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  2. Thyroid Problems During Pregnancy

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Pregnancy brings a lot of changes in a woman’s body. The mom-to-be's organs work overtime to fulfil the needs of the expecting mother and the growing baby. Indeed, there are certain medical conditions like thyroid problems and gestational diabetes which can arise during pregnancy.

The thyroid is a butterfly-shaped gland present in the neck, just below the Adam’s apple. It helps to regulate body functions like heart rate, body temperature and metabolism by releasing a steady amount of thyroid hormones (T3 and T4) into the bloodstream. Thyroid dysfunction can present itself either as hyperthyroidism or as hypothyroidism.

Hypothyroidism is marked by decreased production of thyroxine (T4), which cause the metabolism to slow down, thus leading to weight gain.

Hyperthyroidism occurs when your thyroid gland produces too much of the hormone thyroxine which accelerates the body’s metabolism and may lead to various changes in the body including weight loss.

Thyroid hormone is critical during pregnancy as it is needed for the development of the baby’s brain and nervous system. The foetus depends entirely on the mother for thyroid hormone throughout the first trimester of pregnancy as the baby's thyroid begins to work only after the 12th week of pregnancy. The baby gets the mother’s thyroid hormone through the placenta.

Read more: Yoga for Thyroid Problems

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  1. Thyroid levels during pregnancy
  2. Risk factors for thyroid disease during pregnancy
  3. Symptoms of thyroid disease during pregnancy
  4. Effect of thyroid disease on baby and expecting mother
  5. How to manage thyroid disease during pregnancy?

Thyroid levels during pregnancy

When a woman gets pregnant, there is an increase in hormones like human chorionic gonadotropin (hCG) and estrogen in her body.

hCG is made by the placenta in the expecting mother and is similar to the thyroid-stimulating hormone (TSH). It stimulates the thyroid gland just like TSH, to produce more thyroid hormone. 

The increased levels of estrogen in the expecting mother’s body produce a protein that helps in transporting thyroid hormone in the blood. These proteins are called thyroid-binding globulin or thyroxine-binding globulin. This increases the levels of thyroid hormone in the blood during pregnancy.

Sometimes a pregnant woman can also show hyperthyroidism due to hyperemesis gravidarum. Hyperemesis gravidarum is a condition in which the expecting woman suffers from severe nausea and vomiting during pregnancy. The excessive and persistent vomiting leads to an increase in the hCG levels which increases the amount of thyroid hormone in the blood.

In a healthy pregnant woman, the thyroid gland enlarges slightly. This change is usually not noticeable at all. However, thyroid problems can be difficult to diagnose in pregnancy due to hormonal imbalance, increased thyroid size, fatigue, and other symptoms which are commonly seen in both pregnancy and thyroid disorders.

Normally, thyroid-stimulating hormone (TSH) levels in women range from 0.4 to 4 milli-units per litre (mU/L) of blood. During a healthy pregnancy, they can go up to 0.5 to 5 mU/L. Research shows that TSH levels of 2.5 - 5 mU/L range during the first trimester are associated with an increased risk of miscarriage.

Read more: TSH (Thyroid Stimulating Hormone) Test

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Risk factors for thyroid disease during pregnancy

The risk of getting a thyroid disease increases if a woman has any of the following conditions: 

  • If the woman has goitre, there is a higher chance of her getting a thyroid disease. Goitre is a condition which occurs due to iodine deficiency in the body. In this condition, the thyroid gland gets enlarged making your neck look swollen.
  • If the woman had a thyroid condition in the previous pregnancy (before or after giving birth), then she is prone to get the disease again. 
  • If the pregnant woman has a family history of autoimmune thyroid diseases like Graves’ disease (causes hyperthyroidism) or Hashimoto’s disease (causes hypothyroidism), then she is more prone to get the same during pregnancy.
  • If the pregnant woman has type 1 diabetes, then she is more prone to get thyroid disease as well. Type 1 diabetes is a condition in which the pancreas stops producing insulin which is required to maintain the blood sugar levels. Studies show that people with diabetes are at a high risk of developing thyroid disease.

