Thyroid disorders are prevalent in women of child-bearing age and for this reason commonly [1] present in pregnancy

and the puerperium. Uncorrected thyroid dysfunction in pregnancy has adverse effects on fetal and maternal well-being. The deleterious effects of thyroid dysfunction can also extend beyond pregnancy and delivery to affect neurointellectual development in the early life of the child. Demand for thyroid hormones is increased during pregnancy which may cause a previously unnoticed thyroid disorder to worsen. Still, the overall lack of evidence [2] precludes a recommendation for universal screening for thyroid disorder in all pregnant women.

The Thyroid in Pregnancy

Fetal thyroxine is wholly obtained from maternal sources in early pregnancy since the fetal thyroid gland only becomes functional in the second trimester of gestation. As thyroxine is essential for fetal neurodevelopment it is critical that maternal delivery of thyroxine to the fetus is ensured early in gestation. In pregnancy, iodide losses through the urine and the feto-placental unit contribute to a state of relative iodine deficiency.
[3]

Thus, pregnant women require additional

[4]

iodine intake. A daily iodine intake of 250 mcg is recommended in pregnancy but this is not always achieved even in iodine sufficient parts of the world.

Thyroid hormone concentrations in blood are increased in pregnancy, partly due to the high levels of oestrogen and due to the weak thyroid stimulating effects of human chorionic gonadotropin(hCG) that acts like TSH. Thyroxine (T4) levels rise from about 612 weeks, and peak by mid-gestation; reverse changes are seen with TSH. Gestation specific reference ranges for thyroid function tests are not widely in use although many centres are now preparing them.

Hypothyroidism
Clinical evaluation
Hypothyroidism is common in pregnancy with an estimated prevalence of 2-3% and 0.3-0.5% for subclinical and overt hypothyroidism respectively.
[5]

Endemic iodine deficiency accounts for

[6]

most hypothyroidism in pregnant women worldwide while chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world. The presentation

of hypothyroidism in pregnancy is not always classical and may sometimes be difficult to distinguish from the symptoms of normal pregnancy. A high index of suspicion is therefore required especially in women at risk of thyroid disease e.g. women with a personal or family history of thyroid disease, goitre, or co-existing primary autoimmune disorder like type 1 diabetes.

Risks of Hypothyroidism on fetal and maternal well-being

Hypothyroidism is diagnosed by noting a high TSH associated with a subnormal T4 concentration. Subclinical hypothyroidism (SCH) is present when the TSH is high but the T4 level is in the normal range but usually low normal. SCH is the commonest form of hypothyroidism in

pregnancy and is usually due to progressive thyroid destruction due to autoimmune thyroid disease. Several studies, mostly retrospective, have shown an association between overt hypothyroidism and adverse fetal and obstetric outcomes (e.g. Glinoer 1991).
[7]

Maternal complications such

asmiscarriages, anaemia in pregnancy, pre-eclampsia, abruptio placenta and postpartum haemorrhage can occur in pregnant women with overt hypothyroidism. Also, the offspring of these mothers can have complications such as premature birth, low birth weight and increased neonatal respiratory distress.
[8]

Similar complications have been reported in mothers with

[9]

subclinical hypothyroidism. A three-fold risk of placental abruption and a two-fold risk of pre-term delivery were reported in mothers with subclinical hypothyroidism.
[10]

Another study showed a

higher prevalence of subclinical hypothyroidism in women with pre-term delivery (before 32 weeks) compared to matched controls delivering at term. An association with adverse

obstetrics outcome has also been demonstrated in pregnant women with thyroid autoimmunity independent of thyroid function. Treatment of hypothyroidism reduces the risks of these adverse obstetric and fetal outcomes; a retrospective study of 150 pregnancies showed that treatment of hypothyroidism led to reduced rates of abortion and premature delivery. Also, a prospective intervention trial study showed that treatment of euthyroid antibody positive pregnant women led to fewer rates of miscarriage than non treated controls.
[11]

