Hypothyroidism in Pregnancy: Risks, Symptoms, and How To Manage It?

Hypothyroidism is common during pregnancy, but if it’s a pre-existing issue, then this can make your pregnancy unbearable. There is a direct link between the thyroid and female fertility, which most women are not aware of. That is why it is necessary to manage thyroid hormone levels to ensure the desired results. Almost 10% of pregnant women experience this issue. But with awareness, care, guidance, and the right treatment, you can reduce the risks.

Some even neglect the symptoms of high or low thyroid during pregnancy. So, rather than risking your child’s growth, it is better to get yourself educated. The article will help you know about hypothyroidism in pregnancy, its risks, symptoms, and how you can manage it. 

How Do Thyroid Hormones Support Pregnancy?

Pregnancy is directly accompanied by metabolic changes that are linked to the thyroid gland. Thyroid hormones play a crucial part in the development of the baby’s brain and nervous system. In the first 3 months of pregnancy, the baby gets thyroid hormones through the placenta, which further helps them to develop many changes. Although till the 12th week, the fetus develops thyroid of its thyroid, it does not produce enough thyroid hormones to ensure development till the 20^th week. 

Usually, the thyroid gland enlarges during the phase of pregnancy, and it is usually not noticeable during physical examination by healthcare professionals. But, due to the higher levels of these hormones, they can cause issues like thyroid disorders. If this is left untreated, then it can cause a risk of pregnancy complications like preterm labour, low birth weight, preeclampsia, and cognitive impairment. 

What is Hypothyroidism?

It is also known as an underactive thyroid. It is the condition when the thyroid gland is unable to produce enough thyroid hormones like T3 (triiodothyronine) and T4 (thyroxine), which are necessary to fulfill the needs of the body. It slows down the metabolism, which makes it difficult for the body to burn calories. This causes women to store more fat than usual, resulting in weight gain. Around 5% of women experience this issue, while 20% of older women are prone to this issue. 

For those women who have pre-existing hypothyroidism, make sure to consult with your doctor before even planning to have a baby. They can recommend medications and diet tips that can help to balance the problems. This can also occur during pregnancy. The reason includes o autoimmune disorder where the body targets the thyroid gland mistakenly, or iron deficiency, where insufficient iodine leads to an underactive thyroid.  

Common Symptoms During Pregnancy

• Fatigue: The thyroid gland is unable to produce enough thyroid hormones, which slows down metabolism, muscle control, and brain development, and affects energy levels. Also, as the woman is carrying a fetus, her energy is drained out because the growing fetus also needs a good metabolic process to support the growth. 
• Weight Gain: As the metabolism slows down, this increases fluid retention, leading to an increase in weight and swelling. The body starts to store fat more which makes it difficult for the body to burn enough calories to maintain weight. 
• Cold Intolerance: Hypothyroidism reduces the ability of the body to generate heat, and convert stored energy to unstable energy, contributing to making women sensitive to cold temperatures. 
• Constipation: Metabolism plays a huge role in managing the digestive system. However, the metabolic shutdown impacts the digestive system, the movement of food through the digestive tract, reducing gut mobility, and making stool dry and hard. 
• Slow Heartbeat: Low thyroid hormone levels lead to reduced sympathetic nervous activity, weaker cardiac output, and poor oxygen circulation. Also, an imbalanced electrolyte disrupts the rhythm of the heart. 
• Depression or Foggy memory:  Low T4 and T3 hormones influence neurotransmitters like dopamine and serotonin, which cause cognitive difficulties, anxiety, and depression. Dropped thyroid hormones slow down neuronal activity, making it difficult to concentrate and also causing memory issues. 
• Puffy Face, Hoarse Voice: This happens because of the swelling in tissue and fluid retention. Also, slow metabolism causes water buildup, and thyroid dysfunction affects vocal cord functions.

Why It Matters in Pregnancy?

Often, hypothyroidism symptoms mimic normal pregnancy changes, and undiagnosed issues can further lead to pregnancy complications like premature birth, preterm birth, and preeclampsia. It is necessary to undergo thyroid testing to ensure a smooth pregnancy. Here are some of the issues that can arise because of having a thyroid in pregnancy.  

• Miscarriage- Uncontrolled thyroid disease, infection, or hormonal imbalance can interfere with fetal growth, resulting in loss of pregnancy. Hypothyroidism, which involves low levels of thyroid hormone, can damage implantation and early fetal growth, making a woman susceptible to miscarriage.
• Preterm Labour– Infection, pregnancy, diabetes, or hypertension can cause preterm contractions. This makes women lack thyroid hormones, which causes placental dysfunction, depriving the fetus of oxygen and nutrients, and consequently causing preterm labour.
• Preeclampsia- Inadequate formation of the placenta causes preeclampsia, which causes increased blood pressure and insufficient blood supply to the fetus. Vessel dysfunction, which may be caused by undiagnosed hypothyroidism, will also cause a high risk of preeclampsia.
• Low Birth Weight- When the baby is unable to receive adequate amounts of oxygen and nutrients from the placenta, fetal development can be slowed down. The reduced capability of the metabolic system results in less-than-optimal fetal weight gain and postpartum problems.
• Developmental Delays- Thyroid hormones play a vital role in fetal brain and body development. Deficiency can have the potential to impact neural circuits, resulting in delays in speech, impairment of cognitive functions, and delays in motor development in infants.
• Postpartum Haemorrhage– Preeclampsia or undiagnosed thyroid disease can soften blood vessels and interfere with uterine contraction after delivery, causing excessive haemorrhage. Hormonal dysregulation might disrupt the clotting factors of blood, predisposing a woman to haemorrhage.

How is Hypothyroidism Diagnosed?

