Hypothyroidism effects during pregnancy drive new guidelines for managing thyroid disease

By: Devon Andre | Women's Health | Monday, April 11, 2016 - 11:30 AM

Hypothyroidism effects during pregnancyHypothyroidism effects during pregnancy drive new guidelines for managing thyroid disease. There is growing evidence that insufficient thyroid hormone during pregnancy can have negative impact on the mother, the fetus, and future intellectual development of the child. Because of this, new guidelines have been recommended in order to better manage thyroid disease during pregnancy to prevent thyroid-related complications. The guidelines were created by the American Thyroid Association (ATA) expert task force.

Coauthor Alex Stagnaro-Green said, “Pregnancy has a profound impact on the thyroid gland and thyroid function…. In essence, pregnancy is a stress test for the thyroid, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency.”

Recommendations specify that women with overt hypothyroidism or with subclinical hypothyroidism, who are TPO antibody positive (an indication of ongoing thyroid condition), should be treated with oral levothyroxine. Use of other thyroid preparations such as triiodothyronine or desiccated thyroid to treat maternal hypothyroidism is strongly recommended against. Expecting women with subclinical hypothyroidism who are not initially treated should be monitored for progression to overt hypothyroidism with serum TSH and free T4 tests every four weeks until 16-20 weeks gestation and at least once between 26-32 weeks gestation.

“These important guidelines were developed by a panel of international experts representing the disciplines of endocrinology, obstetrics and gynecology, and nurse midwives. This broad representation of providers that care for pregnant women will significantly increase the impact of these guidelines and translation of findings from the most recent research to clinical practice,” said Gregory A. Brent, MD, professor of medicine and physiology.

Dr. Richard T. Kloos, professor at the Ohio State University and secretary/COO of the ATA, concluded, “Thyroid disease in pregnancy is common, clinically important, and time-sensitive, and our knowledge about it is rapidly changing. This ATA Guideline will disseminate this new information both widely and rapidly to improve patient care, establish what we believe is optimal care for the pregnant woman and her unborn child, and drive future research to further improve our understanding and patient outcomes.”

Hypothyroidism and pregnancy

Aside from the hypothyroidism-related complications that may arise during pregnancy, an underactive thyroid may cause problems even prior to conception. Namely, a woman may have difficulties becoming pregnant. This is why properly managing hypothyroidism is so important, especially if a woman is trying to conceive or she is currently pregnant.

Thyroid hormones are necessary for brain development. Until babies develop their own thyroids, they rely on the mother’s thyroid for proper growth during the first little while. If the supply of thyroid hormones is insufficient, then intellectual development of the child later in life can become affected. Having a sufficient supply of iodine is also important, so many soon-to-be mothers take prenatal vitamin complex, which includes an ample supply of iodine.

Regardless of whether hypothyroidism is mild or severe, any variety of the condition can cause problems with the pregnancy and the fetus. For example, unmanaged hypothyroidism can result in a higher risk of miscarriage during a woman’s first trimester. Other complications associated with untreated or unmanaged hypothyroidism include premature birth, preeclampsia, miscarriage, postpartum hemorrhage, anemia, and abruptio placentae.

The good news is, hypothyroidism treatment is safe to partake in during pregnancy and won’t result in adverse effects on the child, unlike leaving the condition untreated.

Regular monitoring from your doctor can help determine proper treatment dosages, and once your levels begin to moderate, the screening will become less frequent.


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Sources:
http://www.eurekalert.org/pub_releases/2011-07/mali-heo072511.php
http://online.liebertpub.com/doi/abs/10.1089/thy.2011.0087
http://www.thyroidawareness.com/the-thyroid-and-pregnancy


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