It has long been known that cretinism (i.e. gross reduction in IQ) occurs in areas of severe iodine deficiency due to the fact that the mother is unable to make T4 for transport to the fetus particularly in the first trimester. This neurointellectual impairment (on a more modest scale) has now been shown in an iodine sufficient area (USA) where a study showed that the IQ scores of 79 year old children, born to mothers with undiagnosed and untreated hypothyroidism in pregnancy, were seven points lower than those of children of matched control women with normal thyroid function in pregnancy.
[12]

Another study showed that persistent hypothyroxinaemia at 12

[13]

weeks gestation was associated with an 8-10 point deficit in mental and motor function scores in infant offspring compared to children of mothers with normal thyroid function.
[14]

Even maternal

thyroid peroxidase antibodies were shown to be associated with impaired intellectual development in the offspring of mothers with normal thyroid function.
[15][16]

However, no association

was found between isolated maternal hypothyroxinaemia and adverse perinatal outcomes in 2 large US studies, studies. although the behavioural outcomes in the children were not tested in these

Management of hypothyroidism in pregnancy

Levothyroxine is the treatment of choice for hypothyroidism in pregnancy. Thyroid function should be normalised prior to conception in women with pre-existing thyroid disease. Once pregnancy is confirmed the thyroxine dose should be increased by about 30-50% and subsequent titrations should be guided by thyroid function tests (FT4 and TSH) that should be monitored 4-6 weekly until euthyroidism is achieved. It is recommended that TSH levels are maintained below 2.5 mU/l in the first trimester of pregnancy and below 3 mU/l in later pregnancy.
[17]

The recommended

maintenance dose of thyroxine in pregnancy is about 2.0-2.4 mcg/kg daily. Thyroxine requirements may increase in late gestation and return to pre-pregnancy levels in the majority of women on delivery. Pregnant patients with subclinical hypothyroidism (normal FT4 and elevated TSH) should be treated since the condition is associated with maternal and fetal complications.

Hyperthyroidism
Clinical evaluation
Hyperthyroidism occurs in about 0.2-0.4% of all pregnancies. Most cases are due to Graves disease although less common causes (e.g. toxic nodules and thyroiditis) may be seen.
[18]

Clinical assessment alone may occasionally be inadequate in differentiating

hyperthyroidism from the hyperdynamic state of pregnancy. Distinctive clinical features of Graves disease include the presence of ophthalmopathy, diffuse goitre and pretibial myxoedema. Also, hyperthyroidism must be distinguished from gestational transient thyrotoxicosis, a self-limiting hyperthyroid state due to the thyroid stimulatory effects of beta-hCG . This distinction is important since the latter condition is typically mild and will not usually require specific antithyroid treatment. Hyperthyroidism due to Graves disease may worsen in the first trimester of pregnancy, remit in later pregnancy, and subsequently relapse in the postpartum.

Risks of hyperthyroidism on fetal and maternal well-being

Uncontrolled hyperthyroidism in pregnancy is associated with an increased risk of severe preeclampsia and up to a four-fold increased risk of low birth weight deliveries. Some of these unfavourable outcomes are more marked in women who are diagnosed for the first time in pregnancy. Uncontrolled and inadequately treated maternal hyperthyroidism may also result in fetal and neonatal hyperthyroidism antibodies (TRAbs).
[20] [19]

due to the transplacental transfer of stimulatory TSH receptor

Clinical neonatal hyperthyroidism occurs in about 1% of infants born to

mothers with Graves disease. Rarely neonatal hypothyroidism may also be observed in the infants of mothers with Graves hyperthyroidism. This may result from transplacental transfer of circulating maternal anti-thyroid drugs, pituitary-thyroid axis suppression from transfer of maternal thyroxine.

Management of hyperthyroidism in pregnancy

Ideally a woman who is known to have hyperthyroidism should seek pre-pregnancy advice, although as yet there is no evidence for its benefit. Appropriate education should allay fears that are commonly present in these women. She should be referred for specialist care for frequent checking of her thyroid status, thyroid antibody evaluation and close monitoring of her medication needs. Medical therapy with anti-thyroid medications is the treatment of choice for hyperthyroidism in pregnancy.
[21]

Methimazole and propylthiouracil (PTU) are effective in

[2]

preventing pregnancy complications by hyperthyroidism.

