Thyroid Gland and Uterus[/caption]On 26th July 2018, Cloudnine launched a live Tweetinar on Thyroid & Pregnancy on its Twitter handle @CloudnineCare. It was led by Dr Modhulika Bhattacharya, Obstetrician & Gynaecologist at Cloudnine Hospitals, Outer Ring Road and Old Airport Road, Bangalore. The Tweetinar dealt with a plethora of topics on thyroid and pregnancy. Some highlights are included below.
Specialist Details: Dr Modhulika Bhattacharya
Specialty: Obstetrics & Gynaecology
Clinical Focus and Expertise: Infertility evaluation, infertility treatment, high-risk pregnancy care, breast care, hysterectomy, laparoscopy, sexual health, reproductive medicine
1. I have hypothyroidism and have been trying to conceive for a while. I have been married for 3 years. What are my options?
Hypothyroidism can affect fertility by disrupting ovulation, and in turn, menstruation. This can make conception a challenge. The first step to planning a pregnancy with hypothyroidism is keeping your thyroid levels in check by seeking a treatment plan from a specialist.
2. What are the ideal thyroid levels one should aspire to during pregnancy?
The thyroid stimulating hormone (TSH) must be less than 2.5 in early pregnancy, and less than. 3 in later stages of pregnancy. Have yourself reviewed regularly for antibodies by a specialist.
3. Why do thyroid problems appear during pregnancy and fail to recede after delivery?
Thyroid problems during pregnancy occur due to a surge in thyroid hormone. The thyroid gland needs to work more during pregnancy. When the body is unable to keep up with this increased demand, it gives rise to thyroid dysfunction; namely, hypothyroidism. In most cases, hypothyroidism recedes after delivery. In cases where it does not, it is usually linked to preexisting thyroid dysfunction. After delivery, it is important to watch your thyroid levels and taper your medication over time, to the basic minimum dose.
4. How can I get rid of my thyroid problem?
Taking your medication on time is imperative in beating thyroid dysfunction.
5. What is the thyroid?
The thyroid is a gland situated in the neck, that releases thyroid hormone. Thyroid hormone is critical in a host of body functions.
6. I am 30 years old and was diagnosed with hypothyroidism in 2011. Although I am on medication, my weight is constantly escalating and my husband and I are having difficulty conceiving. Can you recommend the best way forward?
Get your thyroid levels checked. Abnormal thyroid levels can lead to miscarriage. That being said, one miscarriage is a fairly common phenomenon in women, with or without hypothyroidism. If you're thinking about growing your family, consult your doctor to boost your chances of conception.
7. What is the impact of thyroid on pregnancy?
If your thyroid is not under control, it can cause problems such as recurrent pregnancy loss, preterm delivery, intrauterine growth restriction and high maternal blood pressure. Keeping your thyroid in check throughout pregnancy can minimise these risks.
8. Does thyroid dysfunction increase the risk of miscarriage?
Yes. Left untreated, thyroid dysfunction can increase the risk of miscarriage.
9. How can one maintain healthy thyroid levels?
Timely medication is key in managing hypothyroidism. Also, it is important to have your thyroid levels checked regularly by a specialist.
10. What is the healthy TSH range for conception?
A value of less than 4 is considered conducive to conception, while one less than 2.5 is considered ideal.
11. I have hypothyroidism and have been taking medication for it. However, I have been unable to conceive. What could be the problem?
If your thyroid values are normal, your inability to conceive may stem from other factors. Meet a specialist to have yourself evaluated.
12. Is it necessary to continue thyroid medication through pregnancy? Does it pose any risks to the baby?
It is extremely important to continue thyroid medication through pregnancy if your thyroid levels are not within the stipulated range. Abnormal thyroid levels can pose several risks to you and your unborn child. A small dose of levothyroxine in the morning is all it takes to keep your thyroid under control. Levothyroxine is extremely safe for use during pregnancy.
13. Is thyroid dysfunction a lifelong condition?
Not for everyone. Thyroid dysfunction can be lifelong depending on its root cause and severity. Post-delivery, it is important to keep track of your thyroid levels. If you show improvement, your doctor may reduce your medication or stop it altogether.
14. Why is thyroid dysfunction linked to pregnancy?
When a woman is pregnant, her body needs almost 50% more thyroid hormone than otherwise, to aid the growth and development of her baby. When the body fails to keep up with the increased demand for thyroid, it develops hypothyroidism.
15. I have hyperthyroidism. If I do get pregnant, will my pregnancy be classified as high-risk?
Hyperthyroidism means that you have surplus thyroid hormone in your body. It generally presents mild symptoms during pregnancy. The condition can be controlled with medication.
