JACKSONVILLE, Fla.--()--Having an uneventful pregnancy and healthy baby is foremost in the minds of prospective parents. Yet many do not realize that mothers and babies require a normal amount of thyroid hormone to ensure this happens.
“It’s well known in the medical community that thyroid hormone plays a critical role during pregnancy. Normal amounts are required for a healthy pregnancy and baby”
Thus, as part of its year-round thyroid awareness campaign, the American Association of Clinical Endocrinologists (AACE) is educating the lay public about thyroid disorders during pregnancy.
“It’s well known in the medical community that thyroid hormone plays a critical role during pregnancy. Normal amounts are required for a healthy pregnancy and baby,” says Jeffrey Garber, M.D., F.A.C.P., F.A.C.E., a thyroid specialist and president of the American College of Endocrinology (ACE), the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). “A challenge is to recognize that symptoms of a thyroid abnormality could easily be mistaken for symptoms of pregnancy.”
When a woman is pregnant, her body needs enough thyroid hormone — produced by the small, butterfly-shaped thyroid gland located centrally at the base of the neck — to support a developing fetus and her own expanded metabolic needs. A healthy thyroid gland naturally meets this demand for increased thyroid hormone. However, if a mother-to-be develops thyroid disease during pregnancy, she may not produce the right amount of thyroid hormone, which can affect her health and the outcome of her pregnancy.
Most pregnant women who develop hypothyroidism, a condition in which the thyroid gland does not make enough thyroid hormone, have mild disease and experience minor symptoms or no symptoms at all. However, women with an undetected thyroid problem before becoming pregnant may find themselves with pronounced symptoms such as extreme fatigue after becoming pregnant.
Pregnancy complications associated with untreated hypothyroidism include anemia, miscarriage, premature birth, preeclampsia (a condition with high blood pressure that may lead to a life-threatening condition known as toxemia), postpartum hemorrhaging and placental abruption, a complication in which the placental lining separates from the mother’s uterus prior to the baby’s delivery. Also, undetected or inadequately treated hypothyroidism in mothers can result in lower IQs in their infants.
The treatment for hypothyroidism is relatively straightforward in many cases, with synthetic thyroid hormone replacement medication being prescribed. “Since these medications are essentially identical to the hormone made by a normal thyroid gland, and there are no side effects for the mother or the baby as long as the proper dose is used, a woman can feel confident that it is perfectly safe to take them during pregnancy,” Dr. Garber notes.
Women with previously treated hypothyroidism should be aware that their dose of medication may have to be increased during pregnancy. They should contact their doctor, who should check their blood level of TSH periodically throughout pregnancy to see if their medication dose needs adjustment.
For those who are pregnant and hyperthyroid, a condition in which an overactive thyroid gland is producing an excessive amount of thyroid hormones, a diagnosis based on symptoms can be particularly challenging, as the two conditions share a host of features. For example, feeling a heart flutter or suddenly experiencing shortness of breath (both symptoms of hyperthyroidism) can be normal in pregnancy, but a patient’s physician still may want to investigate these symptoms. Also, some of the blood tests used to detect hyperthyroidism – high levels of thyroid hormones T3 and T4 and a low level of thyroid stimulating hormone (TSH) – are altered due to the pregnancy.
Once detected, the treatment of hyperthyroidism in pregnancy is limited because the safety of the baby must also be considered. Usually, drugs such as propylthiouracil and methimazole are used. While both of these drugs cross the placenta and can enter the baby's system, treatment is still preferred because of the poor outcomes associated with not treating the condition. Medications to slow the mother’s heart rate down may also be necessary.
Hyperthyroidism during pregnancy, if left untreated, can lead to premature birth, still birth or low birth weight for the baby. In a small number of cases it also can lead to fetal tachycardia, which is an abnormally fast pulse in the fetus; fetal thyrotoxicosis, which is a fetus with hyperthyroidism; or neonatal hyperthyroidism, in which the baby is born with hyperthyroidism. The mother can develop anemia, preeclampsia, congestive heart failure and, rarely, a severe form of hyperthyroidism called thyroid storm, which can be life threatening.
Despite the impact thyroid disease can have on a mother and baby, whether to test every pregnant woman remains a subject of debate in medical circles. As it stands, physicians recommend that women who are experiencing symptoms or are at risk for thyroid disease should have their thyroid evaluated with blood tests. A woman is at risk if she has a history of thyroid disease, a family history of thyroid disease, type 1 diabetes mellitus or any other autoimmune condition, such as celiac disease or lupus. Anyone with these risk factors should be sure to tell their obstetrician or family physician.
“Ideally, women should be tested prior to becoming pregnant at prenatal counseling and as soon as they know they are pregnant,” Dr. Garber says. “By becoming informed prior to and taking charge early in the pregnancy, the patient can optimize the odds of a successful pregnancy.”
ACE and AACE have created a comprehensive consumer website about thyroid awareness. For addition information about thyroid disease and pregnancy, as well as other diseases affecting the thyroid, visit www.thyroidawareness.com.
About the American College of Endocrinology (ACE)
The American College of Endocrinology (ACE) is the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). ACE is the leader in advancing the care and prevention of endocrine and metabolic disorders by: providing professional education and reliable public health information; recognizing excellence in education, research and service; promoting clinical research and defining the future of Clinical Endocrinology. For more information, please visit www.aace.com.
The American Association of Clinical Endocrinologists (AACE)
The American Association of Clinical Endocrinologists (AACE) represents more than 6,500 endocrinologists in the United States and abroad. AACE is the largest association of clinical endocrinologists in the world. The majority of AACE members are certified in Endocrinology and Metabolism and concentrate on the treatment of patients with endocrine and metabolic disorders including diabetes, thyroid disorders, osteoporosis, growth hormone deficiency, cholesterol disorders, hypertension and obesity. For more information, visit the AACE website at www.aace.com, become a fan on Facebook at www.facebook.com/theaace or follow AACE on Twitter at www.twitter.com/theaace.