Pregnancy Archives - ThyForLife https://www.thyforlife.com/category/healthy-living/pregnancy/ Thu, 10 Oct 2024 12:39:27 +0000 en-CA hourly 1 https://www.thyforlife.com/wp-content/uploads/2021/12/favicon-thyforlife.png Pregnancy Archives - ThyForLife https://www.thyforlife.com/category/healthy-living/pregnancy/ 32 32 What is postpartum thyroiditis? https://www.thyforlife.com/postpartum-thyroiditis/ Thu, 10 Oct 2024 12:38:20 +0000 https://www.thyforlife.com/?p=13377 ©Freepik The thyroid gland is a small, butterfly-shaped organ located in the neck, just below the Adam’s apple. The thyroid produces triiodothyronine (T3) and thyroxine (T4), whose production is regulated by the pituitary gland through thyroid-stimulating hormone (TSH). The thyroid hormones control how the body uses energy. T4 is produced and released at higher levels […]

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The thyroid gland is a small, butterfly-shaped organ located in the neck, just below the Adam’s apple. The thyroid produces triiodothyronine (T3) and thyroxine (T4), whose production is regulated by the pituitary gland through thyroid-stimulating hormone (TSH). The thyroid hormones control how the body uses energy. T4 is produced and released at higher levels into blood circulation in the body than T3 is. However, since T3 is the active form of the thyroid hormone, T4 hormone has to be converted into T3 by cells of the body before it can be used by the body.

During pregnancy, the body undergoes significant hormonal changes, which may affect thyroid function. For many women, thyroid hormone levels naturally fluctuate during pregnancy, but for some, these changes can even trigger a thyroid disorder after childbirth. If this happens, it is most likely postpartum thyroiditis.

Postpartum thyroiditis is a condition where the thyroid gland  becomes inflamed within the first year after childbirth, miscarriage, or abortion. This inflammation can lead to temporary hyperthyroidism (an overactive thyroid) followed by hypothyroidism (an underactive thyroid), or just one phase of the two phases. Postpartum thyroiditis affects about 5-10% of women, but the exact prevalence may be higher due to underreporting. 

In the rest of this blog article, we will learn more about postpartum thyroiditis as we answer the following questions:

Risk Factors for Developing Postpartum Thyroiditis

Postpartum thyroiditis is mainly considered an autoimmune condition. In many cases, the immune system, which is usually suppressed during pregnancy to prevent the body from attacking the fetus, becomes more active after delivery. This can trigger an autoimmune response where the body mistakenly attacks its own thyroid gland, leading to inflammation.

Several risk factors increase the likelihood of developing postpartum thyroiditis. While not all women with these risk factors will experience thyroid dysfunction after childbirth, being aware of them helps in early detection and treatment. Here are some of the risk factors:

1. Pre-existing autoimmune thyroid disease

Women with a history of autoimmune thyroid conditions, such as Hashimoto’s thyroiditis or Graves’ disease, are more likely to develop postpartum thyroiditis. Hashimoto’s, in particular, is closely linked to hypothyroidism, which often appears in the later stages of postpartum thyroiditis.

2. Presence of thyroid antibodies

Women who test positive for thyroid peroxidase antibodies (TPOAb) before or during pregnancy are at an elevated risk. These antibodies indicate that the immune system is attacking the thyroid gland, leading to inflammation.

3. Type 1 diabetes

Type 1 diabetes, another autoimmune disorder, is strongly associated with an increased risk of developing postpartum thyroiditis. Approximately 25% of women with type 1 diabetes will experience some form of thyroid dysfunction after childbirth.

4. Family history of thyroid disease

A family history of thyroid disorders, particularly autoimmune thyroid diseases, also raises the risk. Genetic predisposition plays a significant role in the development of thyroiditis.

5. Previous episodes of postpartum thyroiditis

Women who have had postpartum thyroiditis in previous pregnancies are more likely to experience it again in subsequent pregnancies.

6. Environmental and lifestyle factors

While less understood, stress, poor nutrition, and certain environmental toxins may contribute to the development of thyroid disorders. These factors may aggravate autoimmune responses or disrupt normal thyroid function.

Stages of Postpartum Thyroiditis

Postpartum thyroiditis typically progresses through two main distinct stages: hyperthyroidism and hypothyroidism. These phases do not always occur in every woman, and some may experience only one phase or none at all. The phases often manifest within the first 12 months after childbirth, following this general pattern:

1. Hyperthyroidism (Thyrotoxic Phase)

This stage occurs when the thyroid releases an excessive amount of thyroid hormone due to the inflammation. It usually appears within the first 1-4 months after delivery and can last for 1-2 months.

