Hyperthyroidism & Pregnancy
So! You just found out you are pregnant, and you couldn’t be happier! You’re going through all the normal changes associated with becoming pregnant – maybe feeling a little tired, maybe some morning sickness. You think to yourself: “Yes, this is normal.” But then you start to notice other symptoms like…
Rapid weight loss of 5-10 pounds (even though you should be gaining weight…)
Feeling nervous or irritable
Mood swings
Feeling very tired no matter how much your sleep, or having trouble sleeping at all
Shaky hands and muscle weakness
Feeling hot and sweaty most of the time
A fast and irregular heartbeat with or without palpitations\\
Feeling more anxious than usual, maybe some chest tightness
Frequent and soft bowel movements
Some of these symptoms are part of a normal pregnancy and should subside with time. But what if the symptoms persist and in fact seem to get worse? Well, then there might be something going on with a little butterfly-shaped organ that sits on the front of your neck.
What is the thyroid?
The thyroid gland produces the hormones triiodothyronine (T3) and thyroxine (T4), which help regulate the speed of your body’s metabolism. When you’re pregnant, your thyroid works overtime to produce ~50% more T3 and T4. These hormones are super important for your baby’s healthy development. However, sometimes, the thyroid can go into hyperdrive and produce too much hormone. This can lead to a high risk of preeclampsia, premature birth, stillbirth, low birth weight, and miscarriage if left untreated.
What causes hyperthyroidism?
The most common cause of hyperthyroidism in pregnant and non-pregnant women is an autoimmune disorder called Grave’s disease, where your body attacks your thyroid and causes it to release too much T3 and T4. Other possible (less common) causes include excess iodine, thyroiditis, benign thyroid nodules, and excess T4 in the blood.
Hyperthyroidism may first develop during pregnancy if you produce too much hormone human chorionic gonadotropin (hCG), which can lead to thyrotoxicosis. However, it is more common for hyperthyroidism to develop prior to pregnancy.
How is hyperthyroidism diagnosed?
Your doctor will start off with a blood panel to test your thyroid stimulating hormone (TSH), a pituitary gland hormone that stimulates the thyroid. If this is low, a secondary sample may be obtained to check your T3 and T4 levels. You may also be referred for a thyroid scan to determine if there are any nodules or enlargement. In some cases, an MRI or CT scan may be referred. If Grave’s disease is suspected, your doctor may order another blood test to check for an increased amount of antibodies present.
If you are pregnant, your doctor may not automatically screen for thyroid issues without some of the following risk factors, including:
Have symptoms of thyroid disease
A past history of thyroid disease
Have a family history of thyroid disease
Be over the age of 30
Have difficulty conceiving
Have another known autoimmune disorder, such as type I diabetes or celiac’s disease
How am I treated?
Mild hyperthyroidism is usually monitored closely, most often by an endocrinologist. For more severe cases, the treatment of choice is anti-thyroid medication to help slow down the production of T3 and T4. The goal is to keep the mother’s T4 in a high-normal range.
Radioiodine therapy (RAI) is contraindicated during pregnancy due to high risk of complications for the baby. If your hyperthyroidism is not well-controlled with medication, a partial or total thyroidectomy may be considered. This will resolve your symptoms immediately, but you will become hypothyroidic and be on thyroid-replacement medication for the rest of your life.
Will having hyperthyroidism affect my baby?
In most cases, babies born to moms with hyperthyroidism are healthy. If the thyroid is not controlled, there is a small changes that the TSI (thyroid antibodies) may cross the placenta and enter your baby's bloodstream.
Overall…
The diagnosis of hyperthyroidism can feel overwhelming at first. Especially, on top of the anxiety and excitement of the changes your body is experiencing. But the diagnosis does not have to be a death sentence. No matter the cause, those with hyperthyroidism have very good long-term outcomes if treated and managed well. It is important to have a strong therapeutic alliance with both your obstetrician and endocrinologist. And to always advocate for yourself when something feels off!
<3 The Recharged Performance Therapy Team
https://www.rechargedperformancetherapy.com
(321) 802-1630
References
https://www.babycenter.com/pregnancy/health-and-safety/hyperthyroidism-in-pregnancy_20004470
https://www.thyroid.org/hyperthyroidism-in-pregnancy/
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
https://www.healthline.com/health/hyperthyroidism