Thyroid Awareness Month: Thyroid, its impact and management during pregnancy

Updated Jan 31, 2021 | 17:05 IST

Thyroid disease can be challenging during pregnancy because many of its symptoms are common to pregnancy. Let us understand the thyroid function and how it plays an important role in pregnancy.

Thyroid Awareness Month: Thyroid, its Impact and Management during pregnancy | Photo Credit: iStock Images

New Delhi: "Thyroid hormones are critical to the normal development of the foetus’s brain and nervous system, says Dr Mukesh Gupta, Obstetrician & Gynaecologist at Le Nest Hospital Malad, Mumbai. Thyroid conditions are it hypothyroidism or hyperthyroidism must be stringently monitored during pregnancy especially in the first trimester. Babies who don’t get enough of these hormones in the first trimester, when they’re dependent on the mother’s supply, can be born with neurological development problems. Risks if thyroid levels are haywire include premature birth, miscarriage, low birth weight, anaemia, stillbirth along with the impact on cognition skills. The key is to monitor your thyroid levels at regular intervals in pregnancy and accordingly adjustment to the doses of medication can be decided by your doctor. A simple blood test to check for TSH, T3 and T4 levels will determine the levels in the body. The body’s need for thyroid hormone fluctuates during pregnancy, so if you have ever been diagnosed with any thyroid problems in the past or currently take medication for a thyroid condition, be sure to let your practitioner know so that he can guide you regarding the next steps to ensure normal thyroid function in the body during pregnancy"

Thyroid disease can be challenging during pregnancy because many of its symptoms are common to pregnancy. Let us understand the thyroid function and how it plays an important role in pregnancy from Dr Danny Laliwalla, Consultant Obstetrics & Gynaecology at Jaslok Hospital & Research Centre. The thyroid gland functions because of certain hormones secreted by the brain (TSH) & the thyroid gland (T3, T4). Increase or decrease of serum TSH (thyroid-stimulating hormone) can lead to Hypothyroidism or Hyperthyroidism respectively & both can affect the mother & the foetus. S. TSH levels usually range between 0.5 to 5.0 mIU/L, but during pregnancy, these levels differ. In the 1st trimester anything above 2.0 requires treatment.

Hypothyroidism: This is diagnosed by high TSH levels and reduced FT4 level. Symptoms include cold intolerance and slow heart rate. Obstetrics complications include spontaneous abortions, stillbirths, small for gestation babies, high blood pressure during pregnancy. Babies may be born with neurological impairments. (retina defects, hearing disorders, etc may be severe).

Treatment: Check for TSH levels during pre-pregnancy. If high, should be corrected first and then the couple should conceive. If not checked during pre-pregnancies, TSH levels should be checked at first trimester/ first visit and if high, thyroxine supplements should be started after taking an opinion from an endocrinologist. These need to be taken on an empty stomach. TSH levels should be checked in every trimester & doses should be adjusted till normal levels are achieved. During labour frequent foetal heart monitoring is essential. There is no need for decision for a caesarean for Hypothyroidism- to be done only in case of an emergency. These mothers may go into post-partum depression, must look for their signs post-delivery.

Hyperthyroidism: This is diagnosed by low levels of TSH & high T4 levels. Symptoms may include weight loss, high heart rate and vomiting. If untreated it may lead to heart failure & thyroid storm, which is a medical emergency. Also, this can be associated with high blood pressure, miscarriage, foetal deaths, and placental abruption.

Treatment: Treatment options include a set of prescribed medicines post-doctor consultation. Beta-blockers may be needed to control the increased heart rate. Radioactive iodine or few other widely used medicines are strictly contra-indicated during the pregnancy. During labour, watch out for thyroid storm, check for neonatal thyrotoxicosis on D3 & D 10 of life by measuring thyroid levels in the body.

Conclusions: In Hypothyroidism, thyroid hormones are important for the development of the early foetal brain. Adequately treated women with hypothyroidism can expect a good pregnancy outcome. In Hyperthyroidism, if untreated or poorly controlled in pregnancy, may be associated with adverse outcome. Using the lowest possible dose, will minimize the complications, adequately treated women with Hyperthyroidism can expect a good pregnancy outcome.