The thyroid is a butterfly-shaped gland located in the front of the neck. It produces hormones that control metabolism. Thyroid disorders in pregnancy can be a particular concern, because pregnancy-related hormones can affect thyroid hormones. Untreated thyroid disorders in pregnancy increase the risk of pregnancy complications. It may cause harm to the developing fetus.
Hypothyroidism
Hashimoto’s disease is the most common cause of
hypothyroidism. The immune system attacks the thyroid gland. Other causes of hypothyroidism in pregnancy include the following:
- Inadequate treatment of pre-existing hypothyroidism
- Overtreatment of hyperthyroidism with antithyroid medicines
- Increased estrogen levels (causes circulating thyroid hormone to become inactive)
Hyperthyroidism
Graves’ disease is characterized by overactivity of the thyroid. It is the most common cause of
hyperthyroidism. Another cause of hyperthyroidism in pregnancy is very high levels of human chorionic gonadotropin (hCG).
However, these cases usually go away on their own.
Risk Factors
These risk factors increase your chance of developing a thyroid disorder. Tell your doctor if you have any of these risk factors:
- Personal or family history of a thyroid disorder
- History of treatment for a thyroid disorder
-
Presence of a
goiter
(enlarged thyroid gland)
- Hyperemesis gravidarum
(severe form of morning sickness)
- Prematurely gray hair
-
Family or personal history of immune problems (eg,
type 1 diabetes,
vitiligo)
Symptoms
If you have any of these symptoms, do not assume it is due to a thyroid disorder. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
-
Symptoms of hypothyroidism:
- Goiter (swelling) in the front of your neck
- A feeling of fullness or tightness in your throat
- Trouble swallowing foods or liquids
- Tiredness
- Forgetfulness
- Depression
- Dry skin
- Slow heartbeat
- Weight gain
- Constipation
- Intolerance to cold
-
Symptoms of hyperthyroidism:
- Unexplained weight loss
- Heart palpitations or abnormal heart rhythm
- Sweating
- Nervousness
- Tremors
- Protruding eyes
- Intolerance to heat
Diagnosis
Your doctor will ask about your symptoms and medical history. He will also do a physical exam. You may be referred to a doctor who specializes in hormone disorders (endocrinologist).
Tests may include:
- Blood tests—to measure thyroid-stimulating hormone (TSH) and thyroid hormones (free thyroxine, triiodothyronine) and to look for the presence of antibodies that attack the thyroid gland
- Radioactive scan of the thyroid—to determine whether the thyroid is overactive
(This is usually avoided during pregnancy due to the risks to the developing fetus.)
Treatment
Hypothyroidism
Untreated hypothyroidism in pregnancy can:
-
Increase the risk of
miscarriage
and fetal death
- Negatively impact the child’s subsequent psychological development, IQ score, motor skills, attention, language, and reading abilities
To treat hypothyroidism, your doctor will prescribe an oral medicine.
Levothyroxine
(Synthroid) can replace the hormone your thyroid is not producing.
Hyperthyroidism
Untreated hyperthyroidism in pregnancy is associated with:
-
Fetal
tachycardia
(fast heart rate)
- Babies that are small for gestational age
- Prematurity
- Stillbirth
- Fetal hyperthyroidism
- Congenital malformations
Mild hyperthyroidism during pregnancy is often monitored closely without therapy. In some cases, though, you may need to take medicine. If antithyroid medicines do not work,
surgical removal
of your thyroid gland may be done. It is very rarely recommended during pregnancy. Treatment with radioiodine, which destroys the thyroid gland, is not done during pregnancy because of risk to the fetus.
Hormones associated with pregnancy can cause changes in thyroid hormone levels. Therefore, your medicine needs may fluctuate widely during pregnancy. Your doctor will likely check your blood levels of thyroid hormone every 6-8 weeks during pregnancy and four weeks after your medicine dose is changed.
Prevention
There are no known guidelines for preventing thyroid disorders in pregnancy. However, if you think you are at risk for this disorder, talk to your doctor.
American College of Obstetricians and Gynecologists. Thyroid disease in pregnancy.
Practice Bulletin No. 37.
August 2002 (reaffirmed 2010).
Graves’ disease. American Thyroid Association website. Available at:
http://www.thyroid.org/patients/brochures/Graves_brochure.pdf. Accessed August 12, 2005.
Hashimoto’s disease: what it is and how it’s treated. American Academy of Family Physicians website. Available at:
http://familydoctor.org/548.xml. Accessed August 4, 2005.
Hyperthyroidism.
JAMA website. Available at:
http://jama.ama-assn.org/cgi/content/full/294/1/146. Accessed August 12, 2005.
Thyroid disease and pregnancy. American Thyroid Association website. Available at:
http://www.thyroid.org/patients/brochures/ Thyroid_Dis_Pregnancy_broch.pdf. Accessed August 4, 2005.
Thyroid through the ages: the reproductive years (pregnancy). American Association of Clinical Endocrinologists website. Available at:
http://www.aace.com/pub/tam2001/tam-senyrs.php. Accessed August 4, 2005.
Last reviewedDecember 2011by
Ganson Purcell Jr., MD, FACOG, FACPE
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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