Interpreting Thyroid Function Test Results
Thyroid function is initially assessed through testing of TSH, with measurement of serum thyroxine if maternal TSH is either elevated or reduced.
Diagnosis of thyroid dysfunction in pregnancy is complicated by the fact that normal TSH levels differ from the non-pregnant state . Applying the general laboratory reference range for TSH to pregnant women can result in misclassification of thyroid status . TSH levels vary with gestational age and between single and twin pregnancies . Pregnancy-specific reference ranges that take into consideration gestational age and fetal number should therefore be used. In addition, TSH and free thyroxine values differ according to the laboratory method used to perform testing.
Causes Of Hypothyroidism In Pregnancy
A low level of thyroid hormones in the blood causes this condition, where the thyroid gland functions inadequately. Removal of the thyroid, endemic goitre, iodine deficiency, radiation therapy and diseases related to the pituitary gland are its other causes. Hypothyroidism in pregnancy is also caused due to Hashimotos disease, which is a form of inflammation of the thyroid.
What Are The Symptoms Of Graves’ Disease
Symptoms of Graves’ disease include:
- Bulging eyes
- Thickening and reddening of the skin, especially on the shins and upper feet
- Irritability or nervousness
- Weight loss without dieting
- goiter, which is an enlarged thyroid that can cause the neck to look swollen
The symptoms of Graves’ disease can start slowly or very suddenly. Some people do not have any symptoms.
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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.
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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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.
How Are Thyroid Nodules Treated
Treatment depends on the type of nodule or nodules that you have. Treatments include:
- Watchful waiting. If your nodule is not cancerous, your doctor may decide to just watch your condition. You will get regular physical exams, blood tests, and perhaps thyroid ultrasound tests. If your nodule does not change, you may not need further treatment.
- Surgery. Surgery may be necessary to take out nodules that may be cancerous or large nodules that cause problems breathing or swallowing.
- Radioiodine. This type of treatment is helpful if you have nodules that make too much thyroid hormone. Radioiodine causes nodules to shrink and make smaller amounts of thyroid hormone.
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How Is Postpartum Thyroiditis Treated
Treatment for postpartum thyroiditis depends on the phase of the disease and what symptoms you have. For example, if you get symptoms of hyperthyroidism in the first phase, your treatment may include medicines to slow down the heart rate.
In most women who have postpartum thyroiditis, the thyroid returns to normal within 12 to 18 months after symptoms start. But if you have a history of postpartum thyroiditis, your risk is higher for developing permanent hypothyroidism within 5 to 10 years.5
What Are Thyroid Disorders
The thyroid is a gland located in your neck that produces a hormone responsible for regulating your metabolism and controlling many of your body’s organs. Thyroid disease happens when your immune system mistakenly attacks and destroys cells in the thyroid gland. This results in your thyroid producing either too many hormones or too few .
About 2 percent of pregnant women have a thyroid disorder. Some develop the condition before pregnancy, while others experience thyroid problems for the first time during pregnancy or soon after delivery.
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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.
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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Always Be Your Own Advocate
Because providers may differ in their screening practices, its important to be your own advocate on this from the very beginning. Always share your thyroid health history at your very first prenatal appointment. Experts say testing for serum TSH abnormalities should be done by your ninth week of pregnancy or at the time of your first visit.
What Is The Interaction Between The Thyroid Function Of The Mother And The Baby
For the first 18-20 weeks of pregnancy, the baby is completely dependent on the mother for the production of thyroid hormone. By mid-pregnancy, the babys thyroid begins to produce thyroid hormone on its own. The baby, however, remains dependent on the mother for ingestion of adequate amounts of iodine, which is essential to make the thyroid hormones. The World Health Organization recommends iodine intake of 250 micrograms/day during pregnancy to maintain adequate thyroid hormone production. Because iodine intakes in pregnancy are currently low in the United States, the ATA recommends that US women who are planning pregnancy, pregnant, or breastfeeding should take a daily supplement containing 150 mcg of iodine.
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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.
Are There Any Risks To A Baby After Birth
Neonatal Graves disease occurs in about 1 percent of babies born to mothers with active Graves disease or a history of the disease. Babies may be severely affected requiring hospitalization and intensive care support. In its most severe form, hyperthyroidism in the newborn can be fatal. In less severe forms, and with good control, the consequences of Graves disease on the baby are usually temporary. However, even under the best of circumstances there may be permanent consequences of maternal Graves disease on the baby.
The cause of Graves disease in the newborn is the crossing of the moms antibodies through the placenta to the baby. Even for women who were definitively treated for their Graves disease, the maternal antibodies may be present for years afterwards and continue to be a potential risk to the baby. The anti-thyroid medications that the mom takes may also have temporary or permanent effects on the baby. Because of these concerns, it is extremely important to let your physician know if you have Graves disease or a history of Graves disease to ensure both you and your baby are followed more closely.
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What Are The Most Common Causes Of Hypothyroidism During Pregnancy
WHAT ARE THE MOST COMMON CAUSES OF HYPOTHYROIDISM DURING PREGNANCY?