2. Hypothyroidism (Hypothyroid Phase)

After the hyperthyroid phase, the thyroid can become underactive as it struggles to maintain hormone production. This phase often begins 4-8 months postpartum and can last for 6-12 months.

3. Return to Normal (Euthyroid Phase)

Many women eventually see their thyroid function return to normal, typically around one year postpartum. However, in some cases, hypothyroidism can become permanent, requiring ongoing treatment.

Symptoms of Postpartum Thyroiditis

The symptoms of postpartum thyroiditis vary depending on whether the thyroid is overactive  or underactive. Since these symptoms can overlap with common postpartum experiences, they are often overlooked or mistaken for postpartum depression or anxiety. Here’s a breakdown of the most notable symptoms for each phase:

Hyperthyroid Symptoms

  • Unexplained weight loss despite a normal or increased appetite.
  • Rapid heartbeat or palpitations.
  • Anxiety or nervousness.
  • Tremors in the hands.
  • Increased sweating and sensitivity to heat.
  • Fatigue or muscle weakness, particularly in the upper arms and thighs.
  • Sleep disturbances and restlessness.

Hypothyroid Symptoms

  • Excessive fatigue, feeling “slowed down.”
  • Unexplained weight gain or difficulty losing postpartum weight.
  • Dry skin and hair loss.
  • Sensitivity to cold.
  • Depression, mood swings, and memory problems.
  • Constipation and sluggish digestion.
  • Joint pain or muscle aches.

How Postpartum Thyroiditis is Diagnosed

Diagnosing postpartum thyroiditis requires a combination of medical history evaluation and specific thyroid tests. Given that the symptoms of postpartum thyroiditis are nonspecific, the following diagnostic methods are very useful:

Blood tests

The most common tests for postpartum thyroiditis measure levels of TSH and thyroid hormones (T3 and T4) in the blood. In the hyperthyroid phase, TSH levels are typically low, while T3 and T4 levels are elevated. During the hypothyroid phase, TSH levels rise as the thyroid becomes underactive, and T3 and T4 levels drop.

Thyroid antibodies

Testing for TPO antibodies can be useful in diagnosing postpartum thyroiditis. As mentioned earlier, women with these antibodies are more likely to develop the condition. The presence of these antibodies indicates an autoimmune response targeting the thyroid gland.

Medical history

A thorough evaluation of the patient’s medical history, including any prior thyroid issues, autoimmune conditions, or family history of thyroid disease, is important. This is because a history of postpartum thyroiditis also increases the likelihood of recurrence in future pregnancies.

Differences Between Postpartum Thyroiditis and Postpartum Depression

Postpartum thyroiditis and postpartum depression can present with overlapping symptoms, such as fatigue, mood swings, and difficulty concentrating, making it difficult to differentiate between the two conditions. However, they are distinct in their causes and treatments.

Postpartum thyroiditis

  • Caused by inflammation of the thyroid gland, leading to temporary hyperthyroidism or hypothyroidism.
  • Physical symptoms like rapid heartbeat (in hyperthyroidism), weight gain (in hypothyroidism), sensitivity to temperature changes, and muscle weakness are more prominent.
  • Diagnosis is confirmed through blood tests measuring thyroid hormone levels (TSH, T3, T4) and the presence of thyroid antibodies.

Postpartum depression

  • Rooted in emotional and psychological factors, postpartum depression is often triggered by hormonal changes, sleep deprivation, and the stress of adjusting to new motherhood.
  • Symptoms include persistent sadness, lack of interest in daily activities, feelings of guilt, and difficulty bonding with the baby.
  • Treatment usually involves therapy, counseling, and sometimes antidepressant medications.

Given the similar symptoms, healthcare providers make sure tobrule out thyroid dysfunction in new mothers who exhibit signs of depression or fatigue. Misdiagnosing postpartum thyroiditis as depression could delay necessary medical treatment.

