnant women shouldnt take this medicine because it can cause thyroid problems in the baby.
Antithyroid medicines are safe to take at low doses while youre breastfeeding.
If you had hypothyroidism before getting pregnant, you most likely need to increase the amount of medicine you take during pregnancy. Talk to your health care provider about your medicine as soon as you find out youre pregnant. Your provider can check to make sure youre taking the right dose by checking your TSH levels during pregnancy.
Do I Need To Continue To Monitor My Thyroid Levels
It is important to have blood levels checked regularly even after the correct dose is found. Hypothyroidism is often a lifelong and progressive disease and the dose of thyroid hormone replacement may need adjustment.
Frequent monitoring is important if the dose of thyroid replacement hormone is too high, women may develop treatment-induced hyperthyroidism. This could cause heart palpitations, nervousness, and osteoporosis .
If you become pregnant, your doctor will need to monitor your blood every trimester as your levothyroxine dose needs may change due to pregnancy.
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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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Thyroid Trouble May Harm Women’s Fertility: Study
Experts urge routine testing of glandular function for women who have problems conceiving
MONDAY, Jan. 26, 2015 — A new study supports the notion that thyroid disorders can cause significant reproductive problems for women.
The research, published Jan. 23 in The Obstetrician & Gynaecologist, found that 2.3 percent of women with fertility problems had an overactive thyroid , compared with 1.5 percent of those in the general population. The condition is also linked with menstrual irregularity, the researchers said.
“Abnormalities in thyroid function can have an adverse effect on reproductive health and result in reduced rates of conception, increased miscarriage risk and adverse pregnancy and neonatal outcomes,” said study co-author Amanda Jefferys in a journal news release. She is a researcher from the Bristol Center for Reproductive Medicine at Southmead Hospital in Bristol, England.
While the study couldn’t prove cause-and-effect, one expert in the United States said he wasn’t surprised by the findings.
“For over two decades now, we have noticed a strong link between hypo- and hyperthyroidism and infertility as well as adverse pregnancy and neonatal outcomes,” said Dr. Tomer Singer, a reproductive endocrinologist at Lenox Hill Hospital in New York City.
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The Right Hypothyroidism Workout
You might think hypothyroidism has drained you of all energy reserves, but even adding a little more physical activity to your day can help you improve energy levels during the day, and get better sleep at night. Aim for the recommended amount of physical activity from the U.S. Department of Health and Human Services: moderate-intensity aerobic activity for at least 30 minutes on at least five days of the week and strength training activities on least two days a week. Since exercising in the evening can make it difficult to get to sleep, try to get most of your workouts done earlier in the day. The bottom line: the right hypothyroidism workout can help give you back the energy youve been craving.
General Tips On How To Keep You Blood Sugar Levels In Control
- Foods to eat
You should eat foods that are high in protein, fiber, and lower in carbohydrates. You should aim at having around 45 to 60 carbs for each meal. Consistency throughout the day is key to keeping blood sugar levels in control. Foods low in fat and high in nutrients should be picked to maximize your nutrition.
Vegetables and fruits are great as well as eggs, fish, beans, and oatmeal. There is also research that shows cinnamon and apple cider vinegar can help lower your sugar.
- Foods to avoid
Avoiding foods like soda, juice, pasta, candy, and other desserts can help keep your sugar from climbing too high. These foods are high in sugars and fat but low in other nutrients.
Avoiding excess alcohol is also better for you. Read the following article that I wrote about drinking alcohol when you have diabetes to learn more about this topic:
- Signs and symptoms
Signs of high blood sugar include: increased thirst and hunger, blurred vision, irritability, dry mouth, tired, and urinating a lot.
- Look for patterns
Patterns can be great because they help you figure out what is causing undesirable blood sugar values. A good way to track of it is to keep a journal of all of the food you eat, activities you do and your blood sugar levels for 1 week. During this week, check your sugar before and after you eat, as well as in between meals. Also document any insulin that you give yourself.
- Test sugar levels regularly
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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.
What About Thyroid Dysfunction And Male Fertility
An impaired thyroid doesnt just have the power to impact womens ability to conceive theres also an effect on male fertility. Why? Because T3 and T4 both play a role in the development and function of the testes.
Hyperthyroidism can lead to reductions in:
- Semen volume, or how much is ejaculated
- Sperm density, or the sperm count per milliliter of semen
- Sperm motility, or how well and efficiently the sperm move
- Sperm morphology, or the size and shape of sperm
Hypothyroidism can lead to reduction in:
- Sperm morphology
Just like the effects of thyroid dysfunction on people with ovaries, people with testes can reverse thyroid-related fertility issues once the gland is back in working order after treatment.
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What Is Thyroid Cancer
Thyroid cancer happens when cancer cells form from the tissues of the thyroid gland.
Most people with thyroid cancer have a thyroid nodule that does not cause any symptoms. If you do have symptoms, you may have swelling or a lump in your neck. The lump may cause problems swallowing. Some people get a hoarse voice.
To tell if the lump or nodule is cancerous, your doctor will order . Most thyroid nodules are not cancerous.
For more information about thyroid cancer, visit the National Cancer Institute’s thyroid cancer page.
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.
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Tracking Your Tsh At Home With Modern Fertility
Whether you have a diagnosed thyroid condition or you’re experiencing possible symptoms of one , the Modern Fertility Hormone Test is an easy way to check in with your TSH levels and understand how they’re changing over time. Even if you’re currently on hormonal birth control, you can measure your TSH with a simple at-home finger prick as well as fT4 if your TSH levels suggest more thyroid testing is needed.
However you’re measuring TSH levels, it’s always important to talk to your healthcare provider about how to best monitor your thyroid health as you go after your fertility goals, move through your pregnancy, and navigate new parenthood.
This article was reviewed by Dr. Jennifer Conti, MD, MS, MSc.
|*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.|
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 Is Hyperthyroidism Treated
There are many treatment options for hyperthyroidism. Depending on the cause of your hyperthyroidism, some options may be better for you over the long-term. Your healthcare provider will discuss each option with you and help you determine the best treatment for you.
Treatment options for hyperthyroidism can include:
How Can Thyroid Disorders Effect Your Fertility
Hypothyroidism and hyperthyroidism can each negatively impact fertilityboth the ability to become pregnant and the ability to carry a fetus to term. The presence of autoimmune antibodies, with or without hyper or hypothyroidism, can also impact your fertility.
Dr. Elena Christofides MD, FACE, and Fellow of the American Association of Clinical Endocrinologists, explains that abnormal TSH levels can interfere with ovulation, and that, when you have any type of thyroid disorder , you will see a luteal phase disruption.
This is mediated by progesterone levels. If a thyroid disorder is unregulated, a patient could have difficulty getting pregnant because there will not be implantation. You could also experience early miscarriage because of incomplete implantation.
Signs of low levels or misfunctioning of progesterone include:
- A shorter or longer cycle than your typical menstrual cycle
- Lighter or heavier bleeding than is typical for you
- Longer or shorter windows for bleeding than is typical for you
Fertility is not a female-only concern. Thyroid disorders in men can also affect a couples fertility. Dysregulated thyroid function can damage sperm quality and motility, making it difficult for the sperm to enter the egg for implantation.
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