Overall, the most common cause of hypothyroidism is the autoimmune disorder known as Hashimotos thyroiditis . Hypothyroidism can occur during pregnancy due to the initial presentation of Hashimotos thyroiditis, inadequate treatment of a woman already known to have hypothyroidism from a variety of causes, or over-treatment of a hyperthyroid woman with anti-thyroid medications. Approximately, 2.5% of women will have a TSH of greater than 6 mIU/L and 0.4% will have a TSH greater than 10 mIU/L during pregnancy.
The Thyroid And Pregnancy
Even before conception, thyroid conditions that have lingered untreated can hinder a womans ability to become pregnant or can lead to miscarriage. Fortunately, most thyroid problems that affect pregnancy are easily treated. The difficulty lies in recognizing a thyroid problem during a time when some of the chief complaints fatigue, constipation and heat intolerance can be either the normal side effects of pregnancy or signals that something is wrong with the thyroid.
Although detecting a thyroid problem is important, it is equally necessary for those already diagnosed with a condition to have the thyroid checked if they are planning to become pregnant or are pregnant. Thyroid hormone is necessary for normal brain development. In early pregnancy, babies get thyroid hormone from their mothers. Later on, as the babys thyroid develops, it makes its own thyroid hormone. An adequate amount of iodine is needed to produce fetal and maternal thyroid hormone. The best way to ensure adequate amounts of iodine reach the unborn child is for the mother to take a prenatal vitamin with a sufficient amount of iodine. Not all prenatal vitamins contain iodine, so be sure to check labels properly.
A woman with untreated hypothyroidism is at the greatest risk for a miscarriage during her first trimester. Unless the case is mild, women with untreated hyperthyroidism are also at risk for miscarriage.
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Diet Nutrition And Dietary Supplements For Hypothyroidism
The body demands high amounts of nutrients during pregnancy as it needs to balance the mother and babys health. During this period, doctors recommend the mother-to-be to follow a balanced diet and derive the necessary nutrients from prenatal vitamins and iodine-based mineral supplements.
Pregnant women diagnosed with hypothyroidism should ensure that they get the recommended dose of iodine through daily food and replacing iodised salt with normal salt is one way of doing it. Eating greens like spinach, fenugreek and lettuce leaves provide magnesium, which is necessary for the functioning of the thyroid. Blueberries and strawberries are great for the immune system and contain antioxidants, so make sure they are a part of your diet. Include eggs, walnuts, mushrooms and fish like salmon in your diet to get Omega 3 fatty acids and selenium to regulate hormones the natural way. Vitamin B6 is especially beneficial in pregnancy.
Who Is At Risk For Thyroid Cancer
About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.9
Thyroid cancer is more common in women who:10
- Are between the ages of 25 and 65
- Had radiation therapy to the head or neck, especially in childhood, to treat cancer
- Have a history of goiter
- Have a family history of thyroid cancer
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How Does Thyroid Disease Affect Pregnancy
Pregnancy-related hormones raise the level of thyroid hormones in the blood. Thyroid hormones are necessary for the baby’s brain development while in the womb.
It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. But it is especially important to check for problems before getting pregnant and during pregnancy. Uncontrolled hyperthyroidism and hypothyroidism can cause problems for both mother and baby.
Hyperthyroidism that is not treated with medicine during pregnancy can cause:4
- Premature birth
- Preeclampsia, a serious condition starting after 20 weeks of pregnancy. Preeclampsia causes high blood pressure and problems with the kidneys and other organs. The only cure for preeclampsia is childbirth.
- Thyroid storm
- Fast heart rate in the newborn, which can lead to heart failure, poor weight gain, or an enlarged thyroid that can make it hard to breathe
- Low birth weight
Expect More Thyroid Monitoring During Pregnancy
The general population of pregnant people doesn’t receive screening for thyroid dysfunction. However, for those with a personal history of thyroid disorders, the American College of Obstetricians and Gynecology , the Society for Maternal-Fetal Medicine , and the Endocrine Society clinical practice guidelines recommend screening.
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Graves Disease And Pregnancy
Men are advised to wait for 4 months before fathering a child if they have had radioiodine treatment. Women are advised to wait for 6 months before becoming pregnant after radioiodine treatment.
Although your thyroid function may be normal on Levothyroxine after being successfully treated by surgery or radioiodine, there may still be Graves disease antibodies in the blood even if your condition is well under control.
These antibodies can cross the placenta and cause temporary symptoms of Graves disease in the baby during the second half of pregnancy and for up to 2-3 months after delivery.
I hope you found this helpful. Please read my next post about morning sickness and pregnancy – you might be surprised to learn that this is endocrine related.
Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.
As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link
Who Should Be Tested
Despite the impact thyroid diseases can have on a mother and baby, whether to test every pregnant woman remains controversial. As it stands, doctors recommend that all women at high risk for thyroid disease or women who are experiencing symptoms should have a TSH and an estimate of free thyroxine blood tests and other thyroid blood tests, if warranted. A woman is at a high risk if she has a history of thyroid disease or thyroid autoimmunity, a family history of thyroid disease, type 1 diabetes mellitus or any other autoimmune condition. Anyone with these risk factors should be sure to tell their obstetrician or family physician. Ideally, women should be tested prior to becoming pregnant at prenatal counseling and as soon as they know they are pregnant.
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