Long-term Effects of Postpartum Thyroiditis

For most women, postpartum thyroiditis resolves within 12 to 18 months, and thyroid function returns to normal. However, there are some potential long-term effects that women should be aware of:

Permanent hypothyroidism

In approximately 25-30% of cases, postpartum thyroiditis leads to permanent hypothyroidism within 5 to 10 years. This condition occurs when the thyroid gland does not fully recover from the inflammatory damage and fails to produce adequate levels of thyroid hormones. Permanent hypothyroidism requires lifelong thyroid hormone replacement therapy (usually with levothyroxine) to maintain normal metabolism and energy levels.

Increased risk of recurrence

Women who develop postpartum thyroiditis are at a higher risk of experiencing it again in future pregnancies. This can lead to the need for more vigilant monitoring during subsequent postpartum periods to detect early signs of thyroid dysfunction.

Impact on overall health

If left untreated, postpartum thyroiditis can have far-reaching effects on a woman’s health. Untreated hypothyroidism, in particular, can lead to chronic fatigue, depression, weight gain, and increased risk of cardiovascular diseases due to high cholesterol levels.

Treatment Options for Postpartum Thyroiditis

The treatment for postpartum thyroiditis depends on the phase of the condition and the severity of symptoms. Because postpartum thyroiditis usually resolves on its own without the need for aggressive intervention in many cases, treatment typically depends on the phase of the condition and the severity of symptoms. For women with persistent or severe symptoms, treatment can help manage the condition effectively.

1. Treatment during the hyperthyroid phase

  • Beta-blockers: In cases of major hyperthyroid symptoms like a rapid heartbeat or anxiety, doctors may prescribe beta-blockers (e.g., propranolol) to manage symptoms. These medications don’t treat the underlying thyroid dysfunction but help relieve symptoms while the thyroid stabilizes.
  • Thyroid medication: Typically, anti-thyroid medications are not required during the hyperthyroid phase because it tends to be temporary. However, in very rare cases where hyperthyroidism is severe or prolonged, temporary thyroid suppression therapy may be considered.

2. Treatment during the hypothyroid phase

  • Thyroid hormone replacement: If the hypothyroid phase causes significant symptoms like fatigue, weight gain, or depression, doctors may prescribe levothyroxine, a synthetic form of the thyroid hormone T4. This helps normalize thyroid levels and alleviate symptoms.
  • Monitoring: Because hypothyroidism may be temporary, healthcare providers often recheck thyroid levels every few months to determine if long-term medication is necessary. If thyroid function returns to normal, the medication can be discontinued under a doctor’s guidance.

3. Long-term treatment considerations

  • Women who develop permanent hypothyroidism will require lifelong thyroid hormone replacement. Proper medication management is essential for maintaining energy levels and preventing further complications.

Impact of Postpartum Thyroiditis on Breastfeeding

Postpartum thyroiditis can impact breastfeeding, though it varies from woman to woman depending on the severity of thyroid hormone imbalances.

1. Effect on milk supply

  • Hyperthyroid phase: An overactive thyroid can increase metabolism and energy demands, which might affect milk production in some women. However, most women with mild hyperthyroidism don’t experience significant problems with milk supply.
  • Hypothyroid phase: An underactive thyroid can lead to low energy and fatigue, which may contribute to decreased milk production. If hypothyroidism is untreated, it can slow down lactation and affect the overall supply.

2. Safe treatments during breastfeeding

  • Most treatments for postpartum thyroiditis, such as levothyroxine for hypothyroidism or beta-blockers for hyperthyroid symptoms, are considered safe for breastfeeding mothers. These medications typically do not pass into breast milk in significant amounts, making them safe for the baby.

3. Monitoring thyroid function postpartum

  • It’s essential for breastfeeding women to monitor their thyroid function regularly. Thyroid dysfunction can fluctuate in the months after delivery, and proper management helps ensure both the mother’s health and the baby’s well-being.

Postpartum Thyroiditis and Fertility

Postpartum thyroiditis can also have an impact on a woman’s fertility, both immediately after childbirth and in the future. This is primarily because thyroid function is closely linked to reproductive health, and disruptions in thyroid hormones can affect ovulation, menstrual cycles, and overall fertility.

1. Impact on ovulation and menstrual cycles

  • Hyperthyroidism: During the hyperthyroid phase, an overactive thyroid can lead to irregular menstrual cycles, causing lighter periods or even amenorrhea (absence of menstruation). This can delay the return of normal ovulation, which is necessary for fertility.
  • Hypothyroidism: An underactive thyroid can also affect ovulation by disrupting the balance of reproductive hormones. This might result in heavier, more painful periods, or irregular cycles that could make conception more difficult.

