Hyperthyroidism and pregnancy
What you should know
premature labour and delivery. in front of the windpipe. Graves’ disease predominantly affects women of childbearing age2 • Other. the best thing you can do is having your thyroid checked and your hyperthyroidism treated before falling pregnant.1 • Left untreated hyperthyroidism can have serious effects for both mother and baby2 such as still birth. poor growth of the baby in the womb. physical defects in the baby. Mothers with an overactive thyroid
may experience high blood pressure. women don’t need treatment for this form of hyperthyroidism. which control your body’s metabolism. mainly affects women expecting twins or suffer from extreme nausea and vomiting. It produces the thyroid hormones T4 (thyroxine) and T3 (triiodothyronine).3 During pregnancy hyperthyroidism is caused in about 85% of cases by Graves’ disease. premature birth. but also an episode of hyperthyroidism followed by hypothyroidism.
Did you know?
• An overactive thyroid during pregnancy affects about 0.2 or “thyroid storm” where a stressful event or massive infection can cause a dangerous rise in thyroid hormone levels. an autoimmune disorder which causes the thyroid gland to over produce hormones. In PPT either hyperthyroidism or hypothyroidism is seen.1
An overactive thyroid speeds up your metabolism with symptoms such as tiredness or anxiety which are often misunderstood as typical signs of pregnancy. less frequent causes for hyperthyroidism are goiter and thyroid cancer. If your thyroid produces too much thyroid hormones T4 (thyroxine) and T3 (triiodothyronine) you become hyperthyroid. About 7% of women and 18 to 25% of women with type 1 diabetes develop so called postpartum thyroiditis (PPT) within one year after having given birth. To avoid detrimental consequences of hyperthyroidism.1 As a consequence the thyroid gland is growing and producing too much thyroid hormones.1 and 0. a condition that puts you and your baby at risk.Hyperthyroidism and pregnancy: What you should know
When you are falling pregnant you experience various emotional and physical changes. amongst them changes in thyroid hormone levels produced by your thyroid gland.1
Know the facts
The thyroid is a butterfly-shaped gland that sits at the base of the neck. called transient gestational thyrotoxicosis. As it usually resolves between month 3 and 5.1 If your thyroid gland produces too much thyroid hormone your thyroid gland is overactive. • Temporary hyperthyroidism.4
An untreated hyperthyroidism can result in miscarriage. a condition called hyperthyroidism.4% of women1 • Hyperthyroidism is mostly caused by Graves’ disease. an autoimmune disorder in which antibodies attack the thyroid gland. Then your metabolism runs at full speed. child deformities and pre-eclampsia.
but the disease usually worsens again in the first few months after delivery. for example. vomiting or a racing heartbeat. Hyperthyroidism – Knowing the symptoms • Weight loss (even when eating normally) • Anxiety and irritability • Frequent bowel movements • Fast growing fingernails • Thin and very smooth skin • Sweating more than usual If you are pregnant and have some of the a.
The radioactive iodine test for the detection of hyperthyroidism should not be done in pregnant and/or breast-feeding women. staring eyes (typical for Graves’ disease) • Feeling very weak
Pregnant women with Graves’ disease may feel better during pregnancy because the immune system is suppressed to protect the baby. Other members of the committee suggested screening of high-risk women. a test for antibodies will be performed. because of the danger of undetected hyperthyroidism. your doctor will most likely do a physical examination and order a thyroidstimulating hormone (TSH) and a T4 blood test. preterm delivery • Who are treated with levothyroxine for their underactive thyroid In order to diagnose hyperthyroidism. Who is at high risk?1 All women • Over the age of 30 years • With a family history of autoimmune thyroid disease or hypothyroidism • With a goiter • With thyroid antibodies • With symptoms or signs of hyperthyroidism • With type 1 diabetes or other autoimmune disorders • With fertility problems • Who have had miscarriage. you should see your doctor immediately to rule out hyperthyroidism.
• Very fast heart rate (often more than 100 beats per minute) • Trembling hands • Hair loss
• Prominent. excessive sweating. feeling hot. To find out whether your hyperthyroidism is due to Graves’ disease or to gestational thyrotoxicosis.Watch out for …
An overactive thyroid in pregnancy is difficult to diagnose because many of the normal changes during pregnancy are similar to symptoms of the dysfunction.m. you are having hyperthyroidism.
. If your TSH level is low and the T4 concentration high.
