There are important changes regarding the thyroid during pregnancy. These changes vary depending on the stages of pregnancy, and the thyroid gland is also affected in the postpartum period. In addition to the thyroid-related changes caused by pregnancy in a woman who has a normal pregnancy and does not have thyroid problems, it is necessary to evaluate thyroid problems differently in women who have thyroid disease and become pregnant.
A woman who does not have a thyroid problem but becomes pregnant. In women, the need for iodine increases due to hormonal changes specific to pregnancy and the increase in metabolic requirements. Mild iodine deficiency does not cause significant changes, but in areas of intense iodine deficiency, both the mother's thyroid and the fetus (baby in the womb) are affected. A decrease in T4 level causes an increase in TSH. During pregnancy, the thyroid gland enlarges around 10-20%. The World Health Organization recommends the ideal dietary iodine content during pregnancy as 200 mg.
Free T3 and free T4 should be measured to evaluate thyroid functions during pregnancy. TSH level is also affected by pregnancy. Especially in the first 3 months of pregnancy, TSH may fall below normal. It needs to be distinguished whether this condition is a temporary condition related to pregnancy or a reflection of a thyroid disease.
Hypothyroidism: (Insufficiency in thyroid hormones) Menstrual irregularities in women, excessive bleeding from the breast, It causes milk loss and increased hair growth. Pregnancy can occur in mild hypothyroidism, but it causes stillbirth, miscarriage, and premature birth. If hypothyroidism is severe, pregnancy may not occur. The frequency of hypertension increases in hypothyroid pregnant women. It negatively affects the baby's intelligence development. Due to these negativities, a woman with hypothyroidism needs to be treated before pregnancy. When pregnancy is decided, thyroid function tests should be measured immediately after the end of menstruation and medication dosage should be adjusted.
After pregnancy occurs, TSH should be measured at 8-12 weeks of pregnancy and at the 20th week. It is necessary to increase the drug dose, especially in the second half of pregnancy. ST4 and TSH should be measured and checked 1 month after increasing the drug dose. If hypothyroidism is detected for the first time during pregnancy, treatment should be started immediately and the dose should be adjusted by measuring ST4 and TSH after a month. plant.
Hyperthyroidism (Thyrotoxicosis): Hyperthyroidism is the excess of hormones of the thyroid gland. Thyrotoxicosis is the clinical picture that develops after tissues encounter high amounts of thyroid hormones. Thyroid hormones (ST3 and ST4) are increased and TSH is below normal. The most common cause is Basedow-Graves disease.
If a woman of childbearing age with hyperthyroidism plans a pregnancy, the disease should be treated first and then the pregnancy should be planned.
Excessive fatigue, weakness, palpitations, sweating, intolerance to heat, tremors, excessive irritability, inability to gain the required weight every month despite having a good appetite, and detection of poor baby development by ultrasonography during pregnancy should suggest hyperthyroidism. Sometimes it may be accompanied by enlargement of the eyes.
If ST4 is measured high and TSH level is low, it is necessary to perform antibody tests (Anti-TPO, Anti-Tg and TSH receptor antibody) to help diagnosis. Thyroid scintigraphy should never be performed during pregnancy.
If hyperthyroidism is detected in the first half of pregnancy, it should be remembered that this condition may be a temporary pregnancy-related condition and may resolve spontaneously until the 18th week of pregnancy. It should definitely be checked by a doctor and followed up.
Another group of drugs used in the treatment of hyperthyroidism is beta blockers. These drugs are used as an aid to reduce complaints such as palpitations and sweating. However, it should be used with caution in pregnant women. Because, by passing to the baby, it may slow down the development of the baby, prolong the birth process, slow down the pulse rate in the newborn baby, prolong jaundice and reduce blood sugar.
If an operation is decided for the treatment of hyperthyroidism, the most appropriate The time is the second trimester (second three months of pregnancy). The operation is risky in the first and third months. Radioactive iodine (known as atomic therapy) is never used in pregnant women in the treatment of hyperthyroidism.
Thyroid problems that occur after birth: An increase in thyroid dysfunction is observed in the postpartum period. If you have complaints of weakness, irritability, palpitations and heat intolerance, especially in the first 3 months after birth, you should definitely consult a doctor. should be consulted. High levels of ST3, ST4 and TSH below normal indicate thyroid hormone excess. In those with high Anti-TPO and Anti-Tg titers before and during pregnancy, the cause of this thyrotoxicosis (thyroid hormone excess) may be Hashitoxicosis or postpartum thyroiditis. Another cause is Graves' disease and it often occurs in the 6-9 months following birth.
Newborn babies of mothers who have thyroid problems before pregnancy, during pregnancy or after birth, during breastfeeding periods It should also be evaluated very carefully by a neonatologist or pediatric endocrinologist.