2. Future pregnancies

  • Women who have experienced postpartum thyroiditis may need to be more closely monitored during future pregnancies. The condition can recur after subsequent pregnancies, and if left untreated, hypothyroidism can increase the risk of complications such as miscarriage, preeclampsia, preterm birth, and low birth weight.
  • It’s recommended that women with a history of postpartum thyroiditis have their thyroid function checked before conceiving again to ensure that hormone levels are well-controlled for a healthy pregnancy.

3. Thyroid medication and conception

  • Women with permanent hypothyroidism may need to adjust their thyroid hormone medication when planning a pregnancy. Proper thyroid function is crucial for fetal development, particularly in the early weeks of gestation, and maintaining adequate thyroid hormone levels can support both fertility and a healthy pregnancy.

Key takeaways

  • Postpartum thyroiditis affects about 5-10% of women, but the exact prevalence may be higher due to underreporting. Early diagnosis can significantly improve a new mother’s well-being and reduce the risk of long-term thyroid issues.
  • Postpartum thyroiditis often resolves on its own within 12 to 18 months after delivery. Many women will experience a temporary hyperthyroid or hypothyroid phase before their thyroid function returns to normal. However, in some cases, hypothyroidism may become permanent, requiring long-term treatment with thyroid hormone replacement.
  • The symptoms of postpartum thyroiditis and postpartum depression can overlap, such as fatigue, mood swings, and difficulty concentrating. However, thyroiditis is accompanied by physical symptoms like weight changes, rapid heartbeat, temperature sensitivity, and changes in bowel habits. 
  • Postpartum thyroiditis itself does not prevent future pregnancies, but untreated thyroid conditions can affect fertility. Both hyperthyroidism and hypothyroidism can disrupt ovulation and menstrual cycles.
  • Since each woman’s experience with postpartum thyroiditis can vary, treatment is often individualized, with close monitoring of thyroid hormone levels to determine when and if medication is needed.
  • Thyroid medications such as levothyroxine (used to treat hypothyroidism) and beta-blockers (used to manage hyperthyroidism symptoms) are generally safe to take while breastfeeding. These medications do not pass into breast milk in significant amounts and do not harm the baby, especially when dosed appropriately.
  • Monitoring thyroid health is key for women who wish to conceive again after experiencing postpartum thyroiditis. Addressing thyroid imbalances can help restore fertility and reduce risks during future pregnancies.

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]]> Can I Pass My Thyroid Disease to My Children? https://www.thyforlife.com/passing-thyroid-disease-to-my-children/ https://www.thyforlife.com/passing-thyroid-disease-to-my-children/#respond Thu, 13 Apr 2023 19:54:11 +0000 https://www.thyforlife.com/?p=10594 When living with a thyroid condition it can be challenging to exercise and incorporate movement into your daily life. However, exercise can help alleviate symptoms associated with various thyroid conditions and improve the condition.

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Can I pass my thyroid disease to my children
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Dr. Minako Abe
Medically reviewed by

Dr. Minako Abe, M.D., Board-certified emergency medicine physician researching the relationship between lifestyle and disease onset in relation to the immune system and cancer, Japan

The thyroid gland is a small butterfly-shaped organ located at the base of the neck. It regulates energy metabolism, brain development and overall growth through its release of the thyroid hormone (T4 and T3). The thyroid gland typically releases thyroxine (T4), a substantially inactive form of the thyroid hormone, which some organs convert to its active form, triiodothyronine (T3). Also secreted by the thyroid gland is triiodothyronine (T3).

The two main thyroid conditions, characterized by an overproduction of thyroid hormone (hyperthyroidism) or underproduction of thyroid hormone (hypothyroidism), have different causes. Most cases of hyperthyroidism result from an autoimmune disease known as Graves’ disease. Similarly, Hashimoto’s disease, another autoimmune disease, is responsible for most cases of hypothyroidism. Euthyroidism is the name given to the condition of having an optimal level of thyroid hormone in your body.

Anyone can be affected by thyroid diseases, irrespective of sex or age. However, some people are more susceptible to developing thyroid conditions. Also, while some develop thyroid conditions at some point in their life significantly much later after birth, others are born with them. Congenital thyroid disorders, sometimes referred to as neonatal thyroid disorders, come in various forms and are present at birth, as the name implies. So, are children born with these conditions because their parents passed them on? In some cases, yes, and in other cases, no. A hyperthyroid or hypothyroid child can be born to euthyroid parents. Having hyperthyroid or hypothyroid parents give birth to a euthyroid child is also possible. Many factors, such as genetics, come into play in these instances, although congenital thyroid disorders often seem to occur sporadically without a genetic predisposition.

