What Every Pregnant Woman Needs To Know About Hypothyroidism

Do you know that the American Thyroid Association has issued multiple public health statements to warn about the dangers of hypothyroidism and pregnancy?[1] Hypothyroidism, an underactive thyroid, increases the risk of pregnancy complications, such as miscarriage, still birth, infertility, maternal anemia, pre-eclampsia, placental abruption, postpartum hemorrhage, premature delivery, low birth weight and deficits in intellectual development in infants.[2][3] Despite the warnings, not all doctors know the ramifications of an undiagnosed or under-treated thyroid condition on a mother and her fetus, and very few patients know the facts to insist on proper testing.

I learned this the hard way. I was diagnosed with hypothyroidism the year following the birth of my first son in 2006. I trusted my doctors and followed their thyroid drug protocol to the letter never once thinking they might not know everything there was to know about hypothyroidism. I trusted them as the experts especially when I became pregnant again in late 2008. This is the biggest regret of my life. My Thyroid Stimulating Hormone (TSH) rose far above the recommended reference range for pregnancy and I miscarried my child. My doctor had clearly never read the Endocrine Society guidelines for pregnancy.

There is ongoing debate over universal thyroid screening in pregnancy. The argument is that there is insufficient evidence at this time to recommend for or against universal thyroid testing at the first trimester visit, however the scientific research is mounting to show that even mild thyroid dysfunction can have serious adverse effects on mother and child.

What happens to all the women and their babies while we wait for thyroid screening to become universal in pregnancy?

The American Association of Clinical Endocrinologists issued a press release in January 2003 warning that 1 in 10 Americans suffered from thyroid disease yet half, over 13 million, remain undiagnosed.[4] The Thyroid Federation International claims up to 300 million people worldwide suffer from thyroid problems, yet over half are unaware of their condition. According to TFI, thyroid problems are eight times more common in women than in men.[5]

Given these statistics there are pregnant women worldwide this very minute with thyroid disease but they don’t know they have it and their doctors are not aware they are at high-risk. Women will experience miscarriage, still birth, infertility, maternal anemia, pre-eclampsia, placental abruption, postpartum hemorrhage, premature delivery, and births of babies with intellectual development deficits, but they will have no idea their thyroid was to blame.

Take Charge Of Your Thyroid Health

Every woman planning to get pregnant, should get their thyroid tested pre-conception and then again as soon as possible in their first trimester of pregnancy. In early pregnancy the fetus is dependent on the mother to supply the thyroid hormones essential for brain development. If the mother is hypothyroid, she may not be able to supply her fetus with enough thyroid hormones, putting the fetus at risk. Thyroid levels change quickly in pregnancy, so do not delay.

Thyroid testing is currently not mandatory in pregnancy. If your doctor refuses thyroid testing because they do not consider it necessary in prenatal medical care, make your case. In November 2011 The American Thyroid Association updated their guidelines for the diagnosis and management of thyroid disease during pregnancy. According to the new guidelines:[6]

Women who are at high risk for thyroid dysfunction and may benefit from selected screening during pregnancy include those with the following attributes:

• Women with a history of thyroid dysfunction and/or thyroid surgery.
• Women with a family history of thyroid disease.
• Women with a goiter.
• Women with thyroid antibodies.
• Women with symptoms or clinical signs suggestive of hypothyroidism. It is important to note that women with overt hypothyroidism are not invariably symptomatic.
• Women with type I diabetes, in whom the rate of development of new onset hypothyroidism in pregnancy was 16% in one series.
• Women with a history of either miscarriage or preterm delivery.
• Women with other autoimmune disorders that are frequently associated with autoimmune thyroid dysfunction, including vitiligo, adrenal insufficiency, hypoparathyroidism, atrophic gastritis, pernicious anemia, systemic sclerosis, systemic lupus erythematosus, and Sjögren’s syndrome.
• Women with infertility should have screening with TSH as part of their infertility work-up. The prevalence of hypothyroidism (overt and subclinical) among infertile women ranged from 1% to 43% in different studies.
• Women with prior therapeutic head or neck irradiation.
• Women with morbid obesity. A body mass index greater than or equal to 40 kg/m² has been associated with an increased prevalence of hypothyroidism.
• Women age 30 or older. The prevalence of hypothyroidism increases with age.
• Women treated with amiodarone.
• Women treated with lithium.
• Women with a recent (in the past 6 weeks) exposure to iodinated radiological contrast agents.

There are good doctors who understand the importance of testing thyroid for pregnancy. Be an advocate for yourself and your child and find a good doctor, even if that means meeting 10 doctors until you find the one that helps.

My hope is to see the day when every woman planning to conceive and every woman who is pregnant receives comprehensive thyroid screening. Universal thyroid screening in pregnancy is my life’s mission. I will make it happen in memory of my unborn child so that not one more baby is lost needless to maternal thyroid disease. Enough is enough.

I co-authored this book with Mary Shomon, Your Healthy Pregnancy with Thyroid Disease: A Guide to Fertility, Pregnancy, and Postpartum Wellness, so that every woman will know the lab tests, optimal ranges, medications, supplements, dietary recommendations and more so that she will know more than even her doctors about having miracle babies with thyroid disease.

References:

1. American Thyroid Association (2012, June 4). Thyroid Disease and Pregnancy. Retrieved from http://www.thyroid.org/thyroid-disease-and-pregnancy.

2. American Thyroid Association. American Thyroid Association Statement on Early Maternal Thyroidal Insufficiency: Recognition, Clinical Management and Research Directions. Thyroid 2005; 15(1):77-79.

3. American Thyroid Association. General Information/Press Room. Retrieved from http://www.thyroid.org/thyroid-events-education-media/about-hypothyroidism.

4. American Association of Clinical Endocrinologists (2003, January). 2003 Press Release – Over 13 Million Americans with Thyroid Disease Remain Undiagnosed. Retrieved from http://www.hospitalsoup.com/public/AACEPress_release-highlighted.pdf.

5. Thyroid Federation International (2012, May 21). International Thyroid Awareness Week 2012 – Be Thyroid Aware. Retrieved from http://www.thyroidweek.com/en/be-thyroid-aware.html.

6. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved from http://thyroidguidelines.net/pregnancy.