Surgery is considered for patients who

suffer severe adverse reactions to anti-thyroid drugs and this is best performed in the second trimester of pregnancy.Radioactive iodine is absolutely contraindicated in pregnancy and the puerperium. If a woman is already receiving carbimazole, a change to propylthiouracil (PTU) is recommended but this should be changed back to carbimazole after the first trimester. This is because carbimazole can rarely be associated with skin and also mid line defects in the fetus but PTU long term also can cause liver side effects in the adult. Carbimazole and PTU are both secreted in breast milk but evidence suggests that antithyroid drugs are safe during lactation.
[22]

There are no adverse effects on IQ or psychomotor development in children whose

mothers have received antithyroid drugs in pregnancy. Current guidelines suggest that a pregnant patient should be on PTU during the first trimester of pregnancy due to lower tetragenic effect and then be switched to methimazole during the second and third trimester due to lower liver dysfunction side effects.

Postpartum Thyroiditis
Postpartum thyroid dysfunction (PPTD) is a syndrome of thyroid dysfunction occurring within the first 12 months of delivery as a consequence of the postpartum immunological rebound that follows the immune tolerant state of pregnancy. PPTD is a destructive thyroiditis with similar pathogenetic features to Hashimotos thyroiditis.
[23]

The disease is very common with a prevalence of 5-9% of unselected postpartum women. Typically there is a transient hyperthyroid phase that is followed by a phase of hypothyroidism. Permanent hypothyroidism occurs in as much as 30% of cases after 3 years, and in 50% at 7 10 years. The hyperthyroid phase will not usually require treatment but, rarely, propanolol may be used for symptom control in severe cases. The hypothyroid phase should be treated with thyroxine if patients are symptomatic, planning to get pregnant, or if TSH levels are above 10 mU/L. Long-term follow up is necessary due to the risk of permanent hypothyroidism. Nearly all the women with PPTD have positive TPO antibodies. This marker can be a useful screening test in early pregnancy as 50% of women with antibodies will develop thyroid dysfunction postpartum.

In addition some but not all studies have shown an association between PPTD and depression so that thyroid function should be checked postpartum in women with mood changes.

What is thyroid disease?

Thyroid disease is a disorder that affects the thyroid gland. Sometimes the body produces too much or too little thyroid hormone. Thyroid hormones regulate metabolism the way the body uses energyand affect nearly every organ in the body. Too much thyroid hormone is called hyperthyroidism and can cause many of the bodys functions to speed up. To o little thyroid hormone is called hypothyroidism and can cause many of the bodys functions to slow down. Thyroid hormone plays a critical role during pregnancy both in the development of a healthy baby and in maintaining the health of the mother. Women with thyroid problems can have a healthy pregnancy and protect their fetuses health by learning about pregnancys effect on the thyroid, keeping current on their thyroid function testing, and taking the required medications.

What is the thyroid?

The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on either side of the windpipe. The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce, store, and release hormones into the bloodstream. The hormones then travel through the body and direct the activity of the bodys cells. The thyroid gland makes two thyroid hormones, triiodothyronine (T 3) and thyroxine (T4). T3 is the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels. Thyroid hormone production is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production.

How does pregnancy normally affect thyroid function?

Two pregnancy-related hormoneshuman chorionic gonadotropin (hCG) and estrogen cause increased thyroid hormone levels in the blood. Made by the placenta, hCG is similar to TSH and mildly stimulates the thyroid to produce more thyroid hormone. Increased estrogen produces higher levels of thyroid-binding globulin, also known as thyroxine-binding globulin, a protein that transports thyroid hormone in the blood.

