Thyroid Diseases During Pregnancy

Thyroid Diseases During Pregnancy

What is Thyroid Disease?

Thyroid disease is a disease that affects the thyroid gland. Sometimes the organism produces too little or too much Thyroid hormone. Thyroid hormones regulate the body's energy use and metabolism. If too much Thyroid Hormone is produced, this is called HYPERTHYROIDISM and many body functions accelerate. If too little Thyroid Hormone is produced, the resulting condition is called HYPOTHYROIDZM, in which case body functions may slow down.

Thyroid hormone plays a critical role in the health of mother and baby during pregnancy. Pregnant women with thyroid problems should be closely monitored for themselves and their babies. Necessary drug treatments should be given to raise the levels of thyroid hormones if they are low, and to lower them if they are high.

Points to Remember

• Thyroid diseases. As a result, Hyperthyroidism or Hypothyroidism may occur.
• Pregnancy; It may cause changes in the normal function of the thyroid gland or cause disease.
• Uncontrolled Hyperthyroidism during pregnancy can cause serious health problems for the mother and the unborn baby.
• Mild Hyperthyroidism during pregnancy does not require treatment. Severe Hyperthyroidism must be treated.
• Uncontrolled Hypothyroidism during pregnancy causes serious health problems in the mother and adversely affects the growth and brain development of the unborn baby.
• Hypothyroidism during pregnancy is treated by giving Thyroxine, that is, T4 hormone. .
• In Postpartum Thyroiditis, first Hyperthyroidism, then Hypothyroidism develops and then returns to normal. Sometimes Hypothyroidism is permanent.

Postpartum Thyroiditis (Postpartum Thyroid Gland Inflammation)

4% of women in the first year after birth – It is a type of Thyroid Inflammation that affects 10% of people. In this type of Thyroid inflammation, Thyroid hormones stored in Thyroid cells are released into the blood. In this disease, which is thought to be autoimmune, a mild hyperthyroidism situation occurs in the first month or two. In many women, hypothyroidism occurs between 6 and 12 months before the thyroid tissue regains its normal function. During this period, external Thyroid Hormone treatment and should be noted. A small number of patients require lifelong thyroid hormone therapy. Generally, a patient who has had Thyroiditis after a previous birth will also have it after subsequent births. As Recurrent Thyroiditis Attacks destroy the Thyroid Gland, lifelong external Thyroid Hormone treatment becomes inevitable.

Hypothyroidism during Pregnancy is a special Thyroid disease called "Hashimoto's Disease" which occurs in 5 out of every 1000 pregnant women. causes the disease. Hashimoto's disease is a type of chronic inflammation of the thyroid gland. This is also an autoimmune disease. In this disease, the immune system attacks the thyroid gland cells.

Uncontrolled Hypothyroidism during pregnancy causes some problems in the mother and baby;

• Preeclampsia
• Anemia; adequate oxygen intake to the body cannot be provided.
• Abortion
• Low Birth Weight Baby
• Stillbirth
• Congestive Heart Failure

Since the role of Thyroid hormones is very important in the development of the baby's brain and nervous system in the first three months, uncontrolled Hypothyroidism may adversely affect the development of your baby's brain and nervous system.

Treatment of Hyperthyroidism During Pregnancy

Mild Hyperthyroidism during pregnancy is not treated. More severe Hyperthyroidism is treated with Antithyroid drugs.

Radioactive Iodine treatment cannot be performed during pregnancy. Because Radioactive iodine can destroy the baby's Thyroid tissue. If our pregnant woman cannot tolerate antithyroid medications, then she may need to remove the thyroid gland by surgery. may be necessary.

Since antithyroid drugs can cross the placenta and cause Hypothyroidism in the baby, the mother is given the smallest possible dose of the drug to prevent Hypothyroidism in the baby.

Side Effects of Antithyroid Drugs

• Allergic reactions such as skin rash and itching.
• They can suppress the immune system by reducing white blood cells in the body.
• Rarely, they can cause Liver Failure.
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If the following symptoms occur while using antithyroid medications, be sure to consult your doctor to discontinue the medication;

• Fatigue
• Weakness
• Superb abdominal pain
• Loss of appetite
• Skin rash or itching
• Exaggerated bruising even if you slightly bump an area
• Jaundice (on the skin and white parts of the eyes)
• Continuous sore throat
• Fever

Mothers should be supervised during pregnancy. They can safely use antithyroid medications during pregnancy and breastfeeding.

Diagnosis of Hyperthyroidism During Pregnancy

Some symptoms of hyperthyroidism are also present in a normal pregnancy. For example; Increased heart rate, increased body temperature, intolerance, fatigue are also seen in a normal pregnancy.

Fast and irregular heartbeat, tremors in the hands, weight loss or inability to gain weight, severe nausea and vomiting are probably related to Hypothyroidism.

