| Thyroid disease affects different aspects of | | | | control her hyperthyroidism. |
| pregnancy and postpartum health for the mother and | | | | - Uncontrolled hyperthyroidism remains despite |
| the newborn child. There have been varied and | | | | treatment. If the above cases are evident, surgery is |
| contradicting practices with regards to thyroid disease | | | | recommended usually during the second trimester. The |
| and pregnancy. As a result a group of endocrinologists | | | | second trimester for this operation poses less risk to |
| came together to publish a journal containing clinical | | | | the unborn child and danger to the pregnancy. |
| guidelines for the management of thyroid problems | | | | Treating subclinical or mild hyperthyroidism has not |
| during pregnancy and during the postpartum period. | | | | been shown to improve or better the outcome of |
| The creation of this group came about over a | | | | pregnancy. Therefore, treating subclinical or mild |
| two-year period and their findings were published in the | | | | hyperthyroidism is not because of the potential |
| Journal of Endocrinology and Metabolism, the August | | | | negative effects on the unborn child. |
| of 2007 issue. This journal represents the methods | | | | Note: Radioactive iodine should never be administered |
| and practices of endocrinologists all over the world. | | | | to any woman who is or may be pregnant. |
| Some of the main components of that journal are | | | | Antibodies, Graves' Disease and Newborns |
| being discussed below. The points bear crucial | | | | There are two antibodies in a mother that can cross |
| implications for women who are diagnosed with thyroid | | | | the placenta and affect the unborn child's thyroid gland. |
| disease during their pregnancy or even at the | | | | They are called TSH receptor-stimulating or TSH |
| postpartum stage. Some of the information also has a | | | | receptor-binding antibodies. If a woman is diagnosed |
| bearing on women who develop thyroid disease | | | | positive for any of these antibodies while pregnant, her |
| before they get pregnant. | | | | child can be born with hyperthyroidism. It is very |
| Hypothyroidism & Pregnancy | | | | important that these antibodies be measured in both |
| The condition of hypothyroidism in a mother or an | | | | women who have Graves' disease or who have |
| unborn child can cause serious health problems on the | | | | given birth previously to newborn children who |
| unborn baby. If a woman is aware of her condition as | | | | developed Graves' disease. It may be necessary to |
| properly diagnosed hypothyroidism, she should | | | | treat the mother with anti-thyroid drugs in order to |
| reconsider trying to get pregnant or avoid maternal | | | | reduce any risk to the newborn child. |
| hypothyroidism altogether. | | | | If a woman has elevated TSH receptor-stimulating or |
| If a woman should develop hypothyroidism prior to her | | | | TSH receptor-binding antibodies and is treated with |
| pregnancy and it has been properly diagnosed by a | | | | anti-thyroid drugs, a doctor should conduct a fetal |
| doctor or endocrinologist, her thyroid medication will | | | | ultrasound evaluation. This scan will search for any |
| need to be adjusted so that the thyroid stimulating | | | | evidence of dysfunction in the thyroid gland of the still |
| hormone (TSH) level goes no higher than 2.5 prior to | | | | developing baby. Such would include finding any |
| entering pregnancy. | | | | evidence of slow growth and enlargement in the |
| A woman diagnosed as hypothyroid during her | | | | baby's thyroid. |
| pregnancy should undergo treatment immediately. The | | | | If a new mother has been diagnosed with Graves' |
| goal is to restore her thyroid levels back to normal as | | | | disease, her newborn child should still be evaluated |
| soon as possible. Upon entering the first trimester, her | | | | after birth for any dysfunction in its thyroid gland. |
| thyroid-stimulating hormone (TSH) level should be held | | | | Pregnancy with Severe Morning Sickness and |
| at less than 2.5. Upon entering the second and third | | | | Hyperthyroidism |
| trimester, her thyroid-stimulating hormone (TSH) should | | | | Hyperemesis gravidarum is severe morning sickness |
| be maintained at less than 3.0. Thyroid function tests | | | | that may also include dehydrations and significant |
| need to be reviewed and re-evaluated within 30 to 40 | | | | weight loss. All pregnant women diagnosed with |
| days after the initial diagnosis. | | | | hyperemesis gravidarum should have their thyroid |
| When a pregnant woman reaches week four to six, | | | | gland examined for any dysfunction. |
| her thyroid medication dosage will almost always need | | | | If a woman is diagnosed with overt hyperthyroidism |
| to be increased. It is possible that her dosage will | | | | due to Graves' disease and gestational |
| increase by anywhere from thirty to fifty percent. | | | | hyperthyroidism with substantially elevated thyroid |
| Some women have a thyroid auto-immunity as in | | | | hormone levels treatment may be required. |
| cases where she has been previously examined and | | | | Thyroid Nodules, Thyroid Cancer & Pregnancy |
| found to be positive for thyroid antibodies. Woman | | | | A fine-needle aspiration (FNA) biopsy evaluation is |
