Thyroid diseases during pregnancy – are they dangerous? How do they affect the child?

Discover the impact of thyroid diseases during pregnancy on both mothers and their unborn children. Learn how to manage these conditions before and during pregnancy, including important tests and treatments, for a healthy pregnancy outcome. Don't miss this insightful article!
Thyroid diseases during pregnancy

Thyroid function disruptions during the preconception period and pregnancy are prevalent concerns among prospective mothers. Undiagnosed or inadequately managed thyroid disorders may result in fertility challenges or miscarriages. Pregnancy significantly influences thyroid gland function, necessitating increased iodine consumption and excretion, elevating hormone production, and causing glandular enlargement, especially in iodine-deficient regions. During the first trimester, the secretion of Thyroid Stimulating Hormone (TSH) diminishes due to human chorionic gonadotropin (hCG) influencing the thyroid gland, mimicking a hyperthyroid state. In later trimesters, TSH levels experience a minor rise, whereas free hormone levels decline. It is imperative to apply trimester-specific norms for Polish women: 0.009-3.18 mIU/L (I), 0.05-3.44 mIU/L (II), and 0.11-3.52 mIU/L (III). European guidelines recommend upper limits of TSH as 2.5mIU/L (I), 3mIU/L (II), and 3.5mIU/L (III), contrasting with American guidelines which suggest 2.5mIU/L for the first and last trimesters, without a consensus on the optimal value during pregnancy as opposed to non-pregnant norms of approximately <0.7> mIU/L. This variance underscores the necessity of not exclusively depending on laboratory findings for evaluating maternal thyroid status. Clinical evaluation, supplemented by biochemical assessments and patient interviews regarding symptoms indicative of hypothyroidism, such as fatigue or cold intolerance, is essential. This comprehensive approach may uncover conditions like Hashimoto disease or subclinical hypothyroidism, which, contingent on individual evaluations involving elevated serum TSH and symptom presentation, may necessitate therapy. In conclusion, disturbances in thyroid function during the preconception and pregnancy periods pose risks that can lead to significant complications, underscoring the importance of vigilant diagnosis and management to support optimal outcomes for both mother and fetus.

Throughout pregnancy, the thyroid gland undergoes significant changes to meet the increased demands for hormones. It is essential to monitor these changes closely as any imbalances can have detrimental effects on both the mother and baby’s health. Proper management of thyroid disorders during pregnancy is crucial for a successful outcome.

The Graves-Basedow disease often causes eye symptoms such as a characteristic eyelid twitch, swelling of the eyes, itching, pain in the eyeballs, and double vision. This is because inflammation also occurs in the eye tissue.

If Graves-Basedow disease is diagnosed and treated before pregnancy, during trying for a baby it’s important to aim for stable results or “euthyroidism.” Since common medications used for overactive thyroid gland negatively affect the developing thyroid gland of the baby, contact your doctor immediately if there’s any suspicion or confirmation of pregnancy.

During pregnancy: instead of tiamazole starting from week 16, propylotiouracil should be introduced. By week 16 you can continue treatment with either propylotiouracil or switch back to tiamazole used prior to pregnancy. Sometimes if a woman has Graves-Basedow disease and is taking low doses of tiamazole while maintaining hormonal balance (euthyroid), withdrawal might be considered under careful monitoring every two weeks at minimum.

Throughout pregnancy, it’s essential to conduct regular frequency checks on TSH (Thyroid Stimulating Hormone) and FT4 (Free Thyroxine) every four weeks, alongside the standard prenatal care visits as advised by your healthcare provider. It’s recommended to target the upper limit of normal values or slightly above for these tests due to the increased demand during the gestation process. Typically, targets should aim for a FT4 level greater than 20 mcg/dL, although this may vary based on local laboratory norms. Remaining close to these reference ranges ensures optimal outcomes for the mother’s health, avoiding complications associated with hypo/hyperthyroidism that could affect the child’s postnatal growth and development.

Regular testing allows for an accurate assessment and timely intervention, with adjustments made according to the test results. This ensures the health of the mother is maintained despite the natural fluctuations that occur throughout the stages of pregnancy, leading up to labor and postpartum changes. Continuous vigilance is required after delivery until a well-established breastfeeding routine is in place, which reassumes a self-sustaining supply. This underscores the importance of consistent monitoring, particularly frequent checks of the levels mentioned during the critical first trimester when organ formation begins, and continuing through the second and third trimesters. Just like maintaining checkpoints on a long journey, this diligent approach supports healthy pregnancy and child development outcomes.

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