How Can You Avoid The Complications Of Hypothyroidism In Pregnancy
A number of 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.
Your Thyroid While Youre Pregnant
There are a few ways pregnancy can be impacted if thyroid problems arent addressed first.
Increasing demands from a developing baby can occasionally cause new onset or worsening hypothyroidism for pregnant women.
Additionally, impaired thyroid function prior to and during conception can impact healthy brain development in the fetus. That said, T4 therapy through meds like levothyroxine can of babies born with a lower body weight and other complications.
As for pregnancy loss and miscarriage, theres been little evidence found to directly link hyperthyroidism to either. But one study did find that the risk of miscarriage is doubled with hyperthyroid women as compared to women without thyroid issues. In terms of hypothyroidism , there is evidence that suggests that inadequate treatment can lead to infertility, miscarriage, and adverse pregnancy outcomes.
After pregnancy, theres also an increased risk for postpartum thyroiditis, or inflammation of the thyroid this happens to five to ten out of every 100 women within the first year after childbirth. This can lead to temporary hypothyroidism, hyperthyroidism, or hyperthyroidism followed by hypothyroidism.
Understanding Reference Ranges During Pregnancy
When we talk about reference ranges it’s important that you understand what exactly they mean.;
A reference range is created by local lab testing companies.;
These numbers are supposed to represent the average numbers of all people in your local area.;
The goal of these ranges is to include 95% of the population within the ranges provided.;
This means that 2.5% of people tested fall below the reference range and 2.5% of people fall higher than the range provided.;
This idea is very important, especially when it comes to pregnancy and TSH testing.;
The reference ranges provided above based on trimester should only be used if your local lab company cannot calculate the TSH reference ranges for pregnant women who live local to you.;
Put another way:
You should NOT be using generic reference ranges when it comes to your TSH level during pregnancy because the TSH level can vary based on geographic location, ethnicity , and other factors such as your weight and metabolism.;
It’s better to CREATE reference ranges based on your location than to use the generic reference range provided above.;
Unfortunately, not all lab tests do this for pregnant women because there simply isn’t enough information available.;
It’s not always clear if a woman is pregnant early on which can skew the data one way or the other.;
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How Is Hypothyroidism Tested
The main test used to detect hypothyroidism is measuring blood levels of TSH. An elevated TSH level usually means the thyroid gland is not making enough thyroid hormone, and the pituitary gland has responded by making more TSH to try to get the thyroid hormone levels where they should be.
Other blood tests include measuring T4 and thyroid autoantibodies. Antibodies are substances made by your immune system, usually to protect you against bacterial and viral infections. Sometimes, however, the immune system can make antibodies against your own bodysuch as against your thyroid. T4 is a hormone produced directly by the thyroid gland. It is typically low in patients with hypothyroidism. An autoantibody is an antibody that attacks the cells and tissues of the organism that made it. Thyroid autoantibodies are seen in patients with Hashimotos thyroiditis.
Why Thyroid Health Matters In Pregnancy
Pregnancy puts many organs and systems in your body to the test and that includes your thyroid. If youre not yet acquainted with this tiny little gland, your thyroid is located at the front of your neck and produces several hormones that are crucial to maintaining your metabolism as well as co-regulating other hormonal systems in the body.
During pregnancy, your thyroid gland must ramp up production of hormones by more than 50%. This is not only for your body, but because your thyroid hormones are transferred across the placenta throughout pregnancy where they play an essential role in development, particularly for brain development of your baby.
Up until mid-pregnancy, your baby is entirely reliant on your thyroid hormones .
This is all well and good until the thyroid has trouble keeping up with the increased demands of pregnancy. Sadly, this scenario is incredibly common.
The importance of identifying and treating thyroid problems cannot be understated and an underactive thyroid, called hypothyroidism, is the most common manifestation.
As such, this article will primarily focus on hypothyroidism and pregnancy.
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Treatments For Thyroid Disorders
Treating thyroid disorders before trying to have kids can decrease the risk for any issues impacting your ability to get pregnant or have a successful pregnancy. The treatments for hyperthyroidism and hypothyroidism vary depending on severity of symptoms and provider preference, but they can often be treated with medications prescribed by your doctor.
Typically, patients will be under close surveillance with initial treatment until a proper maintenance dose can be picked. Once a patient has a maintenance dose, thyroid labs will still need to be checked on a yearly basis.