Such a patient should have blood tests for TSH, T3, T4 and TSI.

Hyperthyroidism (Overactive Thyroid)

Hyperthyroidism during pregnancy is usually Graves's disease. It occurs due to disease and occurs in one in every 500 pregnancies. Graves' Disease is an autoimmune disease. Normally, the Immune System is programmed to protect the body from external factors, disease-causing factors such as bacteria, viruses, fungi and parasites. In autoimmune diseases, the immune system attacks the body's own cells and organs. In Graves' disease, the immune system secretes a substance called TSI (Thyroid Stimulating Immune Globulin) and since this substance has a structure similar to TSH, it deceives the Thyroid gland and causes it to secrete excessive amounts of Thyroid hormone. These patients have a special appearance where their eyes appear to be popping out of their sockets.

While Graves' disease may first appear during pregnancy, when a woman who previously had Graves' Disease becomes pregnant, a regression in disease symptoms may occur in the second or third trimester of her pregnancy. This is due to the suppressed immune system during pregnancy. The disease usually worsens again shortly after birth. In addition to pregnancy follow-up, pregnant women with Graves' disease also need to be monitored monthly regarding this disease.

Rarely, Hyperthyroidism; It causes problems such as nausea, vomiting, dehydration and weight loss during pregnancy. It is accepted that nausea and vomiting, which are severe in the first half of pregnancy and then disappear, are caused by increased Thyroid hormones due to increased BhCG.

Uncontrolled Hyperthyroidism during pregnancy causes the following conditions in the mother;

• Congestive Heart Failure
• Increased Blood Pressure that may cause Preeclampsia in late pregnancy
• Sudden and very severe emergence of Hyperthyroidism symptoms, which we call Thyroid Storm
• Miscarriage
• Premature Birth
• It may cause the birth of a low birth weight baby.

The following may be seen in the baby of a hyperthyroidic mother; strong>

• Even if a woman with Graves' Disease receives Radioactive Iodine treatment before pregnancy or undergoes a surgical procedure, TSIs in her circulation pass through the Placenta, stimulating the baby's Thyroid gland and revealing signs of Hyperthyroidism in the baby. However, if the mother is treated with an antithyroid medication, the likelihood of these problems occurring in the baby is extremely low.
• The baby's fontanels (fontanels on the baby's head)may close early.
• Tachycardia
• Hyperthyroidic Heart Failure
• Nervousness
• Respiratory Failure due to the pressure of the enlarged thyroid gland on the trachea
• Inadequate weight gain

. The baby and mother should be closely monitored after birth.

How Does Pregnancy Affect Normal Thyroid Gland Functions?

There are two hormones that reach high levels in the blood during pregnancy. One of these is Bhcg and the other is Estrogen. These two hormones are produced by the Thyroid gland. Increases secretion. Therefore, it can sometimes be difficult to interpret these normal physiological changes.

Thyroid Hormone is very important for the development of the baby's brain and nervous system. The mother provides the baby with Thyroid Hormone for the first three months. Thyroid Hormone secreted from the mother's thyroid gland passes to the baby through the placenta and fulfills its function. After the twelfth week, the baby begins to produce its own Thyroid hormone.

The thyroid gland normally grows a little during pregnancy. But this is not enough to be detected manually. If we are faced with a thyroid gland that is enlarged and enlarged enough to be palpable, this may be a symptom of thyroid disease. Since increased Thyroid hormone levels and a slightly enlarged Thyroid gland may be encountered in a normal pregnancy, it is important not to miss any Thyroid disease. Because it may be difficult to diagnose during pregnancy.

Thyroid Gland

The thyroid gland is a butterfly-shaped gland that is approximately 2.5 cm long and weighs 25 g. It is located under the larynx, in front of the voice box, in the area where the windpipe divides into two. Thyroid glandIt is one of the glands that make up the Endocrine System. Glands belonging to the Endocrine System secrete the substances they produce, called Hormones, into the blood. Hormones perform their functions not in the gland where they are secreted, but in target cells or throughout the body by traveling long journeys with the blood.

Thyroid gland secretes two types of Thyroid hormones. One of these is T3, that is, Triiodothyronine, and the other is T4, that is, Thyroxine. T3 is an active hormone and is obtained from T4. Thyroid hormones; It affects metabolism, brain development, respiration, heart and nervous system functions, body temperature, skin moisture level, muscle strength, menstrual cycle and blood cholesterol levels.

Thyroid Hormone production; It regulates the hormone called TSH (Thyroid Stimulating Hormone), which is produced and secreted in the Pituitary gland in the brain. When the Thyroid Hormone levels in the blood are high, the Pituitary gland responds by decreasing the TSH level, and when the Thyroid Hormone levels in the blood are low, the Pituitary gland responds by increasing the secretion of TSH.

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