Patients with thyroid disease are very difficult to get pregnant. These patients are much easier to get miscarriage even they get pregnancy successfully. The more important thing is baby having more chance to get shorter size and lower intelligent due to thyroid hormone problem of mother. So we suggest mother to get thyroid hormone balanced before getting pregnancy.

Thyroid hormones are particularly necessary to assure healthy fetal development of the brain and nervous system during the first three months of your pregnancy since the baby depends on your hormones, which are delivered through the placenta. At around 12 weeks, the thyroid gland in the fetus will begin to produce its own thyroid hormones.

There are 2 pregnancy-related hormones: estrogen and human chorionic gonadotropin (hCG)  that may cause your thyroid levels to rise. This may make it a bit harder to diagnose thyroid diseases that develop during pregnancy. However, your doctor will be on the look-out for symptoms that suggest the need for additional testing.

However, if you have pre-existing hyperthyroidism or hypothyroidism, you should expect more medical attention to keep these conditions in control while you are pregnant, especially for the first trimester. Occasionally, pregnancy may cause symptoms similar to hyperthyroidism; should you experience any uncomfortable or new symptoms, including palpitations, weight loss, or persistent vomiting, you should, of course, contact your physician.

Untreated thyroid diseases during pregnancy may lead to premature birth, preeclampsia (a severe increase in blood pressure), miscarriage, and low birth weight among other problems. Therefore, it is important to talk to your doctor if you have had a history of hypothyroidism or hyperthyroidism so you can be monitored before and during your pregnancy, and to be sure that your medication is properly adjusted, if necessary.  

Q1. What role do thyroid hormones play in pregnancy?

Thyroid hormones are crucial for normal development of your baby’s brain and nervous system. During the first trimester the first 3 months of pregnancy—your baby depends on your supply of thyroid hormone, which comes through the placenta NIH external link. At around 12 weeks, your baby’s thyroid starts to work on its own, but it doesn’t make enough thyroid hormone until 18 to 20 weeks of pregnancy.

Two pregnancy related hormones human chorionic gonadotropin (hCG) and estrogen cause higher measured thyroid hormone levels in your blood. The thyroid enlarges slightly in healthy women during pregnancy, but usually not enough for a health care professional to feel during a physical exam.

Q2. What are the causes of hyperthyroidism in Pregnancy?

Hyperthyroid disease, The most common cause of maternal hyperthyroidism during pregnancy is the autoimmune disorder Grave’s disease. In this disorder, the body makes an antibody (a protein produced by the body when it thinks a virus or bacteria is present) called thyroid-stimulating immunoglobulin (TSI) that causes the thyroid to overreact and make too much thyroid hormone.

 
Even if you've had radioactive iodine treatment or surgery to remove your thyroid, your body can still make the TSI antibody. If these levels rise too high, TSI will travel through your blood to the developing fetus, which may cause its thyroid to begin to produce more hormone than it needs. So long as your doctor is checking your thyroid levels, both you and your baby will get the care needed to keep any problems in check.

Q3. What is the cause of hypothyroidism in pregnancy?

Hypothyroid disease The most common cause of hypothyroidism is the autoimmune disorder known as Hashimoto’s thyroiditis. In this condition, the body mistakenly attacks the cells of the thyroid gland, leaving the thyroid without enough cells and enzymes to make enough thyroid hormone to meet the body's needs. 

Q4. How to diagnosis of Thyroid Disease in Pregnancy?

Hyperthyroidism and hypothyroidism in pregnancy are diagnosed based on symptoms, physical exam, and blood tests to measure levels of thyroid-stimulating hormone (TSH) and thyroid hormones T4, and for hyperthyroidism also T3. 

Q5. What is the med will be prescripted to hyperthyroidism in Pregnancy?

For women who require treatment for hyperthyroidism, an antithyroid medication that blocks production of thyroid hormones is used. This medication propylthiouracil (PTU) is usually given during the first trimester, and if necessary, methimazole can be used, after the first trimester. In rare cases in which women do not respond to these medications or have side effects from the therapies, surgery to remove part of the thyroid may be necessary. Hyperthyroidism may get worse in the first 3 months after you give birth, and your doctor may need to increase the dose of medication. 

Q6. What is the med will be prescripted to hypothyroidism in Pregnancy?

Hypothyroidism is treated with a synthetic (man-made) hormone called levothyroxine, which is similar to the hormone T4 made by the thyroid. Your doctor will adjust the dose of your levothyroxine at diagnosis of pregnancy and will continue to monitor your thyroid function tests every 4-6 weeks during pregnancy. If you have hypothyroidism and are taking levothyroxine, it is important to notify your doctor as soon as you know you are pregnant, so that the dose of levothyroxine can be increased accordingly to accommodate the increase in thyroid hormone replacement required during pregnancy. Because the iron and calcium in prenatal vitamins may block the absorption of thyroid hormone in your body, you should not take your prenatal vitamin within 3-4 hours of taking levothyroxine. 

Q7. How can hyperthyroidism affect me and my baby?

Untreated hyperthyroidism during pregnancy can lead to-miscarriage-premature birth-low birthweight-Preeclampsia a dangerous rise in blood pressure in late pregnancy-Thyroid storm a sudden, severe worsening of symptoms-congestive heart failure

An overactive thyroid in a newborn baby can lead to-a fast heart rate, which can lead to heart failure-early closing of the soft spot in the baby’s skull, lower intelligent-poor weight gain, shorter body size-irritability

Q8. What is postpartum thyroiditis?

