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What Is The Effect Of Thyroid In Pregnancy

Monitor Your Iodine Nutrition Before And During Pregnancy

Thyroid test during pregnancy |Food to avoid for thyroid | Effect of thyroid in 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 vitaminsmay not be recommended if youre 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, its important to talk to your healthcare provider about whether or not a prenatal vitamin with iodine is right for you.

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How Are Thyroid Conditions During Pregnancy Diagnosed

Health care providers dont usually test your thyroid before or during pregnancy unless youre at high risk of having a thyroid condition or you have signs or symptoms of one. If you have signs or symptoms of a thyroid condition, especially during pregnancy, tell your provider. Signs of a condition are things someone else can see or know about you, like that you have a rash or youre coughing. Symptoms are things you feel yourself that others cant see, like having a sore throat or feeling dizzy. Signs and symptoms of thyroid conditions may appear slowly over time. Many are signs and symptoms of other health conditions, so having one doesnt always mean you have a thyroid problem.

Your provider gives you a physical exam and a blood test to check for thyroid conditions. The blood test measures the levels of thyroid hormones and thyroid stimulating hormone in your body. TSH is a hormone that tells your thyroid gland to make thyroid hormones. If you think you may have a thyroid condition, ask your provider about testing.

What Causes Thyroid Problems In Pregnancy

The most common cause of hyperthyroidism in pregnant women is Graves disease. This is an autoimmune disorder in which the immune system attacks the thyroid gland, causing it to produce more thyroid hormone than the body needs.;

If youve been treated for Graves disease with radioactive iodine ablation, your thyroid is now considered to be underactive. The thyroid medication you take, such as levothyroxine, does not cross the placenta and is safe during pregnancy. If you are on thyroid hormone replacement during pregnancy, its likely that your dose will require adjustment. ;Your doctor will check your levels several times during the pregnancy. After the delivery, the dose often needs to be reduced.;

Hypothyroidism in pregnancy;can also be the result of another autoimmune disorder, known as Hashimotos disease. In this case, the immune system also attacks the thyroid gland, causing inflammation and interfering with its ability to produce thyroid hormones. The gland then produces less hormone than the body needs.;

Rest assured: if you have or develop thyroid problems while pregnant, you can still have a healthy pregnancy and protect your babys health.;

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Morning Sickness And Reverse T3

In extreme cases of Gestational transient thyrotoxicosis , hCG-stimulated hyperthyroidism can cause Hyperemesis gravidarum .

In this HG syndrome, the mother experiences an extreme version of morning sickness continual vomiting, weight loss, and dehydration.

These certainly sound like some of the symptoms of thyrotoxicosis in Graves disease.

However, while TSH and Graves disease antibodies tend to enhance T3 secretion more than T4 from the thyroid gland , hCG enhances T4 secretion more than T3 , enabling doctors to distinguish between GTT and Graves autoimmune hyperthyroidism.

In hyperthyroid HG patients who are ill and losing weight, their higher T4 levels lead to much higher levels of Reverse T3.

RT3 increased in HG by an average of 31% higher than healthy pregnant controls in a study by Juras et al, 1983.

Because GTT and even its more severe form HG usually fade by the beginning of the second trimester, it is rarely treated except with fluids and electrolytes and a short course of propranolol to reduce hyperemesis and thyrotoxicosis.

Thyroid Nodules Detected During Pregnancy

Pin on Conditions and Getting Pregnant
  • Prevalence: 1-2% | 90-95% of solitary nodules are benign
  • Aside from history and physical examination, order
  • TSH
  • Neck ultrasound
  • Radioiodine scanning not recommended due to theoretical risk with fetal irradiation
  • However, if patient inadvertently receives radioiodine in the first trimester, risk of fetal thyroid damage low because fetal thyroid is not active until after the first trimester
  • If cancer identified
  • Surgical treatment in first and second trimesters with thyroidectomy may be performed but usually delayed to avoid possible damage to parathyroid glands
    • Management is multidisciplinary and should include possibility of familial cancer syndrome

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    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.

