Hypothyroidism During Pregnancy

If you've got hypothyroidism, you're probably wondering how it will affect

you and baby during pregnancy and how you can safely treat it. Look
no further.
What is hypothyroidism during pregnancy?
Hypothyroidism is when your thyroid gland isnt producing enough hormones. It can
cause some bodily functions to slow.
What are the signs of hypothyroidism?
Weight gain, fatigue and swelling. Sounds like a normal pregnancy, right? Thats
why hypothyroidism can be tough to diagnose during pregnancy.
Are there any tests for hypothyroidism?
Yes, your doc will likely run a blood test to see how much of the thyroid hormones
are running through your bod.
How common is hypothyroidism during pregnancy?
Its actually not so common to see pregnant women with hypothyroidism, since
women with the untreated condition tend to have high rates of infertility.
How did I get hypothyroidism?
We dont know! Causes of hypothyroidism arent clear. Its been linked to
autoimmune disease, treatment for hyperthyroidism, radiation therapy, thyroid
surgery and certain medication.
How will my hypothyroidism affect my baby?
If left untreated, hypothyroidism can cause an increased risk of miscarriage,
preterm birth, low birth weight babies and learning disabilities later in babys life.
Heres the good news: Generally, pregnancy wont worsen your condition, and its
not likely that youll pass it on to baby since the fetus has its own thyroid gland that
kicks in after birth.
Whats the best way to treat hypothyroidism during pregnancy?
Hypothyroid medications (like levothyroxine) are actually completely safe during
pregnancy and can reduce the risk of complications. Women with hypothyroidism

may require a higher dosage of medication while pregnant to control the disease, so
expect monthly check-ins with your health care provider to make sure that you, your
thyroid and baby are all in check.
What can I do to prevent hypothyroidism?
Sorry, but theres nothing you can do since the condition is so mysterious.
What do other pregnant moms do when they have
hypothyroidism?
Its important that I take my medication every day so that the hormones and
symptoms dont affect the baby. My doctor has even been checking my thyroid every
month since Ive been pregnant to ensure it stays normal.
My doctor just called and wants to put me on thyroid medication because of
hypothyroidism. She made it seem like it was a pretty common occurrence. She
wants to check my levels every six weeks, which puts my mind at ease. I was
planning on taking my thyroid pill in the morning, before eating breakfast, and my
prenatals at night.
I have a hypoactive thyroid. I take Synthroid for it. I started the pregnancy at 88 mcg
and then was checked monthly for my T4 levels. Ive gradually worked my way down
to 25 mcg. Its important to get your levels checked often because of the amount of
hormones in your body while youre pregnant.
Are there any other resources for hypothyroidism during
pregnancy?
American Thyroid Association
Plus, more from The Bump:
I may have a thyroid condition. What should I do before TTC?
Pregnant and tired all the time?
What blood tests do I need during pregnancy?

Underactive Thyroid in Pregnancy Can Lead

to Problems in Children
By L.A. McKeown
WebMD Health News

WebMD News Archive

Dec. 9, 1999 (New York) -- A recent study showing that even a mildly underactivethyroid gland in a
pregnant woman can affect her child's brain development has led major physicians' groups to call for
closer monitoring of thyroid hormone levels during pregnancy. In a statement published in the
November/December issue of the journal Endocrine Practice, the American Association of Clinical
Endocrinologists makes six recommendations for clinicians to consider when caring for women of
child-bearing age.
These recommendations come several months after a major study published in The New England
Journal of Medicine showed that an underactive thyroid, orhypothyroidism, in which thyroid hormone
levels are so mildly depressed that the person shows no symptoms, has profound effects on children.
In that study, James Haddow, MD, and colleagues from the Foundation for Blood Research in
Scarborough, Maine, found that school-age children whose mothers were hypothyroid during
pregnancy had lower IQ scores than children whose mothers were not hypothyroid during pregnancy.
Overall, 19% of children of hypothyroid mothers had scores of 85 or lower compared with just 5% of
children born to women with normal thyroids. The average IQ score is 100.
Both animal and human studies have shown that thyroid hormones are crucial tobrain development.
In the new position statement, American Association of Clinical Endocrinologists officers including
president Richard A. Dickey, MD, recommend preconception thyroid hormone testing for all women
considering pregnancy so thathypothyroidism can be diagnosed early and treated prior to pregnancy.
The recommendations also state that routine testing of the level of thyroid stimulation hormone,
known as a TSH or thyrotropin test, early in pregnancy is "reasonable but should be left to the
judgment of the physician, in consultation with the patient."
A co-author of the study on which the new recommendations are based tells WebMD that the
suggestions for clinicians are reasonable and close to what the authors had in mind. "No one really
knows what the right thing to do is," says Walter C. Allan, MD. "When you start talking about
population-wide screening forhypothyroidism, you get into issues of cost. But women who are of childbearing years should be screened with a simple TSH test and if they do indeed have an elevated
TSH, that should definitely be considered during the pregnancy and they should be treated," Allan
tells WebMD. TSH elevation acts to depress the release of hormones from the thyroid gland, thus
leading to hypothyroidism.
He says his group and others think the next step should be to begin thyroid hormone screening in
young women of child-bearing age. A significant percentage will show mild hypothyroidism. These
women should be treated and monitored further during pregnancy where the thyroid hormone levels
are known to decrease.Medication adjustments may be needed during pregnancy as the hormone
levels change "We still need to prove that the model that people are advocating will work and will be
cost effective," says Allan. "Thyroid treatment is inexpensive and not harmful for pregnant women.
There are very few causes of low IQ that we can do anything about. This is a pretty simple thing to do
something about."