There are several tests are there which help to diagnose hypothyroidism. Here is some- 

• TSH Blood Test (Thyroid Stimulating Hormone)- the test is conducted to analyse the thyroid activity in your blood, such as a low level indicates hypothyroidism and a high level indicates hyperthyroidism. 
• Free T4 Levels- This test is conducted to assess the active thyroid hormones in the bloodstream. 
• Auto-antibody this test helps to know about the antibodies that are attacking the thyroid. It also aids in diagnosing Hashimoto’s or Graves disease if an autoimmune origin is suspected, because the effects of hypothyroidism in pregnancy can result in some drastic results. 

Safe Treatment Options

1. Levothyroxine: 

This is one of the safest treatment options, as it is a synthetic thyroid hormone (T4). It helps the baby to receive an adequate number of thyroid hormones. As per the National Institutes of Health (NIH), combining thyroid medication in pregnancy is a safe option. Some people get benefits by combining levothyroxine and liothyronine, but it should be prescribed by a doctor. 

2. Regular Monitoring of TSH Every 4–6 Weeks:

This helps to ensure an adequate thyroid hormone level and prevents the mother and the baby from complications. According to the American Thyroid Association, the first half of the pregnancy is critical because the level of TSH fluctuates a lot. Based on the tests and checks, the medication dose is readjusted by the doctors, according to NIH. 

3. Dose Adjustments 

The female body goes through hormone fluctuation during pregnancy, and the placenta produces human chorionic gonadotropin (hCG), which stimulates hormones and can alter the TSH (thyroid-stimulating hormones). To adjust the thyroid level, dose adjustment is made every 4 to 6 weeks, because the demand of the fetus also changes. 

4. Close Monitoring By Your Obstetrician

This is necessary, especially during the first trimester. The dosage of levothyroxine is increased by 30% upon confirmation of pregnancy. An obstetrician helps to monitor potential complications and also helps in detecting the problematic areas that can become a problem later. 

5. Surgery:

Thyroidectomy is sometimes required during pregnancy and should be reserved for those situations where thioamides produce severe side effects or are unsuccessful in the restoration of euthyroidism (making the thyroid gland produce thyroid hormones accurately). It can also be used for large goitres with compression and must be performed during the second trimester. If Graves’ disease has been previously treated with thyroidectomy, residual thyroid receptor antibodies can cross the placenta, causing fetal hyperthyroidism, requiring a block-and-replace regimen. Radioiodine ablation is contraindicated, and subclinical hyperthyroidism is usually followed without treatment. Periodic monitoring is recommended every 4 to 6 weeks. 

Dietary & Lifestyle Tips

• Iron & Calcium Supplements- These supplements are recommended to be taken separately from thyroid drugs like levothyroxine. This is to optimise the absorption of medication effectively and prevent the patient from drug interactions. Iron and calcium can hinder the absorption of medication, hindering the treatment. 
• Iodine-Rich Foods: It is essential to synthesise T4 and T3 hormones, as these regulate metabolism, overall fetal growth, and energy levels. Without enough iodine, the thyroid gland is less efficient at producing enough hormones. Eggs, lima beans, yoghurt, cheese, nuts, dairy products, shrimps, shellfish, edible seaweed, prunes, and iodised salt are some good sources. 
• Selenium & Zinc-Rich Foods- Lack of these can increase the risk of depression and make the immune system weak, which can attack the thyroid gland. Brazil nuts, oysters, mussels, sunflower seeds, yellowfin tuna, fish, beef, eggs, and chicken are some good sources of selenium and zinc. 
• Regular Light Exercise: Improves the function of the thyroid, reduces TSH levels, manages symptoms like weight gain and mood changes, and increases T4 levels. Low-impact activities like water aerobics, swimming, and regular exercise are some of the great ways to manage the issue. 

Why Choose Cradle for Thyroid-in-Pregnancy Care?

Looking for a hospital that can provide the best care to manage thyroid and pregnancy can be tiring. But at Cradle Children’s Hospital, we offer expert care tailored to ensure the needs of every patient, because everyone is on their unique journey to motherhood. 

• Combined care by gynecologists & endocrinologists, which helps to let you know about pregnancy and childbirth, where endocrinologists provide care and support to deal with hormone disorders. 
• As you already know, the first half of the pregnancy is critical, because TSH changes every trimester. That is why we provide trimester-based hormone monitoring every month, and monitor the fetal growth and the mother’s health. 
• Every woman is experiencing different issues, and to fulfil that need, we are providing a personalised medication plan. From primary treatment, pre-pregnancy optimisation, to adjusting doses throughout the trimester, aids in improving the hypothyroidism issue. 
• Not only this, but we also provide pre-pregnancy thyroid screening. This analysis helps the mother to know about her situation and, based on the condition, we guide and treat her accordingly. 

Conclusion

Hypothyroidism, when well controlled, would not affect pregnancy. By early screening, expert treatment, and customised care, a woman can easily enjoy their pregnancy by managing thyroid hormones and ensuring the health of the unborn child. If you are pregnant or expecting pregnancy, or looking forward to extending your beautiful family, regular thyroid check-ups make the journey smoother. 

At Cradle, our experts with vast experience offer continuous support, guidance, and comprehensive care, and are committed to holding your hand through each step with attention to detail. With proper planning and care, you can enjoy your beautiful journey to motherhood and experience the life growing inside you happily.

FAQs:

“Undiagnosed hypothyroidism during pregnancy might silently impact the development of your child. Early screening and detection are not just recommended- it is essential. So, it is better to stay informed, stay empowered.”

Convinced enough. Now book your appointment with Cradle Children’s Hospital, because nothing matters when it comes to your child and your health.