    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.

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    What Has Been Your Experience Of Pregnancy And Hypothyroidism Were You Considered High Risk

    You can click on the hyperlinks in the above post to learn more and see references to information given.

    See also:

    You, Me and Hypothyroidism: When Someone You Love Has;Hypothyroidism,;a book for those who know someone with hypothyroidism. It looks at how pregnancy, fertility, parenting, home life and more can all be affected by hypothyroidism, and what you can do about it.

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    How Does Pregnancy Affect Thyroid Function

    What is the expected levels of thyroid in pregnancy & can it cause birth defects?-Dr. Beena Jeysingh

    During pregnancy, two hormones, oestrogen and human chorionic gonadotropin are responsible for enhancing your thyroid levels. These thyroid hormones play a vital role in the development of the babys brain and nervous system, and your health when you are pregnant.

    The placenta makes hCG, which is similar to TSH and stimulates the thyroid to create more hormones. Increase in oestrogen levels produces thyroid-binding globulin, a protein that helps thyroid hormone to travel in the blood. In the first trimester, your baby is dependent on you for its thyroid hormone needs, which come through the placenta. This will go on until the 12th week, after which the babys thyroid will begin functioning on its own.

    It is necessary to conduct a thyroid function test to detect any pregnancy problem due to thyroid. The thyroid does increase in size during pregnancy, but that is not enough to conclude the test. Thyroid related issues may be difficult to diagnose during pregnancy because many pregnancy signs seem similar to the symptoms of thyroid disorders, such as an increase in the thyroid hormone level, fatigue and increase in the size of the thyroid.

    Lets take a look at both the conditions a little in detail.

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    Hashimoto’s Thyroiditis Is Caused By An Auto

    The effects depends on the type of thyroid condition you have

    The effects depends on the type of thyroid condition you have. Common thyroid conditions are hyperthyroidism, hypothyroidism and postpartum thyroiditis. It also depends on whether the condition is an auto-immune condition, or has other causes, such as iodine deficiency.

    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

    The most commonly prescribed anti-thyroid medication, called Methimazole or Tapazole , may be associated with birth defects. Current recommendations are to stop MMI during the first trimester and to use Propylthiouracil with a switch back to MMI at the start of the second trimester and for the remainder of the pregnancy. Use of radioactive iodine, in the form of a pill or liquid, damages thyroid cells and is not safe during pregnancy or during lactation . For women who are given radioiodine ablation therapy to treat Graves disease, it is recommended that they wait at least one year after radioiodine treatment to become pregnant. Your healthcare provider will discuss the risks and benefits of treatment with you.

    Women with hyperthyroidism can increase their chances for a healthy pregnancy by getting early prenatal care and working with their healthcare providers in the management of their disease.

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    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.

    Maternal And Fetal Thyroid Physiology

    Subclinical hypothyroidism in pregnancy

    Pregnancy influences thyroid function in multiple ways. Not only does the maternal hypothalamic-pituitary-thyroid axis undergo a series of adjustments, the fetus develops its own HPT axis and the placenta plays an active role in iodide and T4 transport and metabolism. Thus, an integrated three-compartment thyroid model exists during gestation .

    Early in pregnancy estrogen promotes production of a more highly sialylated T4-binding globulin isoform that is less rapidly degraded, resulting in increased serum T4-binding globulin and T4 concentrations . Although a transient decrease in serum free T4, followed by a rise in TSH to a new equilibrium, may occur , this is usually not appreciated with routine thyroid testing. A high circulating CG level in the first trimester leads to CG cross-reactivity with the TSH receptor, prompting a temporary increase in free T4 and partial suppression of TSH. The final physiologic change results from placental deiodination of maternal T4, which increases T4 turnover. In normal pregnant women, the thyroid gland maintains euthyroidism with only minor fluctuations in serum T4 and TSH. However, in women with limited thyroid reserve, due to thyroid autoimmunity or iodine deficiency, hypothyroidism can develop .

