Identification Of Adverse Pregnancy Outcomes
Adverse pregnancy outcomes were identified using medical codes. For the primary analysis, codes relating to miscarriages and stillbirths were used. For a secondary analysis, other adverse pregnancy complications were identified and grouped together using medical codes, specified a priori covering emergency caesarean section, preeclampsia, postpartum hemorrhage, placental abruption, prematurity, low birth weight, growth restriction, need for intensive care, and neonatal death.
Take Charge Of Your Care
Dont assume that your fertility doctor will be on top of your thyroid issues. Surprisingly, some fertility doctors and clinics dont pay much attention to thyroid testing or the management of thyroid disease during preconception, assisted reproduction , or early pregnancy. Choose a fertility doctor who is thyroid-savvy and develop a plan to ensure that your thyroid disease doesn’t interfere with a healthy pregnancy.
Treating Abnormal Tsh Levels
A doctor will diagnose a thyroid disorder by reviewing your medical history, conducting a physical examination, and doing multiple tests, including a blood test. In some, but not all, instances, you may need a thyroid ultrasound or thyroid scan.
Treatments for hypothyroidism and hyperthyroidism can change over time, based on the severity of the condition and your response to medication.
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Who Should Be Tested
Anyone with the symptoms of an overactive or underactive thyroid or postpartum depression should have a TSH test to tell whether thyroid levels are normal. Thyroid hormone levels do not need to be checked unless the TSH is high or low .
Since the symptoms of a change in thyroid function may be so mild as to be missed or mistaken for other health problems, your doctor may also choose to check your TSH level about two to four months after delivery if you or a close relative have ever had a thyroid problem. You may also have a TSH test after pregnancy if your doctor suspects that you are at increased risk for thyroid dysfunction. This could be your situation if you or close relatives have other disorders or physical traits suggesting an increased risk for thyroid problems. These include juvenile diabetes, rheumatoid arthritis, pernicious anemia due to a lack of vitamin B12, colitis, and prematurely gray hair. There is even new research which suggests that if you or a close relative are either left-handed or ambidextrous you may have an increased risk for thyroid dysfunction and other immune problems.
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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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When Tsh Alone Is Not Enough
During diagnosis, most doctors use the TSH test to evaluate thyroid function and determine the optimal course of treatment. There are times, however, when knowing one’s TSH may be insufficient.
For instance, free T4 in addition to TSH is usually tested if a doctor suspects thyroid dysfunction due to disease of the pituitary gland or hypothalamus.
Likewise,;if the TSH is normal, but a person still has symptoms of being hyperthyroid or hypothyroid, free T4 may be checked.
TSH is also not necessarily sufficient to monitor hypothyroidism during pregnancy; T4 and free T4 are often recommended.
What Tests Are Used To Check Thyroid Function
- with symptoms of thyroid dysfunction
- with their own or family history of thyroid disease
- with previous thyroid surgery
- who are severely overweight or obese
- who are aged 30 or older
If you feel you fit into one or more of the above categories, ask your doctor or midwife if your thyroid function should be checked.
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Facts About Hypothyroidism And Pregnancy
Hypothyroidism is a condition that is caused by an underactive thyroid gland. It may happen during pregnancy. Many symptoms of the condition are similar to pregnancy symptoms. For example, they can both cause fatigue, weight gain, and changes in menstruation. Having low thyroid hormone levels can also cause problems with becoming pregnant. It can also be a cause of miscarriage.;
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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When Abnormal Thyroid Function Tests Are Not Due To Thyroid Disease
While blood tests to measure thyroid hormones and thyroid stimulating hormone are widely available, it is important to remember that no all tests are useful in all circumstances and many factors including medications, supplements, and non-thyroid medical conditions can affect thyroid test results. An endocrinologist can help you make sense of thyroid test results when there is a discrepancy between your results and how you feel. A good first step is often to repeat the test and ensure there are no medications that might interfere with the test results. Below are some common reasons for mismatch between thyroid tests and thyroid disease.
Non-thyroidal illness Significant illness, such as an infection, cancer, heart failure, or kidney disease, or recent recovery from an illness can cause changes transient changes in the TSH. Fasting or starvation can also cause a low TSH. An endocrinologist can help to interpret changes in thyroid function tests in these circumstances to distinguish non-thyroid illness from true thyroid dysfunction.
Test interference Biotin, a common supplement for hair and nail growth, interferes with many thyroid function tests and can lead to inaccurate results. Endocrinologists recommend stopping biotin supplements for 3 days before having a blood test for thyroid function.
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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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.