These normal hormonal changes can sometimes make thyroid function tests during pregnancy difficult to interpret. Thyroid hormone is critical to normal development of the babys brain and nervous system. During the first trimester, the fetus depends on the mothers supply of thyroid hormone, which comes through the placenta. At around 12 weeks, the babys thyroid begins to function on its own. The thyroid enlarges slightly in healthy women during pregnancy, but not enough to be detected by a physical exam. A noticeably enlarged thyroid can be a sign of thyroid disease and should be evaluated. Thyroid problems can be difficult to diagnose in pregnancy due to higher levels of thyroid hormone in the blood, increased thyroid size, fatigue, and other symptoms common to both pregnancy and thyroid disorders.

Hyperthyroidism
What causes hyperthyroidism in pregnancy?
Hyperthyroidism in pregnancy is usually caused by Graves disease and occurs in about one of every 500 pregnancies. Graves disease is an autoimmune disorder. Normally, the immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the bodys own cells and organs. With Graves disease, the immune system makes an antibody called thyroid -stimulating immunoglobulin (TSI), sometimes called TSH receptor antibody, which mimics TSH and causes the thyroid to make too much thyroid hormone. In some people with Graves disease, this antibody is also associated with eye problems such as irritation, bulging, and puffiness. Although Graves disease may first appear during pregnancy, a woman with preexisting Graves disease could actually see an improvement in her symptoms in her second and third trimesters. Remissiona disappearance of signs and symptomsof Graves disease in later pregnancy may result from the general suppression of the immune system that occurs during pregnancy. The disease usually worsens again in the first few months after delivery. Pregnant women with Graves disease should be monitored monthly.
2 1

Rarely, hyperthyroidism in pregnancy is caused by hyperemesis gravidarum severe nausea and vomiting that can lead to weight loss and dehydration. This extreme nausea and vomiting is believed to be triggered by high levels of hCG, which can also lead to temporary hyperthyroidism that goes away during the second half of pregnancy.

How does hyperthyroidism affect the mother and baby?

Uncontrolled hyperthyroidism during pregnancy can lead to congestive heart failure

preeclampsiaa dangerous rise in blood pressure in late pregnancy thyroid storma sudden, severe worsening of symptoms miscarriage premature birth low birth weight

If a woman has Graves disease or was treated for Graves disease in the past with surgery or radioactive iodine, the TSI antibodies can still be present in the blood, even when thyroid levels are normal. The TSI antibodies she produces may travel across the placenta to the babys bloodstream and stimulate the fetal thyroid. If the mother is being treated with antithyroid medications, hyperthyroidism in the baby is less likely because these medications also cross the placenta. Women who have had surgery or radioactive iodine treatment for Graves disease should inform their health care provider, so the baby can be monitored for thyroid-related problems later in the pregnancy. Hyperthyroidism in a newborn can result in rapid heart rate, which can lead to heart failure; early closure of the soft spot in the skull; poor weight gain; irritability; and sometimes an enlarged thyroid that can press against the windpipe and interfere with breathing. Women with Graves disease and their newborns should be closely monitored by their health care team.

How is hyperthyroidism in pregnancy diagnosed?

Health care providers diagnose hyperthyroidism in pregnant women by reviewing symptoms and doing blood tests to measure TSH, T3, and T4 levels. Some symptoms of hyperthyroidism are common features in normal pregnancies, including increased heart rate, heat intolerance, and fatigue. Other symptoms are more closely associated with hyperthyroidism: rapid and irregular heartbeat, a slight tremor, unexplained weight loss or failure to have normal pregnancy weight gain, and the severe nausea and vomiting associated with hyperemesis gravidarum. A blood test involves drawing blood at a health care providers office or commercial facility and sending the sample to a lab for analysis. Diagnostic blood tests may include TSH test. If a pregnant womans symptoms suggest hyperthyroidism, her doctor will probably first perform the ultrasensitive TSH test. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Generally, below-normal levels of TSH indicate hyperthyroidism. However, low TSH levels may also occur in a normal pregnancy, especially in the first trimester, due to the small increase in thyroid hormones from HCG. T3 and T4 test. If TSH levels are low, another blood test is performed to measure T 3 and T4. Elevated levels of free T4the portion of thyroid hormone not attached to thyroid-binding proteinconfirm the diagnosis.