In cases where genetic factors are absent, other factors, such as pregnancy conditions, including quality of diet during pregnancy, could affect the thyroid development of the fetus. For instance, a lack of iodine in a pregnant woman’s diet, regardless of her thyroid condition, could result in congenital hypothyroidism in her unborn child. This is because the baby needs iodine to make the thyroid hormone. Also, if a pregnant woman develops a thyroid condition which is left untreated, it can result in the development of thyroid problems in the fetus. In extreme cases, it could be fatal.

Aside from the rare instances of thyroid disease being directly passed on from parent to offspring through genetic mutation, it is important to acknowledge that maternal thyroid disorders can also impact the overall well-being of the infant. For instance, thyroid problems during pregnancy may result in pregnancy loss, premature birth, low birthweight, or congestive heart failure in the infant.

The rest of this article highlights two main distinct forms of congenital thyroid disorders:

  • Congenital hypothyroidism
  • Congenital hyperthyroidism

Congenital Hypothyroidism

Congenital hypothyroidism is a condition characterized by thyroid hormone deficiency present at birth. Congenital hypothyroidism can lead to intellectual disability if left untreated. Thanks to newborn screening programs, neurological deficits that result from congenital hypothyroidism can be prevented. Early detection and treatment of this disorder guarantee normal growth of the child. This condition can be managed with levothyroxine. The dosages of the prescription will require some adjustments by a pediatric endocrinologist as the child grows.

The incidence of congenital hypothyroidism is higher in females than males. The reason for this, however, is yet to be scientifically established. This disorder occurs due to a lack of iodine in a pregnant mother’s diet. The advent of iodized diets is believed to have significantly reduced the incidence of congenital hypothyroidism. Compared to congenital hyperthyroidism, congenital hypothyroidism is apparently more common, although both are collectively not very common. Congenital hypothyroidism occurs in about 1 in every 2,000 to 4,000 newborns.

This condition comes in various forms, namely:

  • Thyroid dysgenesis — This is a developmental defect of the thyroid gland characterized by an absent or underdeveloped thyroid gland. While its cause remains largely unknown, this is the most common form of congenital hypothyroidism. It is twice as common in females as in males. Studies suggest that only a small percentage (about 2% to 3%) of this condition is inherited.
  • Thyroid dyshormonogenesis — This occurs when the thyroid gland is present, but thyroid hormone production is minimal or absent due to genetic mutations that disrupt the production of thyroid hormones. The thyroid gland may be either normal-sized or enlarged (goiter).
  • Central/pituitary hypothyroidism — This is a disorder where the pituitary gland, which is located at the base of the brain, is unable to properly stimulate the thyroid hormone production process, resulting in diminished levels of the thyroid hormone, even though the thyroid gland is, in this case, functioning normally. Typically, the pituitary gland produces enough thyroid-stimulating hormone (TSH) to induce thyroid hormone production by the thyroid gland. However, a defective pituitary gland, hypothalamus, or both disrupt this process.
  • Syndromic congenital hypothyroidism — This is when congenital hypothyroidism occurs as part of syndromes affecting other organs of the body. Brain-lung-thyroid syndrome and Pendred syndrome are examples of this condition.

Congenital Hyperthyroidism

The most common cause of congenital hyperthyroidism in newborns is Graves’ disease in the mother. Neonatal Graves’ disease (GD), also known as neonatal hyperthyroidism, remains the most common cause of hyperthyroidism in neonates and is potentially fatal if not detected and treated early by a pediatric endocrinologist. An increased level of circulating and free T4 with a concomitantly decreased level of TSH in the blood of the neonate or fetus is typically indicative of hyperthyroidism. Treatment can begin as early as the fetal stage before the baby is born. While still a fetus, the condition at this stage can be treated using antithyroid medication taken by the mother.

Neonatal GD occurs in about 1% to 5% of infants born to mothers with GD and may cause permanent impairment of brain development if it is not detected and treated early. Although this disorder is rare, it is transient (not permanent). This condition occurs when a mother with Graves’ disease passes her thyrotropin receptor antibodies (TrAb) to her child. These antibodies cross the placenta and stimulate the thyroid gland of the baby. Once these antibodies are cleared from the infant’s bloodstream, the disease should finally disappear.