16. Is it advisable to get one’s thyroid levels checked before planning a baby?
Thyroid levels are important for fertility. If there are variations in the thyroid, it can give rise to menstrual irregularities and ovulatory problems. Also, the thyroid plays a critical role in pregnancy. It's a good idea to check your thyroid levels before planning a baby.
17. How often should I test my thyroid levels during pregnancy if I have a history of thyroid dysfunction?
In the first half of pregnancy, thyroid levels should be checked monthly. Changes in medication can take 4 to 6 weeks to reflect in your thyroid levels.
18. How long after starting thyroid treatment can one plan a child?
You can start planning as soon as you see that your TSH level is under control. Check your thyroid level at least 4 to 6 weeks before trying for a pregnancy.
19. I have had hypothyroidism in the past, but my thyroid levels have normalised now. What are the chances that the condition will recur during pregnancy?
It's difficult to predict the recurrence of hypothyroidism during pregnancy. Since you have a history of thyroid dysfunction, there is a chance it may return. It is imperative to check thyroid levels before and during pregnancy. In the event of major fluctuations, you may be prescribed medication to keep your thyroid under control.
20. If thyroid levels are normal during the first trimester, do they need to be tracked through the rest of the pregnancy?
This is usually case-dependent. The first trimester serves as a control window for thyroid. If thyroid levels show significant improvement, you may not be advised follow-ups at later stages. However, if you are prescribed medication to aid your condition, you may need to be monitored at regular intervals.
21. Do both hypothyroidism and hyperthyroidism impair fertility?
In either case, it depends on how high or low your thyroid levels are. If they are enough to cause menstrual irregularities and ovulation problems, fertility may be affected.
22. How often should thyroid levels be checked during pregnancy?
If you're on medication, a check-up once every 4 weeks is ideal.
23. What are the symptoms of thyroid dysfunction?
90% of women do not experience any symptoms. Symptoms of hypothyroidism include weight gain, menstrual irregularities and chronic fatigue, while symptoms of hyperthyroidism include restlessness, irritability and nervousness.
24. Are there any side effects of thyroid hormone medication?
No, thyroid hormone medication typically does not present side effects.
25. What are the precautions a woman with thyroid dysfunction must take to minimise the risk of miscarriage and neurological issues in her baby?
The chances of miscarriage, high blood pressure and neurological disorders in the fetus rise with a thyroid imbalance. The key to minimising these risks is to keep your thyroid in check. If you're planning a pregnancy, first get your thyroid under control.
26. I have heard that thyroid is contagious. Is that true?
The thyroid is not contagious. It is a disorder of the thyroid gland that doesn't spread via touch.
27. My wife has a history of hypothyroidism. What are the chances that our baby will also develop the condition?
Hypothyroidism is a combination of genetic and environmental factors. The condition may or may not be genetically triggered in your child in the future.
28. Is lifelong medication the only solution to correct thyroid issues?
Lifelong medication in the form of thyroid replacement therapy may be the only way when other methods are exhausted.
29. Does thyroid dysfunction come in the way of natural childbirth?
Not at all. The condition has nothing to do with the mode of delivery.
30. Do women with thyroid dysfunction have more complications during pregnancy?
Yes. This is why it is crucial to get your thyroid checked early, to rule out potential complications.
31. If I am fit and lead a healthy life, are there still chances of developing a thyroid deficiency?
Thyroid disorder is a combination of genetic and lifestyle factors. Even with a healthy lifestyle, you may harbour a genetic predisposition for hypothyroidism. It is advisable to check your thyroid levels before and during pregnancy.
32. My gynaecologist used to say that children born to mothers with hypothyroidism during pregnancy risked a lower IQ and impaired development. Do low TSH levels lead to developmental impairments?
TSH can play a critical role in fetal development. It is essential to keep your TSH levels in check throughout pregnancy.
33. What is Hashimoto's thyroiditis?
Hashimoto's thyroiditis is an autoimmune disease that causes the inflammation of the thyroid gland and gives rise to hypothyroidism.
34. Can thyroid dysfunction be cured or reversed?
While thyroid dysfunction can certainly be regulated, it may or may not be reversible (this depends on how high or low your thyroid levels are).
35. Does hypothyroidism during pregnancy lead to a heavier baby?
No. Hypothyroidism has no bearing on the weight of your baby.
36. I was diagnosed with hypothyroidism in my teens. Although I have since been treated with medication, I am still prone to relapse, especially when I develop hypertension. What is the best way forward?
An unchecked thyroid can lead to complications, so it is essential that you have it checked at least once a year.