Thyroid Diseases During Pregnancy
What is Thyroid Diseases During Pregnancy?
Thyroid disease is a disease that affects the thyroid gland. Sometimes the organism produces too little or too much Thyroid hormone. Thyroid hormones regulate the body’s energy use and metabolism. If too much Thyroid Hormone is produced, it is called HYPERTIROIDISM and most of the body functions are accelerated. If too little Thyroid Hormone is produced, the condition that occurs is called HYPOTYROIDZM, in which case body functions may slow down.
Thyroid hormone plays a critical role in maternal and infant health during pregnancy. Pregnant women with thyroid problems should be closely monitored for themselves and their babies. If the levels of thyroid hormones are low, medication should be given to increase them, and if they are high, to lower them.
Points to Remember
- Hyperthyroidism or Hypothyroidism pictures may occur as a result of thyroid diseases.
- Pregnancy; can also make normal function changes in the thyroid gland and cause disease.
- Uncontrolled hyperthyroidism during pregnancy can cause serious health problems in the mother and unborn baby.
- Mild Hyperthyroidism during pregnancy does not require treatment. Severe Hyperthyroidism must be treated.
- While uncontrolled hypothyroidism during pregnancy causes serious health problems in the mother, it adversely affects the growth and brain development of the unborn baby.
- Hypothyroidism during pregnancy is treated by giving Thyroxine, T4 hormone
- In Postpartum Thyroiditis, first Hyperthyroidism, then Hypothyroidism develops and then returns to normal. Sometimes Hypothyroidism is permanent.
Postpartum Thyroiditis (Postpartum Thyroid Gland Inflammation)
It is a type of Thyroid Inflammation that affects 4-10% of women in the first year after birth. Thyroid hormones stored in thyroid cells are released into the blood in this type of thyroid inflammation. In this disease, which is thought to be autoimmune, a mild hyperthyroidism picture occurs in the first few months. In many women, Hypothyroidism occurs between 6 and 12 months before the thyroid tissue regains its normal function. During this period, external Thyroid Hormone treatment should be given. A small number of patients require lifelong Thyroid hormone therapy. Generally, the patient who had thyroiditis after the previous birth will have it after the next births. As recurrent Thyroiditis Attacks destroy the Thyroid Gland, a lifetime external Thyroid Hormone treatment becomes inevitable.
The issue to be considered here may sometimes be confused with Postpartum Hypothyroidism and Postpartum Depression. Symptoms such as moodiness, restlessness, fatigue, weakness, exhaustion, lethargy that start after birth can be thought of as Postpartum Depression. If the symptoms of hypothyroidism are evident, Thyroid Hormone should be given.
Diagnosis and Treatment of Hypothyroidism
The following symptoms occur in pregnant women with hypothyroidism;
- Intolerance to cold
- Muscle cramps
- Memory and concentration problems
TSH, T3, T4 levels are checked for diagnosis. Hypothyroidism must be treated for a healthy pregnancy and baby at any level. Thyroid Hormone is given externally in the treatment.
Hypothyroidism (Inadequate Thyroid)and Thyroid Diseases
Hypothyroidism during pregnancy is caused by a special Thyroid disease called Hashimoto’s Disease, which occurs in 5 out of every 1000 pregnant women. Hashimoto’s disease is a type of chronic inflammation of the thyroid gland. This is also an Autoimmune disease. In this disease, the immune system attacks the cells of the thyroid gland.
Uncontrolled Hypothyroidism during pregnancy causes some problems in mother and baby;
- Anemia; Adequate oxygen intake cannot be provided to the body.
- Low Birth Weight Baby
- Congestive Heart Failure
Uncontrolled Hypothyroidism can adversely affect your baby’s brain and nervous system development, as Thyroid hormones play a huge role in the baby’s brain and nervous system development in the first three months.
Hyperthyroidism Treatment and Thyroid Diseases During Pregnancy
Mild Hyperthyroidism during pregnancy is not treated. More severe Hyperthyroidism is treated with Antithyroid drugs.
Radioactive Iodine treatment cannot be applied during pregnancy. Because Radioactive iodine can destroy the baby’s Thyroid tissue. If our pregnancy cannot tolerate antithyroid drugs, then it may be necessary to remove the Thyroid Gland with surgery.
Since antithyroid drugs may cross the placenta and cause hypothyroidism in the baby, the mother is given the smallest possible dose of medication so that the baby does not develop hypothyroidism.
Side Effects of Antithyroid Drugs
- Allergic reactions such as skin rash, itching.
- By reducing the white blood cells in the body, they can suppress the immune system.
- Rarely, they may cause Liver Failure.
If the following symptoms occur while using antithyroid medications, be sure to talk to your doctor to stop the medication;
- Ambiguous abdominal pain
- Loss of appetite
- Skin rash or itching
- Exaggerated bruising even if you bump slightly
- Jaundice (in the skin and white parts of the eyes)
- Constant sore throat
Mothers can safely use Antithyroid drugs during pregnancy and breastfeeding under supervision.