In the meantime, antithyroid medication is used to manage the condition before the antibodies are cleared from the baby’s blood circulation. Essentially, the prognosis of this condition is good with early detection and treatment. It is also best to still have your child regularly checked by a pediatric endocrinologist, as it is possible for the child to develop a thyroid condition later in the first year of life.

Key Takeaways

  • Can you pass your thyroid disease to your child? Yes, you can, but it is generally not very likely. Genetic factors only account for a small fraction of cases of congenital hypothyroidism.
  • Can a child be born with a thyroid condition even if one or both parents are euthyroid? Yes, this is possible, albeit rare.
  • Thyroid disorders can develop at any stage of life. Anyone can be affected, even though some people may be at a higher risk.
  • Congenital hypothyroidism remains one of the easily preventable causes of intellectual disability. Early diagnosis and treatment prevent neonates from growing with neurodevelopmental challenges.
  • Neonatal Graves’ disease, albeit rare,  is eminently treatable without permanent sequelae if detected early.
  • Newborn screening of congenital thyroid disorders is essential so treatment can begin soon after a diagnosis. Pediatric endocrinologists usually treat cases of congenital thyroid disorders.

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]]> https://www.thyforlife.com/passing-thyroid-disease-to-my-children/feed/ 0 Hypothyroidism and Pregnancy: What you should know https://www.thyforlife.com/hypothyroidism-in-pregnancy/ https://www.thyforlife.com/hypothyroidism-in-pregnancy/#respond Fri, 28 Jan 2022 07:48:28 +0000 https://44.199.17.173/?p=4125 Medically reviewed by Natalie Bessom, D.O. Board-certified family medicine doctor with specialty training in nutrition, USA Hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone, is a common concern during pregnancy. It can pose various risks for both the mother and the fetus, making understanding and managing this condition essential for […]

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Young woman or girl shows positive pregnancy test with two stripes. Lifestyle background. Pregnancy family concept.
Dr. Natalie Bessom
Medically reviewed by

Natalie Bessom, D.O. Board-certified family medicine doctor with specialty training in nutrition, USA

Hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone, is a common concern during pregnancy. It can pose various risks for both the mother and the fetus, making understanding and managing this condition essential for a healthy pregnancy.

Despite nearly 45% of all pregnancies in the U.S. being unintended, an increasing number of women are choosing to plan their pregnancies. In medical terms, this planning phase is known as preconception care. For women intending to conceive, it is crucial to recognize the significance of maintaining optimal thyroid function, as it plays a vital role in ensuring the health and well-being of both mother and baby.

In order to cope with the physical changes and demands during pregnancy, the thyroid often goes through a number of noticeable changes. However, an undiagnosed thyroid problem may put mothers at risk of having issues when trying to conceive and during pregnancy. These problems can include miscarriages, infertility, and menstruation issues. 

This article examines, the following questions will be answered: 

What are the common causes and symptoms of hypothyroidism in pregnancy?

Pregnant Woman

Iodine is an essential nutrient vital and necessary nutrient for the production of thyroid hormones and for human development. Globally, iodine deficiency is the leading cause of hypothyroidism.

However, in iodine-sufficient populations such as in the United States, the most common cause of hypothyroidism is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an autoimmune disease where the body attacks its own healthy thyroid cells. 

Common symptoms of hypothyroidism include: 

  • Thinning of hair
  • Weight gain
  • Bloating
  • Heartburn 
  • Constipation 
  • Brain Fog 
  • Dry or rough skin
  • Aches and pains of muscles 

What are the risks of hypothyroidism to the mother and baby?

African young man in mask measuring the pulse of pregnant woman and caring about her health at hospital

Throughout pregnancy, the thyroid hormone is critical for the brain development and overall growth of the baby. Mothers who have been diagnosed with hypothyroidism should have their thyroid health and levels checked as soon as the pregnancy is confirmed. 

Hypothyroidism affects between 3-5% of all pregnant women and, it left untreated,  can lead to complications such as: 

  • preeclampsia
  • low birth weight
  • premature birth
  • impaired brain development of the child
  • respiratory problems in the newborn

Some studies have also found a strong association between severe iodine deficiency during pregnancy and an increased risk of:

Who needs to be tested for hypothyroidism?

