HHypothyroidism is a relatively common condition during pregnancy which could affect your baby’s growth if not treated properly.
How common is hypothyroidism during pregnancy? Is it a dangerous condition? Does it affect the growth of the baby?
Before answering in-depth, let me give you a brief introduction about the thyroid gland. The thyroid gland is a butterfly-shaped gland found in front of our neck. It produces thyroid hormones (namely T3 and T4) and releases it into the blood. Iodine is needed for the production of thyroid hormones.
The function of the thyroid gland is under the control of our brain. Thyroid hormones are needed for the basal metabolism (working) of our body. It also regulates a person’s sleep and appetite, and in the case of women, their menstrual cycles. It also has a role in the development of body, especially its neurological function, and it also influences the functioning of our hearts. In a nutshell, it is a very important part of our body.
What is hypothyroidism?
Hypothyroidism is a condition in which thyroid hormones are present in less quantities in our blood, even if the presence of the thyroid stimulating hormone is more. In hyperthyroidism, thyroid hormones will be more than normal in blood, and obviously, the amount of TSH will be less. During pregnancy, there is a higher demand for thyroid hormones, so more thyroid hormones should be produced. For increased production, more iodine is required.
Due to iodine deficiency or some inherent problems of the thyroid gland, the production may not be enough to meet the increased demand, so hypothyroidism occurs during pregnancy. This is why during pregnancy, some people do develop hypothyroidism, even if their hormonal functions are normal, due to excess demand.
The thyroid hormone plays an important role in the neurological development of the baby. Therefore, hypothyroidism can cause lower IQ, autism, language delay or ADHD in the baby. It can also be a cause of early miscarriage, low birth weight of baby, increased chances of hypertension, and preeclampsia for the mother. So it is very important to detect it early and get proper treatment.
How is hypothyroidism detected?
Hypothyroidism can be detected by doing a blood test. Usually a sample taken during fasting is preferred, but it can be taken in other circumstances as well. A complete thyroid function test (TFT) or screening TSH can be done. During pregnancy, it is advised to do a TSH and Free T4 test for screening.
If your TSH is abnormal, doctors will sometimes request you to undergo a TPO antibody test to rule out inherent problems of thyroid glands, as TPO-related hypothyroidism will cause more harm to your baby. Since the incidence of hypothyroidism is on the rise, and its adverse outcomes are totally preventable, universal screening is now recommended, particularly among Asian ladies who have more chances of getting hypothyroidism. It is better to do the test now so that there are no regrets later.
What is the best time to take this test during pregnancy?
Usually, the test should be taken during the seventh or eighth week of pregnancy. The normal level of TSH in pregnancy is around 2.5. I have been told by the doctor that I have hypothyroidism. Should I start medication? Can it be treated by diet modification alone?
According to scientific recommendations, if your TSH is more than 10, we have to start medications immediately, and if it is between 2.5 and 10, we must first do a TPO antibody testing and start medicine accordingly. From a more practical view, though, since more adverse pregnancy outcomes are associated if TSH levels are more than four, most of the doctors prefer starting patients on medication. That is a widely accepted consensus.
You need to take iodine rich food such as dairy products, eggs, seafood and iodised salt. It is better to avoid tapioca and cabbage. But diet modification alone won’t be enough to prevent complications, you must start medicines as prescribed by the doctor. The medicine referred to here is levothyroxine, a synthetic thyroid hormone. It has to be taken in the prescribed dosage on an empty stomach, preferably early in the morning
If you are on thyroid medication, it is recommended to do your TSH every four weeks up to 30 weeks of pregnancy, and titrate dosages according to the result.
Do I have to continue this medicine for the rest of my life?
Usually, hypothyroidism during pregnancy is a transient condition due to the increased demand for the hormone, so after delivery most ladies can stop medication.
Doctors usually give it up to six weeks after delivery, then do the TSH, if it is normal, then taper the dosage and subsequently stop it. For lower doses, you can stop it directly. In a nutshell, hypothyroidism is an easily detectable and treatable condition during pregnancy.