Whole Wheat Food Items
The diet of a pregnant woman should have limited items that are made of refined wheat, such as white bread, white rice, maida rotis, etc. Instead, attention should be given to foods made of whole wheat cereals, whole wheat bread, barley, oats, and other items that are manufactured from whole grains. These are the perfect fit in the diet of a pregnant woman with hypothyroidism since they support the proper functioning of the thyroid gland.
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What Are The Main Kinds Of Thyroid Conditions
There are two main kinds of thyroid conditions:
If you have a thyroid condition during pregnancy, treatment can help you have a healthy pregnancy and a healthy baby.
Initiation Of Thyroid Hormone Therapy
For a total of 5050 pregnancies with TSH testing, the women were started on thyroid hormone therapy. Those initiated on thyroid hormone therapy had a median of 4 TSH measurements during pregnancy. Thyroid hormone therapy was initiated at a median gestational age of 7 weeks. Women who initiated thyroid hormone therapy during pregnancy had their first TSH test earlier in gestation than women who had a TSH test but did not initiate thyroid hormone therapy . Levothyroxine was the type of thyroid hormone therapy initiated in 5028 of these pregnancies. The mean dose of levothyroxine initiated in pregnancy was 44.1 g/day, and the median dose was 50 g/day. For the remaining 22 pregnancies, desiccated thyroid was prescribed.
Among the 16 141 pregnancies with a highest TSH value ranging from 2.51 to 4.00 mIU/L, thyroid hormone therapy was initiated during 1371 of the pregnancies . Among the 1709 pregnancies with a first measured TSH value of 10.00 mIU/L or higher, thyroid hormone therapy was initiated during only 300 of the pregnancies .
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In People With Thyroid Disease
In people being treated for hypothyroidism, a low TSH level may mean:
- Overmedication with thyroid hormone replacement
- Interactions that cause increased absorption or activity despite an optimal dose of medication
- Central hypothyroidism
In people being treated for hyperthyroidism, a low TSH level usually means that further treatment is needed to reduce thyroid hormone levels.
It could also mean that a person must continue to be monitored to make sure thyroid hormone levels return to normal. This is often the case for people who have temporary thyroiditis related to pregnancy or chemotherapy treatment.
Treatment may need to be more aggressive
Medication may not be absorbing enough
Treatment may be more aggressive than needed
Medication may be absorbing too much
How Does Our Thyroid Affect Fertility
As you can see although hypo/hyperthyroidism often have opposing symptoms, they BOTH can cause menstrual irregularities. Menstrual irregularities including irregular cycles and anovulation can significantly impact your ability to get pregnant. Again, if you dont ovulate, you cant get pregnant. This is why proper comprehensive thyroid lab work 6-8 months BEFORE trying to conceive is something I recommend to all of my patients.
Low thyroid function, like that seen in hypothyroidism, can also lead to a decrease of serum FSH and LH . FSH and LH are the primary hormones released by the brain to stimulate your ovaries to ovulate. Without proper FSH and LH function, the ovaries cannot function properly.
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Thyroid During Pregnancy: Hypothyroidism
In India, approximately 1 in every 10 women suffer from thyroid problems. Because thyroid issues are so common, we check the Thyroid Stimulating Hormone levels for all women during their pregnancy as early as possible, says Dr. Priti.
Most women with thyroid disease are diagnosed with hypothyroidism in which case the gland doesnt produce enough thyroid hormone. Symptoms of hypothyroidism include irregular periods and difficulty with getting pregnant. ;
A milder form of thyroid during pregnancy is mild or subclinical hypothyroidism. In this condition, the symptoms of thyroid imbalance may not be visible, but the TSH levels during pregnancy are too high and need treatment.
Subclinical hypothyroidism should also be treated for women planning a pregnancy, says Dr. Priti.
Ideally, thyroid treatment should begin before conception; but it should definitely be addressed in early pregnancy to avoid complications.
If left untreated, thyroid disorders can interfere with your babys cognitive development. In rare cases, untreated thyroid issues can lead to preterm labour, gestational hypertension, or even miscarriage.
Want to know how to manage your thyroid during pregnancy? Speak to consult a gynecologist about it. Schedule a free consultation with a senior gynecologist at our hospital in South Delhi.
Please call on +91 9871001458 to schedule appointment.
2. Thyroid During Pregnancy: Hyperthyroidism
Mineral Deficiency And Thyroid Function
The thyroid gland required iodine and selenium and major co-factors in its function to regulate metabolism. If these nutrients are missing, the thyroid cannot properly function.
Hypothyroidism is often very high in populations whose diet is very low in selenium but most importantly in iodine. The diet plays a very important t role in regulating thyroid function and maintenance of thyroid balance.
If you are borderline hypothyroid, where the TSH levels are within the normal range but you are experiencing common symptoms, following a good thyroid diet may be the way to go.
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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 womans 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.
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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