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Thyroid troubles

PHOTO: AFP

PROMPT TREATMENT Of thyroid disease is essential for the wellbeing of mother and child

The thyroid gland is butterfly-shaped and located at the base of the neck.

The thyroid gland has an enormous impact on your health.

Every aspect of your metabolism, from your heart rate to how quickly you burn calories, is regulated by thyroid hormones. You cannot live without your thyroid gland or the thyroid hormones.

Occasionally, the thyroid may not produce enough of the hormone thyroxine. This is called hypothyroidism.

Sometimes, there is an overproduction of the hormone. This is called hyperthyroidism.

Diagnosis of thyroid disease

Blood tests are done to measure TSH and free T4. If the TSH is raised and the free T4 is low, then you have hypothyroidism. Decreased TSH and raised T4 are indicative of hyperthyroidism.

Hypothyroidism

This is a condition in which the body lacks sufficient thyroid hormone.

Since the main purpose of thyroid hormone is to regulate the body’s metabolism, people with this condition will have symptoms associated with a slow metabolism.

Causes of hypothyroidism during pregnancy

The most common cause of hypothyroidism is the autoimmune disorder known as Hashimoto’s thyroiditis.

Inadequate treatment of a woman already known to have hypothyroidism or over-treatment of a hyperthyroid woman with anti-thyroid medications can also result in problems.

The risks of hypothyroidism to the mother

Most women with mild hypothyroidism may have no symptoms. Untreated, or severe hypothyroidism has been associated with anaemia, muscle pain and weakness, low birth weight infants, and postpartum haemorrhage (bleeding).

The risks of maternal hypothyroidism to the baby

Thyroid hormone is critical for brain development in the baby.

Do not stop your thyroid medication when you find out you are pregnant.

The effect of maternal hypothyroidism on the baby’s brain development is not clear. It is important that hypothyroidism be adequately treated in pregnancy. TSH and free T4 levels must be checked regularly in pregnancy to monitor if you are getting enough hormone replacement.

Children born with congenital hypothyroidism (no thyroid function at birth) can have severe cognitive, neurological and developmental abnormalities if the condition is not recognized and treated promptly. It is recommended that babies of mothers with hypothyroidism be tested for thyroid function on the 3rd or 4th day of life. In fact, it would be ideal for all newborns to be tested for thyroid function. Treatment of hypothyroidism during pregnancy

There must be adequate replacement of thyroid hormone in the form of synthetic thyroxine.

Thyroxine requirements frequently increase during pregnancy, often times by 25 to 50 per cent.

Women with known hypothyroidism should have their thyroid function tested as soon as pregnancy is detected and their dose adjusted by their physician as needed to maintain a TSH in the normal range.

Hyperthyroidism in pregnancy

Hyperthyroidism is the medical term to describe the signs and symptoms associated with an over production of thyroid hormone.

Causes of hyperthyroidism during pregnancy

The most common cause (80-85 per cent) of maternal hyperthyroidism during pregnancy is Graves’ disease and occurs in 1 in 1500 pregnant patients. Diagnosis is based on a careful history, physical exam and laboratory testing.

The risks of hyperthyroidism to the mother

Graves’ disease may present initially during the first trimester or may be exacerbated during this time in a woman known to have the disorder.

Inadequately treated maternal hyperthyroidism can result in premature labour and pre-eclampsia. Very severe hyperthyroidism known as thyroid storm may also develop.

The risks of hyperthyroidism to the baby

If hyperthyroidism is treated adequately, the risks to the baby are very low.

It is important to see your physician before you get pregnant so that the proper medication can be given in the sufficient dose.

Treatment options for a pregnant woman with hyperthyroidism

When hyperthyroidism is severe enough to require therapy, anti-thyroid medications are the treatment, with propylthiouracil (PTU) being the drug of choice.

After delivery

Hyperthyroidism typically worsens in the postpartum period, usually in the first 3 months after delivery.

Higher doses of anti-thyroid medications are frequently required during this time. At usual, close monitoring of thyroid function tests is necessary.

Breastfeeding

It is safe to breastfeed the baby if you are on propylthiouracil (PTU). The baby will require periodic assessment of its thyroid function to ensure maintenance of normal thyroid status.

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women’s health issues.)

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