Underactive Thyroid in Pregnancy Can Lead

to Problems in Children
WebMD News Archive
Vital Information:

In pregnant women with untreated hypothyroidism, even if it is so mild that there are no
symptoms, the condition can negatively affect a child's braindevelopment.

New guidelines issued by a professional organization of endocrinologists call for thyroid

screening of all women considering pregnancy and treating and closely monitoring pregnant women
with depressed levels of thyroid hormones.
Thyroid treatments are inexpensive and are not harmful to pregnant women.

Thyroid conditions present risks for

pregnant women and their babies.

Thyroid conditions can, for the most part, be easily managed in

day-to-day life with the right medications and hormone therapy.
However, the risks of low or high thyroid hormone levels become
much more apparent during pregnancy.
Research published in the Endocrine Society's Journal of Clinical
Endocrinology & Metabolism shows that the risk of complications
increases for both women with underactive thyroid glands, or
hypothyroidism, and those with overactive thyroid glands, or
hyperthyroidism. Using data from the Consortium on Safe Labor
on 223,512 single-child pregnancies, researchers found that these
conditions can increase the risk of obstetrical, labor, and delivery
issues.
"Women need appropriate thyroid hormone levels to support a
healthy pregnancy, so it is very important to carefully monitor
expecting mothers who have thyroid diseases," said Dr. Pauline
Mendola of the National Institute of Healths Eunice Kennedy
Shriver National Institute of Child Health and Development
(NICHD) in a press release.

With up to four percent of pregnancies involving thyroid disorders,

understanding how to keep the conditions in check is crucial for
both mother and child.
"In the United States, at least 80,000 pregnant women each year
have thyroid diseases," said the study's lead author, Dr. Tuija
Mnnist of the NICHD, in a press release. "These women are at
increased risk of having serious adverse pregnancy outcomes,
including hypertension and preterm birth. They also have a higher
rate of labor inductions and other birth interventions."

Thyroid Hormone Doses During

Pregnancy
Women require an increase in thyroid hormones during
pregnancy, and many who are using the synthetic hormone
levothyroxine need to boost their doses early in pregnancy.
However, these hormonal changes can then lead to
hypothyroidism. The researchers found that up to 60 percent of
women treated with the levothyroxine had elevated levels of
thyrotropin, the thyroid-stimulating hormone.
This points to the need for improved dose adjustments for
pregnant women with thyroid conditions. According to the study,
Poor control of hyperthyroidism during pregnancy is also
associated with increased risk of miscarriage and stillbirth,
hypertension in pregnancy, preterm births, and maternal heart
failure.

What Current Medical Research Says

More research needs to be done to improve thyroid disorder
treatment, but researchers know in which direction they need to
move.

Although we lacked information on treatment during pregnancy,

these nationwide data suggest either a need for better thyroid
disease management during pregnancy or that there may be an
intrinsic aspect of thyroid disease that causes poor pregnancy
outcomes, the study authors wrote. Future research is still
needed to distinguish if women with adequately treated thyroid
disease have higher risk of pregnancy complications due to the
disease itself or if treatment can truly prevent adverse
outcomes.

What Should You Know?

As for whether women with thyroid conditions should rethink
pregnancy, Mendola has reassuring advice.
Although they were more likely to have obstetric complications
than women without thyroid disease, it is important for individual
women to know that most women with thyroid disease in our
study did not experience complications, she said. More research
is needed to identify ways to further reduce their risk, and careful
monitoring of thyroid function during the course of pregnancy
may be helpful.
Information on thyroid dysfunction during pregnancy can also be
found in The Endocrine Society's clinical practice guidelines.