Hypothyroidism during pregnancy often goes undiagnosed, primarily due to the overlap of its symptoms—like fatigue and weight gain—with common pregnancy experiences, making them easy to dismiss. Additionally, not all regions or medical institutions practice universal screening for thyroid dysfunction in pregnant women; instead, many only screen those at high risk, such as individuals with a history of thyroid issues. This approach can miss cases among those without evident risk factors. The variability in thyroid levels during pregnancy and the lack of consistent application of pregnancy-specific thyroid function test norms further complicate the diagnosis.

According to the 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum, routine thyroid laboratory tests are not recommended for all women planning a pregnancy. However, all women who opt for a preconception consultation or attend their first pregnancy appointment should undergo a clinical evaluation. If any of the following risk factors are identified, testing for serum levels of thyroid-stimulating hormone (TSH) is recommended:

  • History of hypothyroidism or hyperthyroidism
  • Current symptoms or signs of thyroid dysfunction
  • High levels of anti-thyroid antibodies
  • The presence of a goiter
  • History of radiation to the head or neck or prior thyroid surgery
  • Age (above 30 years)
  • Type 1 diabetes or other autoimmune disorders
  • History of pregnancy loss, preterm delivery, or infertility
  • Multiple prior pregnancies (2 or more)
  • Family history of autoimmune thyroid disease or thyroid dysfunction
  • Morbid obesity (Body Mass Index of or greater than 40 kg/m2)
  • Use of amiodarone or lithium, or recent administration of iodinated radiologic contrast
  • Residing in an area of moderate to severe iodine deficiency

According to these guidelines, when low serum TSH levels are detected in the first trimester, it is recommended to review the medical history, perform a physical examination, and test the levels of FT4 or TT4 in the serum. Additionally, assessing TRAb and TT3 levels may be useful in determining the cause of thyrotoxicosis.

How is hypothyroidism during pregnancy treated?

The main goal for treating hypothyroidism during pregnancy is to ensure that there is an adequate replacement of thyroid hormones for the health of mother and child. 

The most common treatment for hypothyroidism is synthetic thyroid hormone, levothyroxine (LT4). 

Because thyroid hormone levels change during pregnancy, a hypothyroid woman’s medication dosage should also be adjusted once pregnancy is confirmed. An increase in levothyroxine dosage by 25% to 50% is usually recommended.

Additionally, regular monitoring of thyroid function helps ensure that thyroid hormone levels are within the normal range during the pregnancy. According to the American Thyroid Association, thyroid function tests should be performed every 4 weeks during the first half of pregnancy. 

The American Thyroid Association also recommends that levothyroxine should not be taken at the same time as prenatal vitamins and should be separated by at least 4 hours. This is because prenatal vitamins contain iron and calcium and can interfere with the absorption of the medication. 

Most importantly, pregnant women should always consult and follow the advice of their healthcare provider in order to minimize risks and complications.

What is postpartum thyroiditis?

Postpartum thyroiditis is an inflammatory condition of the thyroid gland that typically occurs within the first year after childbirth. It affects about 5-10% of women and can manifest as transient hyperthyroidism followed by hypothyroidism. While the hyperthyroid phase often goes unnoticed, the hypothyroid phase can cause symptoms like fatigue and depression. Most women eventually recover normal thyroid function, but some may develop permanent hypothyroidism.

Women are at greater risk of developing postpartum thyroiditis if they have: 

  • An autoimmune disorder 
  • High levels of antithyroid antibodies 
  • A history of thyroid dysfunction
  • A history of postpartum thyroiditis 
  • A  family history of thyroid dysfunction or diseases

Mothers who are aware of these conditions or experience symptoms postpartum should consult their healthcare provider immediately.

Key Takeaways

  • Hypothyroidism affects 3-5% of pregnant women and requires careful monitoring and management to prevent complications such as preeclampsia and developmental issues in children.
  • Symptoms of hypothyroidism can overlap with normal pregnancy symptoms, often leading to undiagnosed cases.
  • Universal screening for thyroid dysfunction during pregnancy is not consistently practiced, which may contribute to undiagnosed cases of hypothyroidism.
  • Maintaining optimal thyroid function is crucial during the preconception phase to promote a healthy pregnancy and fetal development.
  • Postpartum thyroiditis occurs in about 5-10% of women, initially presenting as hyperthyroidism followed by hypothyroidism, and can lead to permanent thyroid dysfunction in some cases.
  • High levels of thyroid antibodies increase the risk of developing conditions like postpartum thyroiditis.

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