| who have an auto-immunity and who possess normal | | | | recommended for pregnant women with thyroid |
| thyroid stimulating hormone (TSH) levels in early stages | | | | nodules measuring larger than 1 cm in size. |
| of pregnancy can still be at risk of becoming | | | | Once a pregnant woman is diagnosed with malignancy |
| hypothyroid at any point in the pregnancy. It is | | | | or cancerous thyroid nodules and they are such |
| recommended that she be monitored regularly | | | | nodules are found during the first or second trimester, |
| throughout the pregnancy for elevated thyroid | | | | surgery should be recommended in the second |
| stimulating hormone (TSH). | | | | trimester. |
| If a woman is diagnosed with subclinical hypothyroidism | | | | Note: Well-differentiated thyroid cancers grow at a |
| which involves a thyroid stimulating hormone (TSH) | | | | much slower rate. If the evaluation or biopsy shows |
| level above normal with normal free T4 levels, her | | | | the cancer to be papillary or follicular without any |
| condition can lead to a negative health outcome for | | | | evidence of advanced disease, a woman may be able |
| her and her unborn child. Immediate treatment of the | | | | to choose having the surgery after childbirth. |
| mother can help to ensure a healthier pregnancy and | | | | A pregnant woman previously diagnosed with thyroid |
| birth outcome. However, treatment has not been | | | | cancer or a woman (as in the above case) diagnosed |
| proven to guarantee long-term neurological | | | | with a well-differentiated thyroid cancer opting to have |
| development of the baby. In spite of this, experts | | | | surgery after her child is born can still receive |
| believe that the possible benefits of treatment still | | | | treatment that can help to suppress thyroid stimulating |
| outweigh any possible risks if the mother went without | | | | hormone (TSH). Though her thyroid stimulating |
| treatment. The consensus is that treatment is | | | | hormone (TSH) level may be suppressed, it would still |
| recommended even in women with subclinical | | | | be detectable. The desirable situation is to have free |
| hypothyroidism. | | | | T4 or total T4 levels remain within the normal range |
| Once childbirth has occurred, most women who have | | | | for the pregnancy. |
| been diagnosed with hypothyroidism will need to have | | | | Note: Radioactive iodine should never be administered |
| their medication dosage reduced. | | | | to women who are breastfeeding. |
| Hyperthyroidism & Pregnancy | | | | Women who are receiving therapeutic doses of |
| It has been found that hyperthyroidism can be brought | | | | radioactive iodine should wait a minimum of six months |
| on by Graves' disease. Transient hyperthyroidism can | | | | and up to a year before becoming pregnant. This will |
| also trigger hyperemesis gravidarum, which is a | | | | ensure stability of thyroid function and that the cancer |
| condition of pregnancy that causes severe morning | | | | is in remission. |
| sickness. The diagnosis involves determining whether a | | | | Postpartum Thyroid Problems After Pregnancy |
| woman has a goiter, tests positive for thyroid | | | | A thyroid evaluation should be conducted three to six |
| antibodies or both. | | | | months after a woman has given birth if she has |
| If a pregnant woman's hyperthyroidism is triggered by | | | | already tested positive for thyroid peroxidase |
| Graves' disease or nodules are found in the gland, she | | | | antibodies. |
| should begin treatment for hyperthyroidism immediately. | | | | In women with type 1 diabetes, postpartum thyroiditis is |
| Generally, pregnant women are given anti-thyroid | | | | three times more likely to occur. That being the case, |
| medication as part of treatment especially when initially | | | | woman with type 1 diabetes should have thyroid |
| diagnosed. | | | | evaluation three months and six months after childbirth. |
| The most common antithyroid medication given usually | | | | Women who already have a history of postpartum |
| during the first trimester is propylthiouracil. | | | | thyroiditis have a significantly increased risk of |
| Propylthiouracil is generally the drug of choice because | | | | developing hypothyroidism within five to ten years |
| methimazole contains has a slightly higher risk of birth | | | | after a postpartum thyroiditis episode. Any women |
| defects. Methimazole is used, but it is only prescribed if | | | | that fall into this group should have their thyroid |
| propylthiouracil is not available or if a woman is | | | | checked and evaluated annually. |
| experiencing complications with it. | | | | Screening for Thyroid Dysfunction During Pregnancy |
| There are situations where surgery may be the only | | | | In particular, women who face a higher risk of thyroid |
| recommended method for treatment instead of drugs. | | | | disease should be screened and evaluated. It is |
| They are: | | | | recommended that these evaluations occur in women |
| - If there is a severe negative reaction to anti-thyroid | | | | who are having an infertility evaluation. |
| drugs. | | | | It is also recommend that women who fall into the |
| - If a woman requires an extremely high dosage to | | | | at-risk groups below be evaluated. |