Rarely, in a woman with hyperthyroidism, free T 4 levels can be normal but T3 levels are high. Because of normal pregnancy-related changes in thyroid function, test results must be interpreted with caution. TSI test. If a woman has Graves disease or has had surgery or radioactive iodine treatment for the disease, her doctor may also test her blood for the presence of TSI antibodies.

How is hyperthyroidism treated during pregnancy?

During pregnancy, mild hyperthyroidism, in which TSH is low but free T 4 is normal, does not require treatment. More severe hyperthyroidism is treated with antithyroid medications, which act by interfering with thyroid hormone production. Radioactive iodine treatment is not an option for pregnant women because it can damage the fetal thyroid gland. Rarely, surgery to remove all or part of the thyroid gland is considered for women who cannot tolerate antithyroid medications. Antithyroid medications cross the placenta in small amounts and can decrease fetal thyroid hormone production, so the lowest possible dose should be used to avoid hypothyroidism in the baby. Antithyroid medications can cause side effects in some people, including allergic reactions such as rashes and itching a decrease in the number of white blood cells in the body, which can lower a persons resistance to infection liver failure, in rare cases Stop your antithyroid medication and call your health care provider right away if you develop any of the following signs and symptoms while taking antithyroid medications: fatigue weakness vague abdominal pain loss of appetite a skin rash or itching easy bruising yellowing of the skin or whites of the eyes, called jaundice persistent sore throat fever

Hypothyroidism
What causes hypothyroidism in pregnancy?
Hypothyroidism in pregnancy is usually caused by Hashimotos disease and occurs in three to five out of every 1,000 pregnancies. Hashimotos disease is a form of chronic inflammation of the thyroid gland.
2

Like Graves disease, Hashimotos disease is an autoimmune disorder. In Hashimotos disease, the immune system attacks the thyroid, causing inflammation and interfering with its ability to produce thyroid hormones. Hypothyroidism in pregnancy can also result from existing hypothyroidism that is inadequately treated or from prior destruction or removal of the thyroid as a treatment for hyperthyroidism.

How does hypothyroidism affect the mother and baby?

Some of the same problems caused by hyperthyroidism can occur with hypothyroidism. Uncontrolled hypothyroidism during pregnancy can lead to preeclampsia anemiatoo few red blood cells in the body, which prevents the body from getting enough oxygen miscarriage low birth weight stillbirth congestive heart failure, rarely Because thyroid hormones are crucial to fetal brain and nervous system development, uncontrolled hypothyroidism especially during the first trimestercan affect the babys growth and brain development.

How is hypothyroidism in pregnancy diagnosed?

Like hyperthyroidism, hypothyroidism is diagnosed through a careful review of symptoms and measurement of TSH and T4 levels. Symptoms of hypothyroidism in pregnancy include extreme fatigue, cold intolerance, muscle cramps, constipation, and problems with memory or concentration. High levels of TSH and low levels of free T4 generally indicate hypothyroidism. Because of normal pregnancy-related changes in thyroid function, test results must be interpreted with caution. The TSH test can also identify subclinical hypothyroidism a mild form of hypothyroidism that has no apparent symptoms. Subclinical hypothyroidism occurs in 2 to 3 percent of pregnancies. Test results will show high levels of TSH and normal free T 4. Experts differ in their opinions as to whether asymptomatic pregnant women should be routinely screened for hypothyroidism. But if subclinical hypothyroidism is discovered during pregnancy, treatment is recommended to help ensure a healthy pregnancy.
2

How is hypothyroidism treated during pregnancy?

Hypothyroidism is treated with synthetic thyroid hormone called thyroxine a medication which is identical to the T4 made by the thyroid. Women with preexisting hypothyroidism will need to increase their prepregnancy dose of thyroxine to maintain normal thyroid function. Thyroid function should be checked every 6 to 8 weeks during pregnancy. Synthetic thyroxine is safe and necessary for the well-being of the fetus if the mother has hypothyroidism.