Symptoms of thyroid disease during pregnancy

The symptoms of thyroid disease can vary in the case of hypothyroidism and hyperthyroidism.

Symptoms of hypothyroidism during pregnancy

An underactive thyroid may present the following symptoms in a pregnant woman: 

Symptoms of hyperthyroidism during pregnancy

Some signs and symptoms of hyperthyroidism often occur in normal pregnancies, including faster heart rate (tachycardia), trouble dealing with heat, and tiredness.

Other signs and symptoms can suggest hyperthyroidism:

  • Unable to tolerate heat
  • Fatigue
  • Unable to gain pregnancy weight or sometimes deal with weight loss
  • Rapid and irregular heartbeat
  • Sweaty and shaky hands

Effect of thyroid disease on baby and expecting mother

The effects of thyroid disease during pregnancy can vary for hypothyroidism and hyperthyroidism.

Effect of hypothyroidism during pregnancy

Uncontrolled hypothyroidism during pregnancy can lead to the following complications:

  • Preeclampsia: Preeclampsia is a life-threatening condition in which the mom-to-be gets high blood pressure in the 20th week of pregnancy. The expecting mother can also have protein in the urine and swelling in the feet and legs. 
  • Anaemia: The mother may have anaemia, which means there is a lack of blood-forming red blood cells in the body that reduces the amount of oxygen to the body.
  • Miscarriage: Hypothyroidism can cause the foetus to die before the 20th week of pregnancy.
  • Low birth weight: Hypothyroidism can lead to low birth weight of the baby, that is weight less than 2.5 kilograms at birth. 
  • Stillbirth: Hypothyroidism may lead to a stillbirth. Stillbirth is the birth of a baby who has died in the womb.
  • Placental abruption: Placental abruption is a serious condition where the placenta gets detached before the child is born. This can lead to internal bleeding in the pregnant woman’s uterus and also extremely low blood pressure.
  • Congestive heart failure: In very rare cases, hypothyroidism can also lead to heart failure of expecting mothers.
  • Postpartum haemorrhage: Hypothyroidism during pregnancy can lead to uncontrolled bleeding after delivery.
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Hyperthyroidism during pregnancy

There are certain complications of hypothyroidism which can also be seen in hyperthyroidism. These common complications are preeclampsia, low birth weight, miscarriage, placental abruption and congestive heart failure. Uncontrolled hyperthyroidism during pregnancy can also lead to the following complications:

  • Thyroid storm: Thyroid storm is a rare but life-threatening condition in which the pre-existing symptoms get worse. Expecting mothers who have thyroid storm are at a high risk of heart failure. 
  • Premature birth: Hyperthyroidism can lead to premature labour which would result in the premature birth of the baby. 

How to manage thyroid disease during pregnancy?

Management of thyroid disease is extremely important in pregnancy, as it affects both the expecting mother and the unborn baby. 

Medicines for hypothyroidism during pregnancy

The aim of hypothyroidism treatment is to provide thyroid hormone to the expecting mother and the unborn baby for its normal growth. 

Subclinical hypothyroidism (mild hypothyroidism) does not require any medical treatment. 

During the early stages of pregnancy, the T3 hormone of the mother’s body anyway can't enter the baby’s brain. Thus, doctors prescribe levothyroxine (T4), a medication which mimics the hormone made by the thyroid gland. This medication is crucial for the baby’s brain development until the baby starts making his or her own thyroid hormones towards the end of the first trimester of pregnancy.

Medicines for hyperthyroidism during pregnancy

Your doctor may not give you medications for mild hyperthyroidism. If the hyperthyroidism is due to hyperemesis gravidarum, then anti-emetic medications are only given for nausea and vomiting.

The doctors may prescribe antithyroid medications like propylthiouracil during the first trimester and methimazole for the second and third trimester of pregnancy. These medications should only be taken after doctor’s recommendation as misuse of these can lead to birth defects in the baby.

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