What Should I Eat During Pregnancy To Help Keep My Thyroid And My Babys Thyroid Working Well
Because the thyroid uses iodine to make thyroid hormone, iodine is an important mineral for you while youre pregnant. During pregnancy, your baby gets iodine from your diet. Youll need more iodine when youre pregnantabout 250 micrograms a day.1 Good sources of iodine are dairy foods, seafood, eggs, meat, poultry, and iodized saltsalt with added iodine. Experts recommend taking a prenatal vitamin with 150 micrograms of iodine to make sure youre getting enough, especially if you dont use iodized salt.1 You also need more iodine while youre breastfeeding since your baby gets iodine from breast milk. However, too much iodine from supplements such as seaweed can cause thyroid problems. Talk with your doctor about an eating plan thats right for you and what supplements you should take. Learn more about a healthy diet and nutrition during pregnancy.
Thyroid Dysfunction And Pregnancy
Your thyroid gland produces hormones that control how your body uses energy and help support you and your baby during pregnancy. Thyroid gland dysfunction during pregnancy can lead to too much or little thyroid hormone, which may cause problems for you and your baby. Understanding the thyroid glands role in pregnancy will help you better understand why your doctor has recommended supplements or medicines, and when to seek further advice.
Thyroid Dysfunction And Reproductive Health
Thyroid function is regulated by the hypothalamus-pituitary axis , an interconnected duo made up of the hypothalamus and the pituitary gland . This pair is as thick as thieves when one of these organs sends a signal, it sets off a chain reaction in the other.
Because the HPA also controls the production of some of the most important hormones related to fertility, thyroid dysfunction can impact how much of those hormones are released. When any of these deviations from the status quo happen, they can disrupt menstrual cycles. Without the complete cycle, including ovulation, fertilization, and implantation, you cant get pregnant naturally.
As a result of these hormone changes, both hyperthyroidism and hypothyroidism have been linked to abnormal menstrual cycles.
All that said, getting a handle on your thyroid through treatment can reduce the chances of related fertility issues down the line. In one study of a group of almost 400 women suffering from infertility, 24% of participants were found to have hypothyroidism but within a year of treatment, 76% were able to conceive.
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How Do Doctors Treat Postpartum Thyroiditis
The hyperthyroid stage of postpartum thyroiditis rarely needs treatment. If your symptoms are bothering you, your doctor may prescribe a beta-blocker, a medicine that slows your heart rate. Antithyroid medicines are not useful in postpartum thyroiditis, but if you have Graves disease, it may worsen after your baby is born and you may need antithyroid medicines.
Youre more likely to have symptoms during the hypothyroid stage. Your doctor may prescribe thyroid hormone medicine to help with your symptoms. If your hypothyroidism doesnt go away, you will need to take thyroid hormone medicine for the rest of your life.
How Do Doctors Treat Hypothyroidism During Pregnancy
Treatment for hypothyroidism involves replacing the hormone that your own thyroid can no longer make. Your doctor will most likely prescribe levothyroxine, a thyroid hormone medicine that is the same as T4, one of the hormones the thyroid normally makes. Levothyroxine is safe for your baby and especially important until your baby can make his or her own thyroid hormone.
Your thyroid makes a second type of hormone, T3. Early in pregnancy, T3 cant enter your babys brain like T4 can. Instead, any T3 that your babys brain needs is made from T4. T3 is included in a lot of thyroid medicines made with animal thyroid, such as Armour Thyroid, but is not useful for your babys brain development. These medicines contain too much T3 and not enough T4, and should not be used during pregnancy. Experts recommend only using levothyroxine while youre pregnant.
Some women with subclinical hypothyroidisma mild form of the disease with no clear symptomsmay not need treatment.
If you had hypothyroidism before you became pregnant and are taking levothyroxine, you will probably need to increase your dose. Most thyroid specialists recommend taking two extra doses of thyroid medicine per week, starting right away. Contact your doctor as soon as you know youre pregnant.
Your doctor will most likely test your thyroid hormone levels every 4 to 6 weeks for the first half of your pregnancy, and at least once after 30 weeks.1 You may need to adjust your dose a few times.
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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.
Can I Take The Test At Home
Several test kits are commercially available that allow you to provide a sample for TSH testing at home. Some kits test only TSH, and others test TSH in combination with other thyroid hormones or additional hormones, such as cortisol and free testosterone.