Postpartum Thyroiditis

What is postpartum thyroiditis?

Postpartum thyroiditis is an inflammation of the thyroid that affects about 4 to 10 percent of women during the first year after giving birth. Thyroiditis causes stored thyroid hormone to leak out of the inflamed thyroid gland and raise hormone levels in the blood. Postpartum thyroiditis is believed to be an autoimmune condition and causes mild hyperthyroidism that usually lasts 1 to 2 months. Many women then develop hypothyroidism lasting 6 to 12 months before the thyroid regains normal function. In some women, the thyroid is too damaged to regain normal function and their hypothyroidism is permanent, requiring lifelong treatment with synthetic thyroid hormone. Postpartum thyroiditis is likely to recur with future pregnancies. Postpartum thyroiditis often goes undiagnosed because the symptoms are mistaken for postpartum bluesthe exhaustion and moodiness that sometimes follow delivery. If symptoms of fatigue and lethargy do not go away within a few months or a woman develops postpartum depression, she should talk with her health care provider. If the hypothyroid symptoms are bothersome, thyroid medication can be given.
2

Points to Remember
Thyroid disease is a disorder that results when the thyroid gland produces more or less thyroid hormone than the body needs. Pregnancy causes normal changes in thyroid function but can also lead to thyroid disease. Uncontrolled hyperthyroidism during pregnancy can lead to serious health problems in the mother and the unborn baby. During pregnancy, mild hyperthyroidism does not require treatment. More severe hyperthyroidism is treated with antithyroid medications, which act by interfering with thyroid hormone production. Uncontrolled hypothyroidism during pregnancy can lead to serious health problems in the mother and can affect the unborn babys growth and brain development. Hypothyroidism during pregnancy is treated with synthetic thyroid hormone, thyroxine (T 4). Postpartum thyroiditisinflammation of the thyroid glandcauses a brief period of hyperthyroidism, often followed by hypothyroidism that usually goes away within a year. Sometimes the hypothyroidism is permanent.

Hypothyroidism and Pregnancy

Because some of the symptoms of hypothyroidism, such as tiredness and weight gain, are already quite common in pregnant women, it is often overlooked and not considered a possible cause of these symptoms. Blood tests, particularly measuring the TSH level, can determine whether a pregnant woman's problems are due to hypothyroidism or not. Since thyroid medications (particularly levothyroxine) are essentially identical to the thyroid hormone made by the normal thyroid gland, a woman with an underactive thyroid gland can feel confident that it is perfectly safe to take thyroid hormone medication during pregnancy.

There are no side effects for the mother or the baby as long as the proper dose is used. In the case where hypothyroidism in the mother is NOT detected, the thyroid will still develop normally in the baby. Women with previously treated hypothyroidism should be aware that their dose of medication may have to be increased during pregnancy. They should contact their doctor, who should check their blood level of TSH periodically throughout pregnancy to see if their medication dose needs adjustment. Thyroid function tests should continue to be reviewed every 2 to 3 months throughout the pregnancy. After delivery, the thyroxine dose should be returned to the pre-pregnancy dose and thyroid function tests reviewed two months later.

