Thyroid problems during pregnancy: Risks & management strategies

Prameyanews English

Published By : Prameya News Bureau | May 17, 2024 IST

Thyroid problems during pregnancy can significantly impact both maternal and fetal health

Thyroid problems during pregnancy can significantly impact both maternal and fetal health. Proper diagnosis and management are crucial to ensure a healthy pregnancy outcome. Here’s an overview of the risks and management strategies for thyroid issues during pregnancy.

Risks of Thyroid Problems During Pregnancy

1. Hypothyroidism:

Causes: Often due to Hashimoto's thyroiditis, an autoimmune disorder.

Maternal Risks:

Miscarriage

Preeclampsia

Anemia

Placental abruption

Postpartum hemorrhage

Fetal Risks:

Low birth weight

Preterm birth

Stillbirth

Neurodevelopmental delays

Congenital hypothyroidism

2. Hyperthyroidism:

Causes: Commonly due to Graves' disease, another autoimmune disorder.

Maternal Risks:

Severe nausea and vomiting (hyperemesis gravidarum)

Preeclampsia

Heart failure

Thyroid storm (a rare, life-threatening condition)

Fetal Risks:

Miscarriage

Preterm birth

Low birth weight

Fetal growth restriction

Neonatal thyrotoxicosis (excessive thyroid hormone in the newborn)

Stillbirth

Management Strategies

1. Preconception Counseling:

Women with pre-existing thyroid conditions should seek medical advice before conceiving.

Ensure thyroid function is well-controlled prior to pregnancy.

2. Screening and Diagnosis:

Initial Screening: Thyroid function tests (TSH, Free T4) early in pregnancy or preconception.

Risk Factors for Screening:

History of thyroid disease or dysfunction

Family history of thyroid disease

Presence of goiter

Symptoms of thyroid dysfunction

Type 1 diabetes or other autoimmune disorders

3. Management of Hypothyroidism:

Levothyroxine Therapy: The standard treatment, safe during pregnancy.

Dosage Adjustment: Often requires a 30-50% increase in dose due to increased thyroid hormone demand during pregnancy.

Monitoring: Regular TSH and Free T4 levels every 4-6 weeks to adjust dosage.

Nutritional Support:

Adequate iodine intake is crucial for thyroid function.

Prenatal vitamins typically contain sufficient iodine.

4. Management of Hyperthyroidism:

Antithyroid Medications: Propylthiouracil (PTU) is preferred during the first trimester, switching to methimazole in the second and third trimesters.

Monitoring: Regular thyroid function tests to adjust medication dosage.

Beta-blockers: May be used short-term to manage symptoms like palpitations and tremors.

Surgical Intervention: Rarely necessary; thyroidectomy is considered if medication is ineffective or not tolerated.

Radioactive Iodine: Contraindicated during pregnancy.

5. Monitoring and Follow-up:

Frequent thyroid function tests throughout pregnancy.

Close collaboration between obstetricians, endocrinologists, and primary care providers.

Adjustments in medication dosages based on trimester-specific reference ranges for TSH and Free T4.

6. Postpartum Care:

Hypothyroidism: Monitor thyroid function after delivery; dosage adjustments may be needed.

Hyperthyroidism: Watch for postpartum thyroiditis, which can occur in women with a history of Graves' disease.

Breastfeeding: Both levothyroxine and antithyroid medications are generally safe, but close monitoring of the infant’s thyroid function is advisable.

Thyroid problems during pregnancy require careful management to minimize risks to both the mother and the fetus. Regular monitoring, appropriate medication adjustments, and a multidisciplinary approach are key strategies to ensure a healthy pregnancy and optimal outcomes for both mother and baby.

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  • Thyroid in pregnancy

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