These kits may be purchased online and include the materials you need to take a finger prick sample of blood and return it to the company for testing. Your test results will be reported to you via a secure online platform.
At-home testing is convenient and can help you participate in your health care. But at-home tests cannot replace working with a health care provider. If you have symptoms or are concerned that your thyroid is not functioning properly, be sure to share your concerns with your doctor. If an at-home test detects an abnormal TSH level, your doctor is likely to retest the TSH and follow-up with additional testing if the second TSH test is also abnormal.
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How To Read An Analog Pregnancy Test
Theres nothing that compares to the few minutes between peeing on a stick, and potentially receiving live-changing information. When those results begin to appear, make sure you know how to read them!
By Halle Tecco
There is a surge in purchases of analog pregnancy tests. They are just as accurate as digital tests, better for the environment, and less expensive. But they do require a little interpretation, so lets get to the basics.;;;
- The Natalist Pregnancy Test is over 99% accurate when used correctlyso be sure to read all the instructions before you start.;
- Its best to test first thing in the morning when your urine is most concentrated. If youre pregnant, there will be more hCG for the test to detect. This is especially important if youre taking the test before your expected period. If you take it later in the day, make sure you dont drink a lot of liquid in the hours before testing.
- Notice the arrow be careful not to pee above this arrow or on the test window. It could invalidate your test results.;
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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Monitor Your Iodine Nutrition Before And During Pregnancy
Iodine is a key nutrient for thyroid hormones and thyroid health.* During pregnancy and lactation , iodine requirements from the US Food and Drug Administration increase from 150 for nonpregnant people micrograms to 290 mcg.
That said, supplemental iodine which is a common component of prenatal vitamins may not be recommended if you’re taking levothyroxine , also known as L-thyroxine, a manufactured form of the thyroid hormone thyroxine . Since prenatal vitamins are an essential part of preconception and pregnancy nutrition, it’s important to talk to your healthcare provider about whether or not a prenatal vitamin with iodine is right for you.
Healthy Tsh In Pregnancy Vs Outside Of Pregnancy
The information I’ve referenced above is recommended based off of several studies.;
There is one big problem, though:
Most of the studies that we have on pregnant women include gathered information and data, not true double blind, placebo controlled tests .;
Furthermore, the information here is generalized, but we know that each person is unique and different.;
Normal TSH levels based off of individuals, age, ethnicity, and numerous other factors.;
So how can we create a “standard” range and then apply it to everyone?
And the studies I’ve referenced above indicate that you should keep the TSH less than 2.5 in the first trimester and with another breath also claim that normal TSH standard reference range from lab companies is as high as 4.5.;
So how can studies of healthy individuals show that a healthy TSH is less than 2.5 and then recommend that same level for pregnant women knowing that pregnancy places an increased demand on the thyroid?
How is it possible for some women to be completely “normal” with a TSH of 0.1 ranging all the way up to 2.4?
This range is MASSIVE.;
It doesn’t make a lot of sense, but this is the data that we are left with and we have to sort it out.;
My personal recommendation and feeling, based off of treating hundreds of people, is that a healthy and normal TSH is probably much closer to 1.0 in the nonpregnant state.;
Why do I make these recommendations?
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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.
Experts do agree that untreated hypothyroidism with symptoms is linked with an increased risk of problems, both for the mother and the child. In addition to high blood pressure, these include preterm birth, miscarriage and even fetal death. However, screening of all pregnant women is not recommended by many organizations, including the American College of Obstetricians and Gynecologists and the Endocrine Society.
How Is Thyroid Dysfunction In Pregnancy Managed
If you have hypothyroidism, your doctor may prescribe thyroxine tablets before and after conception to optimise your thyroid hormone levels. This treatment is usually accompanied by regular thyroid function tests to ensure your thyroid level is in the recommended range. If left untreated, low levels of thyroid hormone can cause complications in pregnancy, such as premature birth, low birth weight and miscarriage. It may also affect the intellectual development of your baby.
If you have hyperthyroidism, your doctor or specialist may prescribe medication to block thyroid hormone production . The most common medicine used for this is called propylthiouracil. Uncontrolled overactive thyroid during pregnancy has been associated with complications such as a higher fetal heart rate , small gestational size, premature birth or stillbirth.
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