    Physiologic and nutritional influences on maternal thyroid function . The sizes of the circles do not imply relative importance of each biochemical or physiologic pathway.

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    Overview Of Tests & Screening To Spot Low Thyroid Problems During Pregnancy

    There should be thyroid screening and tests for pregnant women especially if they have certain risk factors for the development of a thyroid disorder.

    These risk factors include:

    • ver 30 Years of Age
    • Family History of Thyroid Issues and/or Autoimmune Diseases
    • History of Radiation to Neck Area
    • Personal or Family History of Thyroid Cancer
    • Past Problems Getting Pregnant or Staying Pregnant Until Full-Term
    • History of Past Miscarriages or Preterm Births
    • History of Thyroid Surgery

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    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.

    Next Steps

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    Unusual Signs Or Symptoms After Delivery May Indicate Thyroid Complications

    Some thyroid complications can occur postpartum. People with a history of thyroid problems are at an increased risk of postpartum thyroiditis, a condition that occurs in about 5%-10% of people with ovaries when the thyroid becomes inflamed after having a baby. It may first cause the thyroid to be overactive, but it can eventually lead to an underactive thyroid.

    What Are The Causes Of Low Tsh Levels

    Safety of thyroid medicines in pregnancy & its effect on baby -Dr. Beena Jeysingh

    A low level of Thyroid Stimulating Hormone generally indicates hyperthyroidism. This means that the thyroid gland is secreting an abnormal amount of thyroxine hormone. Hyperthyroidism may lead to an increased rate of metabolism. It may cause irregular heartbeat and unintentional weight loss. Following are the causes of low TSH levels:


    Hyperthyroidism may lead to low TSH levels. The cause of hyperthyroidism may be permanent or temporary. This may be due to autoimmune diseases or pregnancy-related thyroiditis.

    The Central Cause Of Hypothyroidism

    TSH is secreted by the pituitary gland when stimulated by Thyroxine releasing hormone secreted by the hypothalamus. Thus, there might be a problem in the hypothalamus or pituitary gland that may lead to a low level of TSH.

    Over Response Of Thyroid Medications

    Overresponse to medications administered to increase the level of thyroxine may lead to low levels of TSH.

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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.

    Risks Of Hyperthyroidism On Fetal And Maternal Well

    Uncontrolled hyperthyroidism in pregnancy is associated with an increased risk of severe pre-eclampsia and up to a four-fold increased risk of low birth weight deliveries. Some of these unfavourable outcomes are more marked in women who are diagnosed for the first time in pregnancy. A recent study has also shown that already high normal maternal FT4 levels are associated with a decrease in child IQ and gray matter and cortex volumes, similar to the effects of hypothyroidism.

    Uncontrolled and inadequately treated maternal hyperthyroidism may also result in fetal and neonatal hyperthyroidism due to the transplacental transfer of stimulatory TSH receptor antibodies . Clinical neonatal hyperthyroidism occurs in about 1% of infants born to mothers with Graves disease. Rarely neonatal hypothyroidism may also be observed in the infants of mothers with Graves hyperthyroidism. This may result from transplacental transfer of circulating maternal anti-thyroid drugs, pituitary-thyroid axis suppression from transfer of maternal thyroxine.

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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.

    Risks Associated With Thyroid Dysfunction In Pregnancy

    Thyroid and Fertility
    • Overt hypothyroidism and hyperthyroidism are associated with a range of adverse obstetric outcomes and risks to the baby .
    • Studies are now focusing on the potential effect of subclinical thyroid dysfunction and autoimmune disease. A systematic review found that subclinical hypothyroidism in pregnancy is associated with pre-eclampsia and perinatal mortality and the presence of maternal thyroid autoantibodies is associated with miscarriage and preterm birth . A meta-analysis of cohort studies had similar findings for miscarriage and another for preterm birth .

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