Diagnosis of Hyperthyroidism and Thyroid Diseases During Pregnancy
Some symptoms of hyperthyroidism are also present in a normal pregnancy. For example; Increased heart rate, increased body temperature, intolerance, fatigue are also seen in a normal pregnancy.
Fast and irregular heartbeat, tremors in the hands, weight loss, or inability to gain weight, severe nausea, vomiting, possibly associated with hyperthyroidism.
Such a patient should have TSH, T3, T4, and TSI tests in the blood.
Hyperthyroidism (Overactive Thyroid)
Hyperthyroidism during pregnancy is usually caused by Graves’ Disease and occurs in one out of every 500 pregnancies. Graves’ Disease is an autoimmune disease. Normally, the Immune System is programmed to protect the body from pathogenic factors such as bacteria, viruses, fungi, and parasites. In autoimmune diseases, the immune system attacks the body’s own cells and organs. In Graves’ disease, the immune system secretes a substance called TSI (Thyroid Stimulant Immune Globulin) and since this substance has a structure similar to TSH, it tricks the Thyroid gland and releases excessive amounts of Thyroid hormone. These patients have a special appearance that looks like their eyes popped out of their sockets.
Graves ‘disease may occur for the first time in pregnancy, or when a woman with Graves’ disease becomes pregnant, the symptoms may regress during the second or third trimester of pregnancy. The reason for this is the suppressed Immune system during pregnancy. The disease usually gets worse again shortly after birth. In addition to the pregnancy follow-up of the pregnant woman with Graves’ disease, it is also required to be followed up monthly for this disease.
Rarely Hypertitoid; It causes problems such as nausea, vomiting, dehydration, weight loss during pregnancy. It is accepted that nausea and vomiting, which is severe in the first half of this pregnancy and then passes, is caused by increased Thyroid hormones due to increased Big.
Uncontrolled Hyperthyroidism and Thyroid Diseases during pregnancy causes the following conditions in the mother;
- Congestive Heart Failure
- Blood Pressure Rise That May Cause Preeclampsia in Late Pregnancy
- The symptoms of Hyperthyroidism, which we call Thyroid Storm, may appear suddenly and very severely.
- Early Birth
- Low Birth Weight can cause a baby to be born.
The following can be seen in the baby of a hyperthyroidism mother;
Even if a woman with Graves’ disease receives Radioactive Iodine treatment before pregnancy and undergoes a surgical procedure, TSIs in her circulation pass the placenta and stimulate the baby’s Thyroid gland and reveal signs of Hyperthyroidism in the baby. However, if the mother is being treated with an anti-thyroid drug, the probability of these problems in the baby is extremely low.
- The baby’s fontanelles (fontanelles on the baby’s head) may close early.
- Hyperthyroidism Heart Failure
- Respiratory Failure due to the compression of the enlarged thyroid gland on the windpipe
- Insufficient weight gain
- It can lead to problems such as. After birth, the baby and the mother should be closely monitored.
How Does Pregnancy Affect Normal Thyroid Gland Functions?
Two hormones reach high levels in the blood during pregnancy. One of them is Big and another is Estrogen. These two hormones increase the secretion of Thyroid Hormone from the Thyroid gland. Therefore, it can sometimes be difficult to interpret these normal physiological changes.
Thyroid Hormone is very important for the brain and nervous system development of the baby. The mother provides Thyroid Hormone to the baby in the first three months. The thyroid hormone secreted from the mother’s thyroid gland passes to the baby through the placenta and fulfills its function. After the twelfth week, the baby begins to produce its own Thyroid hormone.
The thyroid gland normally grows somewhat during pregnancy. But this is not enough to be determined manually. If we are dealing with a Thyroid gland that is enlarged and enlarged enough to be palpable, this may be a symptom of Thyroid disease. Since increased Thyroid hormone levels and a slightly enlarged Thyroid gland can be encountered in a normal pregnancy, it is necessary not to miss any Thyroid disease. Because it can be difficult to diagnose during pregnancy.
The thyroid gland is a butterfly-shaped gland about 2.5 cm in length and 25 grams in weight. It is located under the larynx, in front of the voice box, where the windpipe is divided into two. The thyroid gland is one of the glands that make up the Endocrine System. The glands belonging to the Endocrine System secrete substances called the Hormone they produce into the blood. Hormones restore their functions, not in the gland they are secreted from, but in the target cells or in the whole body by taking long journeys with blood.
The thyroid gland secretes two types of Thyroid hormones. One of them is T3, Triiodothyronine, and the other is T4, Thyroxine. T3 is an active hormone and is derived from T4. Thyroid hormones; affect metabolism, brain development, respiratory, heart, and nervous system functions, body temperature, skin moisture level, muscle strength, menstrual cycle, and blood cholesterol levels.
Production of Thyroid Hormone; It regulates a hormone called TSH (Thyroid Stimulating Hormone), which is made and secreted in the pituitary gland in the brain. When Thyroid Hormone levels in the blood are high, the Pituitary gland responds by decreasing the TSH level, and when the Thyroid Hormone levels in the blood are low, the Pituitary gland increases TSH secretion.