Thyrotoxicosis, or hyperthyroidism in pregnancy, is a common endocrine pathology among pregnant women. Gestational thyrotoxicosis is the increased concentration of hormones produced by the thyroid gland, such as thyroxine or triiodothyronine. What are the causes and symptoms of an overactive thyroid in pregnancy? How is the treatment going?
Gestational thyrotoxicosis , i.e.hyperthyroidism in pregnancyis a condition that has a negative impact not only on the mother's body, but also on the developing one fetus. Improper hormonal balance may complicate not only pregnancy, but also childbirth, where the most dangerous condition is a thyroid crisis.
The endocrine system of the body is closely related, and its proper functioning is extremely important for maintaining the body's homeostasis. The thyroid gland itself, and more specifically its work, is controlled by the superior structure of the pituitary gland. In pregnancy, this function is additionally performed by the chorionic gonadotropin - βhCG.
In the first trimester of pregnancy, the mother's thyroxine is essential for the proper development of the nervous system. Only about 20-25 t.c. this function is taken over by the fetal thyroid gland. Therefore, a properly functioning mother's thyroid gland is extremely important.
Diagnostics of thyroid diseases in pregnancy
In order to identify abnormalities in the functioning of the endocrine system, it is necessary to measure the concentration of thyroid hormones in the mother's serum. When interpreting the results, one should bear in mind the physiological changes in the mother's body during pregnancy. The changes affect not only the endocrine system itself, but are related to the metabolism of these substances, for which the kidneys are responsible. The test result should also include all medications that the mother is taking. In hyperthyroidism, there is an increased secretion of thyroid hormones, and more precisely, the concentration of free forms not related to transport proteins. The essential hormone TSH is present in a reduced amount because the endocrine system acts as a feedback loop and a higher concentration of free hormones reduces the concentration of the starting hormone.
TSH test during pregnancy - check what it is
Effect of hyperthyroidism on pregnancy
Pathognomonic symptoms of hyperthyroidism include:
- hyperactivity
- anxiety
- shaking hands
- constant fatigue
Some symptoms may be interpreted as pregnancy, which delays diagnosis and initiation of appropriate treatment. Patients also report reduced tolerance to exercise. Other symptoms include enlargement of the mother's neck circumference, more precisely, the so-called goiter of the thyroid gland.
In the case of a reliable ultrasound examination of the fetus, it happens that a qualified ultrasound specialist observes a slightly enlarged goiter in the fetus. Many of the aforementioned ailments overlap with those reported by patients during physiological pregnancy. The pathognomonic symptom may be a lack of weight gain or weight loss.
Other symptoms of an overactive thyroid gland include palpitations. The frequency and strength of myocardial contractions increase, which is sometimes interpreted by the patient as a feeling of heartbeat. This translates into the work of the fetal heart which also becomes faster. Hyperthyroidism is a predictive factor for the development of arterial hypertension, which in turn is associated with a serious pathology such as pre-eclampsia.
With regard to the fetus, apart from tachycardia, damage to the nervous system, rarely generalized fetal edema, is observed in the case of untreated hyperthyroidism. Many children are born even before 30 t.c. which in turn has all the consequences of prematurity.
Thyrotoxicosis of pregnant women
This term is used to describe a pregnancy-related hyperthyroidism. In this case, the increased concentration of thyroid hormones is a consequence of the action of the chorionic gonadotropin. This disease is much more common in the case of multiple pregnancies or in the case of incontinent vomiting, where in both situations there is an increased concentration of gonadotropin. This state appears around 15-20 t.c. and tends to limit itself.
Thyroid crisis as a complication of thyrotoxicosis
The most dangerous complication is thyroid crisis. Its characteristic symptoms include:
- body temperature 38-40 degrees C
- shortness of breath
- palpitations
- diarrhea / vomiting
- over-agitation or pathological sleepiness
All these symptoms are indications for quick intervention and require urgent hospitalization.
Treating hyperthyroidism in pregnancy
The treatment of hyperthyroidism involves the use of thyreostatic drugs: mainly metamizole. Toxic effect on the fetus has not been proven, therefore it can be safely used during pregnancy. Isotope treatment practiced in the case of hyperthyroidism induring pregnancy is absolutely contraindicated.