Screening for hyperthyroidism
Should all pregnant women be screened for hyper thyroidism? Some experts of the committee being involved in establishing the new guideline of the Endocrine Society1 recommended screening of all pregnant women at week 9 of pregnancy or at the first visit. symptoms such as a heartbeat above 100 beats per minute and losing weight.
Hyperthyroidism in PPT most commonly occurs around three months after the baby is born and usually lasts one to two months. Thyroid Function Tests. J Clin Endocrinol Metab 2012. Up to 7% of women develop postpartum thyroiditis (PPT). 4.webwiki. 2010 31:702-755
For further information
If you would like further information regarding thyroid dysfunction before.1 Since PPT generally is a transient condition. He or she will know whether the antithyroid medication should be altered. During. your hyperthyroidism must not be treated with radioactive iodine.
If you are planning for a baby or are already pregnant and you are hyperthyroid. New mothers with hyperthyroidism symptoms can be treated with the betablocking agent propranolol if they suffer from their symptoms.How hyperthyroidism in pregnancy is treated
The aim of treatment for your overactive thyroid is to reduce the thyroid hormones within the blood. during or after pregnancy. an inflammation of their thyroid gland. American Thyroid Association.endo-society.org/Resources/upload/PG-Maternal-Hypothyroidism-Web. weight loss. Some women who do not respond to treatment or cannot tolerate it will need surgery which is best done in the middle of pregnancy when the risks of miscarriage or premature labour are at their lowest. at any point up to a year after childbirth. Alexander EK.org/guidelines/upload/Thyroid-Exec-Summ.5
1. After the birth Once the baby is born. Crit Care Nurse 2004. This drug can harm your baby’s thyroid. 2012 http://www. nervousness. Management of Thyroid Dysfunction during Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline.com and was created in November 2012. Treatment for hyperthyroidism before pregnancy If you are taking antithyroid medication.1 In PPT either hyperthyroidism or hypothyroidism can develop as well as an episode of hyperthyroidism followed by hypothyroidism.pdf Patient Guide to Detecting and Treating Hypothyroidism Before. Lobert S. 97 (8): 2543-2565 2. You must consult a suitable qualified healthcare professional on any problem or matter which is covered by any information in this booklet before taking any action.pdf Accessed November 2012 3. Please refer to the Privacy and Legal Statement on the aforesaid website when reading this. Krassas GE. a drug that destroys your thyroid gland. These include fatigue.1 Surgery is carried out to remove part of the thyroid gland. Glinoer D (2010) Thyroid function and human reproductive health. Amino N.pdf Accessed November 2012.thyroid. Treatment for hyperthyroidism during pregnancy If your hyperthyroidism is due to Graves’ disease your doctor will start treatment with propylthiouracil (PTU) for the first trimester.thyroidweek. Endocr.org/patients/brochures/FunctionTests_brochure. methimazole given in the early stage of pregnancy may cause birth defects in the baby. Brewer JM.hormone. During. most women need no treatment but monitoring four and eight weeks after diagnosis. 2012 http://www. and After Pregnancy. De Groot L. This Factsheet has been downloaded from the website www. Your doctor will dose it as low as possible. De Groot LJ. see your doctor as soon as you know about being pregnant. Between 20 – 30% of women who develop PPT have hyperthyroid symptoms. A Medical Emergency. palpitations. anxiety and irritability. women who have had previous thyroid dysfunctions may experience a flare up of their disease. Abalovich M. Waltman PA.Rev. The reason for this: In rare cases PTU is associated with liver damage in the mother.org Patient information by the Thyroid Federation International http://www.1
If you are planning for a family you should be aware of thyroid disease that can occur before. Barbour L et al. 24 (2): 74-79 5.hormone. during and after pregnancy.org/upload/PG-MgmtHyperthyroid-v5. and After Pregnancy. By the Hormone Health Network’s http://www.
An initiative supported by
. please visit: www. Hormone Health Network’s Patient Guide to Detecting and Treating Hyperthyroidism Before.pdf The Endocrine Society’s Clinical Practice Guideline The information in this Factsheet is not intended as a substitute for informed medical advice.de/thyroid-fed. This may be associated with postnatal depression. Antithyroid medication can be taken during pregnancy. Thereafter you probably will get another antithyroid drug called methimazole.thyroidweek.com Official website of the International Thyroid Awareness Week of the Thyroid Federation International http://www. In case you have had radioactive iodine treatment you should wait six months before planning for a family. Thyroid Storm During Pregnancy. Mestman J. Poppe K. heat intolerance.