Hyperthyroidism and Pregnancy

Hyperthyroidism refers to the signs and symptoms which are due to the production of too much thyroid hormone. An overactive thyroid gland (hyperthyroidism) often has its onset in younger women. Because a woman may think that feeling warm, having a hard or fast heartbeat, nervousness, trouble sleeping, or nausea with weight loss are just parts of being pregnant, the symptoms and signs of this condition may be overlooked during pregnancy. In women who are not pregnant, hyperthyroidism can affect menstrual periods, making them irregular, lighter, or disappear altogether. It may be harder for hyperthyroid women to become pregnant, and they are more likely to have miscarriages. If a woman with infertility or repeated miscarriages has symptoms of hyperthyroidism, it is important to rule out this condition with thyroid blood tests. It is very important that hyperthyroidism be controlled in pregnant women since the risks of miscarriage or birth defects are much higher without therapy. Fortunately, there are effective treatments available. Antithyroid medications cut down the thyroid gland's overproduction of hormones and are reviewed on another page on this site. When taken faithfully, they control hyperthyroidism within a few weeks. In pregnant women, thyroid experts consider propylthiouracil (PTU) the safest drug. Because PTU can also affect the baby's thyroid gland, it is very important that pregnant women be monitored closely with examinations and blood tests so that the PTU dose can be adjusted. In rare cases when a pregnant woman cannot take PTU for some reason (allergy or other side effects), surgery to remove the thyroid gland is the only alternative and should be undertaken prior to or even during the pregnancy if necessary. Although radioactive iodine is a very effective treatment for other patients with hyperthyroidism, it should never be given during pregnancy because the baby's thyroid gland could be damaged. Because treating hyperthyroidism during pregnancy can be a bit tricky, it is usually best for women who plan to have children in the near future to have their thyroid condition permanently cured. Antithyroid medications alone may not be the best approach in these cases because hyperthyroidism often returns when medications is stopped. Radioactive iodine is the most widely recommended permanent treatment with surgical removal being the second (but widely used) choice. It is concentrated by thyroid cells and damages them with little radiation to the rest of the body. This is why it cannot be given to a pregnant woman, since the radioactive iodine could cross the placenta and destroy normal thyroid cells in the baby.

The only common side effect of radioactive iodine treatment is underactivity of the thyroid gland, which occurs because too many thyroid cells were destroyed. This can be easily and safely treated with levothyroxine. There is no evidence that radioactive iodine treatment of hyperthyroidism interferes with a woman's future chances of becoming pregnant and delivering a healthy baby.

Thyroid Problems After Pregnancy

One of every twenty women develop thyroid inflammation within a few months after delivery of their baby, a condition called postpartum thyroiditis.This form of thyroid inflammation is painless and causes little or no gland enlargement. However, the condition interferes with the gland's production of thyroid hormones. Thyroid hormone may leak out of the inflamed gland in large amounts, causing hyperthyroidism that lasts for several weeks. Later on, the injured gland may not be able to make enough thyroid hormone, resulting in temporary hypothyroidism. Symptoms of hyperthyroidism and hypothyroidism may not be recognized when they occur in a new mother. They may be simply attributed to lack of sleep, nervousness, or depression.

Thyroid Symptoms Occasionally Overlooked in New Mothers

Hyperthyroidism

Fatigue Insomnia Nervousness Irritability Hypothyroidism Fatigue Depression Easily upset Trouble losing weight Postpartum thyroiditis goes away on its own after 1 to 4 months. While it is active, however, women often benefit from treatment for their thyroid hormone excess or deficiency. Some of the symptoms caused by too much thyroid hormone, such as tremor or palpitations, can be improved promptly by medications called beta-blockers(eg, propranolol). Antithyroid drugs, radioactive iodine, and surgery do not need to be considered because this form of hyperthyroidism is only temporary. If thyroid hormone deficiency develops, it can be treated for one to six months with levothyroxine. Women who have had an episode of postpartum thyroiditis are very likely to develop the problem again after future pregnancies. Although each episode usually resolves completely, one out of four women with postpartum thyroiditis goes on to develop a permanently underactive thyroid gland in future. Of course, levothyroxine fully corrects their thyroid hormone deficiency, and when used in the correct dose, can be safely taken without side effects or complications.

Thyroid Problems in the Baby

Rarely, a baby may be born without a thyroid gland. This birth defect is notcaused by thyroid problems in the mother. If an infant's hypothyroidism is not recognized and treated promptly, he/she will not develop normally. Therefore, all newborn babies in the United States routinely have a blood test to be sure that hypothyroidism is diagnosed and treated. Most thyroid medications will have no effect on the baby. The exception to this generality is the administration of radioactive iodine to the mother during pregnancy. Radioactive iodine can cross the placenta and it can destroy thyroid cells in the fetus.