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Diseases of the thyroid gland during pregnancy (both hyperthyroidism and hypothyroidism, or thyroiditis) can be dangerous both for the pregnant woman and for the proper development of the fetus. Therefore, if a woman is planning to become pregnant or is expecting a baby, she should have her thyroid gland tested. In addition, it is worth knowing what are the symptoms of thyroid diseases during pregnancy, what tests should be performed and what possible treatment procedures look like.

Thyroid diseases - both hyperthyroidism and hypothyroidism - are dangerous to he alth, and if left untreated, they can be life-threatening. Both of these conditions are especially dangerous in pregnant women as they can adversely affect the condition of the fetus1,2. Most people recognize that the thyroid gland is a small gland in the neck area and that it requires iodine to function.

Meanwhile, the thyroid gland is a very important gland for the functioning of the entire body. It produces and secretes into the blood the hormones triiodothyronine (T3) and thyroxine (T4), which control metabolism in all organs and tissues of the body. By influencing the metabolism and the function of various cells, thyroid hormones play a huge role in the work of the digestive system, heart, muscles and nervous system. Thyroid hormones have a significant impact on the activity of the entire system. Therefore, the secretion of thyroid hormones into the blood in excessive (hyperthyroidism) or insufficient (hypothyroidism) amounts results in the appearance of disease symptoms.

It is worth mentioning one more hormone - thyrotropin (TSH) produced by the pituitary gland - which stimulates the thyroid to produce and secrete hormones into the blood. When there are too few thyroid hormones, the concentration of TSH increases, and vice versa - an excess of thyroid hormones blocks the secretion of TSH. In other words, TSH levels are usually low in hyperthyroidism and high in hypothyroidism.

Thyroid diseases: dangerous imbalance

Thyroid hormones are necessary for the proper development of the fetus - they regulate the growth of tissues and the formation of certain enzymes, and above all, they stimulate the maturation of the central nervous system (including the brain) and bones. Hypothyroidism can cause severe mental retardation in the baby2and skeletal defects, premature detachment of the placenta, and even miscarriage. Increased hypothyroidismthyroid gland prevents you from getting pregnant at all.

An overactive thyroid in pregnancy may also lead to complications such as hypertension, pre-eclampsia, and changes in the cardiovascular system. In extreme cases, it may cause a miscarriage or serious fetal defects1 .

All of these consequences, of course, occur when a poorly functioning thyroid is left untreated or inadequately treated. However, in order to take appropriate treatment, a woman planning motherhood or expecting a child must be aware of the potential presence of the disease.

According to an expertDr hab. n. med. Edward Franek, endocrinologist, Department of Internal Medicine, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw

If there are symptoms of thyroid disease, the pregnant woman should immediately inform her doctor. Since some normal pregnancy symptoms can sometimes mimic those of the thyroid gland, hormone tests are necessary. Even if the results are abnormal, it does not necessarily mean the presence of a pathological condition, but in such a case you should always consult an endocrinologist. It is worth remembering that the symptoms of thyroid disease may also appear for the first time after childbirth. In many cases, postpartum thyroiditis (PPT), a variant of Hashimoto's disease, is responsible. It usually develops within a few months after birth (up to a year) and can cause both hyperthyroidism and hypothyroidism. PPT can cause the onset or worsening of symptoms of postpartum depression - therefore, in women suffering from it, thyroid hormone tests are recommended.

What is the TSH test in pregnancy?

Symptoms of thyroid dysfunction in pregnancy

Hypothyroidism slows down the metabolism - as a result, the body temperature is lowered and the heart rate is slower. Often the first visible symptom of iodine deficiency and hypothyroidism is the so-called goiter, i.e. enlargement of the thyroid gland. Other symptoms include a constant feeling of coldness, drowsiness and weakness, dry and rough skin, excessive weight gain, constipation, difficulty concentrating, decreased sex drive2 .

In turn, with hyperthyroidism, the metabolism is much faster - oxygen consumption and heat production increase. It is accompanied by increased body temperature, increased heart rate and increased systolic blood pressure. The sick person is constantly hot, irritable, shaky - easily upset. Other telltale symptoms include muscle tremors, palpitations, wet and hot skin, diarrhea1 .

Likeyou can see that many of these symptoms are deceptively similar to the normal symptoms of pregnancy, which is why it is particularly difficult to diagnose thyroid disease in pregnant women. So let's do a blood test to make sure that the future mother's thyroid is functioning properly.


Iodine - an element especially important for pregnant women

A common cause of hypothyroidism is iodine deficiency, from which the gland produces hormones. Iodine is an important component of the future mother's diet - during pregnancy, the demand for this element is 180-200 μg / day. The best sources of it are sea fish (herring, mackerel, halibut, salmon) and seafood; it is also contained in some types of mineral waters and iodized s alt (but it cannot be consumed more than 1 teaspoon a day). This element is also present in most preparations for pregnant women. Increased doses of iodine are recommended for all pregnant women, except those with diagnosed hyperthyroidism.

Thyroid testing in pregnant women

  • Before getting pregnant

It is recommended to test for thyroid diseases when planning a pregnancy1,2 , especially when a woman notices symptoms of the disease or there has been a history of thyroid disease in her family . It is also worth checking yourself in a situation where there have been miscarriages in the past for no known cause. Women with a history of thyroid diseases (e.g. thyroid surgery, thyroid nodules) who are planning a pregnancy should have a thyroid gland test, even if these problems are long gone.

The basic examination for thyroid diseases is the determination of the concentration of hormones in the blood. You should ask your GP or pay for a referral. Blood for testing can be taken on any day of the cycle. To assess the condition of the thyroid gland before pregnancy, it is sufficient to determine the concentration of TSH in the blood serum (it is assumed that the normal level of TSH is 0.4-6.0 IU / ml, but the norms may differ in different laboratories; usually the range of the norm is indicated on the result) . If the result is abnormal, you should see your endocrinologist for further tests or treatment. Only when the thyroid function is balanced, i.e. the concentration of its hormones in the blood is within the normal range, you can start thinking about your baby1 .

  • Pregnant

Pregnant women who did not perform the tests before becoming pregnant can do them during pregnancy. However, in pregnant women it is not enough to determine the concentration of TSH, because its concentration - especially in the first trimester - is physiologically lowered; it is also necessarydetermination of fT3 and fT4 levels (these are free fractions of T3 and T4 thyroid hormones) - the correct results are: fT3 2.0-4.0 pg / ml and fT4 0.7-2.2 ng / 100 ml (the norms may be different e.g. due to different assay kits; usually the standard is listed in the result). In pregnant women with hypothyroidism, the levels of fT3 and fT4 and cholesterol are high2. However, in pregnant women with hyperthyroidism, high fT4 levels, low (sometimes undetectable) TSH levels and lower cholesterol levels are observed1 .


Graves' disease

It is an autoimmune disease. A malfunctioning immune system forces the thyroid gland to secrete an excessive amount of hormones. This disease is one of the most common causes of hyperthyroidism1 .

Hashimoto's disease

It is a chronic autoimmune thyroiditis. The body produces antibodies that destroy the cells of its own thyroid gland. The disease usually proceeds in two phases: first as mild hyperthyroidism, then - hypothyroidism2 . Pregnant women with Hashimoto's disease should be closely monitored by gynecologists and endocrinologists because of the increased risk of miscarriage.

Thyroid tests in pregnancy

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