Postpartum thyroiditis is an inflammation of the thyroid that affects about 1 in 20 women during the first year after giving birth1 and is more common in women with type 1 diabetes. The inflammation causes stored thyroid hormone to leak out of your thyroid gland. At first, the leakage raises the hormone levels in your blood, leading to hyperthyroidism. The hyperthyroidism may last up to 3 months. After that, some damage to your thyroid may cause it to become underactive. Your hypothyroidism may last up to a year after your baby is born. However, in some women, hypothyroidism doesn’t go away.

Q9. What are the symptoms of postpartum thyroiditis?

The hyperthyroid phase often has no symptoms or only mild ones. Symptoms may include irritability, trouble dealing with heat, tiredness, trouble sleeping, and fast heartbeat.

Symptoms of the hypothyroid phase may be mistaken for the “baby blues”—the tiredness and moodiness that sometimes occur after the baby is born. Symptoms of hypothyroidism may also include trouble dealing with cold; dry skin; trouble concentrating; and tingling in your hands, arms, feet, or legs. If these symptoms occur in the first few months after your baby is born or you develop postpartum depression NIH external link, talk with your doctor as soon as possible.

Q10. What causes postpartum thyroiditis?

Postpartum thyroiditis is an autoimmune condition similar to Hashimoto’s disease. If you have postpartum thyroiditis, you may have already had a mild form of autoimmune thyroiditis that flares up after you give birth.

Q11. How do doctors treat postpartum thyroiditis?

The hyperthyroid stage of postpartum thyroiditis rarely needs treatment. If your symptoms are bothering you, your doctor may prescribe a beta-blocker, a medicine that slows your heart rate. Antithyroid medicines are not useful in postpartum thyroiditis, but if you have Grave’s disease, it may worsen after your baby is born and you may need antithyroid medicines.

Q12. Is it safe to breastfeed while I’m taking meds?

Certain beta-blockers are safe to use while you’re breastfeeding because only a small amount shows up in breast milk. The lowest possible dose to relieve your symptoms is best. Only a small amount of thyroid hormone medicine reaches your baby through breast milk, so it’s safe to take while you’re breastfeeding. However, in the case of antithyroid drugs, your doctor will most likely limit your dose to no more than 20 milligrams (mg) of methimazole or, less commonly, 400 mg of PTU.

Q13. What should I eat During Pregnancy?

What should I eat during pregnancy to help keep my thyroid and my baby’s thyroid working well?Because the thyroid uses iodine to make thyroid hormone, iodine is an important mineral for you while you’re pregnant. During pregnancy, your baby gets iodine from your diet. You’ll need more iodine when you’re pregnant about 250 micrograms a day.1 Good sources of iodine are dairy foods, seafood, eggs, meat, poultry, and iodized salt, salt with added iodine.

Experts recommend taking a prenatal vitamin with 150 micrograms of iodine to make sure you’re getting enough, especially if you don’t use iodized salt.1 You also need more iodine while you’re breastfeeding since your baby gets iodine from breast milk. However, too much iodine from supplements such as seaweed can cause thyroid problems. Talk with your doctor about an eating plan that’s right for you and what supplements you should take. Learn more about a healthy diet and nutrition during pregnancy External link.

Q14. If you have an underactive thyroid (hypothyroidism). Please br reminded following:

1. If you are planning a pregnancy you should speak to your GP to arrange thyroid blood tests and ideally aim for a Thyroid Stimulating Hormone (TSH) level of less than 2.5mU/l at the time of conception
 

2. It is recommended that your TSH should be less than 2.5mU/l in the first trimester of pregnancy and less than 3.0mU/l after that

3. As soon as you know you are pregnant it is usually recommended that your levothyroxine is increased immediately by 25-50mcg daily. You should then contact your GP and arrange to have a thyroid blood test

4. If you have had thyroid cancer and are already on doses of levothyroxine that keeps your TSH level suppressed, you will probably not need to increase your levothyroxine but you should discuss this with your GP or specialist

5. Thyroid blood tests should be checked every four to six weeks during pregnancy and with a further test a few weeks after delivery. It may not be necessary to test so frequently in later pregnancy if your thyroid levels are stable

6. After delivery you will probably need to return to your pre-pregnancy dose of levothyroxine and patients taking levothyroxine for subclinical hypothyroidism may be able to stop treatment. You should discuss this with your GP or specialist before making any changes to your dose

7. Breastfeeding is safe while taking levothyroxine

Q15. If you have an overactive thyroid (hyperthyroidism). Please be reminded following:

1. Discuss your plans for pregnancy with your endocrinologist before you try to conceive as it may be necessary to change your medication, or in some cases, it can be stopped

2. Arrange to have thyroid blood tests checked as soon as pregnancy is confirmed

3. If you are being treated with antithyroid drugs (e.g. carbimazole or Propylthiouracil (PTU)) and you haven’t already discussed your pregnancy plans with them beforehand, you should contact your endocrinologist or GP as soon as possible after pregnancy is confirmed as it may be necessary to adjust your medication

4. You may need to have your thyroid blood tests checked every four weeks throughout the pregnancy but not all patients will need checks this frequently. This will be decided by your endocrinologist

5. If you are using antithyroid drugs and develop a rash, sore throat or an unexplained fever you must see a doctor immediately and ask for a full blood count to be arranged due to the small risk of agranulocytosis (low white blood cells)

6. People using PTU have a very small risk of liver problems so if you notice any itching or yellowing of your eyes you must see a doctor immediately

7. Breastfeeding while taking antithyroid drugs is generally safe but check with your endocrinologist