Reema (name changed), a 32-year-old woman, is a banker by profession and is 5 months pregnant with her first baby. Up until now, she has had a wonderful pregnancy. But recently, she started noticing that her blood pressure is on the higher side, her face swells up and she feels tired and weak all the time. While they may all seem pregnancy related, her doctor thinks it could be Hypothyroidism!
Thyroid disorders are extremely common in women. Like Reema, Hypothyroidism can affect women of all ages, especially women of reproductive ages. In fact, it is the second most common type of endocrine disorder that occurs in women during their reproductive years. It’s very common in women who are pregnant.
What is Thyroid disorder?
The thyroid is a small butterfly-shaped gland at the base of the neck. It is responsible in producing the thyroid hormone, which regulates vital body functions, including how fast the heart beats.1
Thyroid disorders, such as Hypothyroidism are rapidly becoming common. It occurs when the thyroid gland produces too little of the thyroid hormone, which isn’t enough to meet the body’s needs.1,2 When this condition is diagnosed early, it is called subclinical hypothyroidism.2
However at an early stage, it does not manifest itself in the form of visible symptoms. Often, a person may not even know about their condition.3
Hypothyroidism and Pregnancy
While pregnancy remains a beautiful experience in most women’s life, it can also be a time of uncertainty. Pregnancy comes with its unique set of challenges, which if not tackled effectively, can harm the mother or the baby. For instance, Hypothyroidism during pregnancy can dramatically affect pregnancy outcomes.4 According to a study, Hypothyroidism complicates up to 3 of 1000 pregnancies.5
In India, there is a high prevalence of hypothyroidism in pregnant women, at 44 per cent in the first trimester, reported a study conducted in 11 cities across 9 states and published in the Indian Journal of Endocrinology and Metabolism in 2016.6
Pregnancy influences Thyroid function
The body’s demand for thyroid hormones increases during pregnancy.7 In a normal pregnancy, the size of the thyroid gland increases, thus increasing the production of thyroid hormones and iodine requirements. The healthy thyroid adapts seamlessly to these alterations, but because of pathological processes, thyroid dysfunction can occur in many pregnant women which may lead to Hypothyroidism.8
Thyroid hormones are vital for Mother & Baby
A baby’s thyroid gland starts producing thyroid at around week 12 of gestation and begins to make enough thyroid hormones by weeks 18-20. During this period, the baby relies on the mother for thyroid hormones. Therefore, an adequate supply of maternal thyroid hormones is important for the normal development of the baby’s brain and nervous system.9
Too little thyroid hormone during this critical time can have irreversible effects on the baby, such as lower IQ and impaired mental development.10 However, Hypothyroidism during pregnancy could lead to problems for both the mother and the baby.
Problems for the mother can include: 10,11,12
- Preeclampsia — A rise in blood pressure in late pregnancy
- Anaemia — This happens when there aren’t enough healthy red blood cells to carry oxygen to the rest of the body
- Myopathy – Muscle pain, weakness
- Recurrent pregnancy losses
- Placental abruption—This can decrease the supply of oxygen and nutrients to the baby
- Gestational diabetes
- Preterm birth – Early delivery of the baby
- Increased risk of caesarean section
Problems for the baby can include: 10,11,12
- Low birthweight
- Possibility of a birth defect
- Problems with the brain and nervous system development—
- Lower IQ
- Reduced mental and motor development
Early diagnosis of Hypothyroidism is crucial for positive pregnancy outcomes. If Hypothyroidism is detected early, it is easy to treat, and one can have a healthy pregnancy and a healthy baby too. 5,11
The symptoms of Hypothyroidism
The signs of Hypothyroidism in pregnancy may be mild and similar to pregnancy-related symptoms and can often go undetected. They include: 13
- Weight gain
- Trouble dealing with cold
- Muscle cramps
- Problems with memory or concentration
- Swelling of the face
- Skin and hair changes (You may notice dry skin)
Unfortunately, women with subclinical hypothyroidism may have no symptoms or may attribute their symptoms to pregnancy.11
A simple screening test is all it takes to diagnose the condition and helps in taking corrective measures.
Medical associations and guidelines in India and across the globe recommend testing of thyroid functions (levels of thyroid hormones) in all pregnant women.8,12
- The Federation of Obstetric and Gynaecological Societies of India (FOGSI) recommends screening all pregnant females for thyroid disorder (measuring TSH
levels) during the first antenatal visit.14
- The Spanish Society of Endocrinology and Nutrition and the Indian Thyroid Society have expressed support for universal screening in early pregnancy or preconception.8,12
With the help of treatment, Hypothyroidism can be easily managed. However, if not treated early, it could affect your baby and you.10 In case you are planning to conceive or are pregnant, please consult your doctor for a thyroid check-up.
- The Office on Women’s Health. Thyroid disease [Internet]. Available at: https://www.womenshealth.gov/a-z-topics/thyroid-disease. Accessed on Sep 3, 2020.
- American Thyroid Association. Hypothyroidism in children and adolescents [Internet]. Available at: https://www.thyroid.org/hypothyroidism-children-adolescents/. Accessed on Sep 2, 2020.
- Livingston EH. Subclinical Hypothyroidism. JAMA. 2019;322(2):180.
- Sahay RK, Nagesh VS. Hypothyroidism in pregnancy. Indian J Endocrinol Metab. 2012;16(3):364–70.
- Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstetrics & Gynecology. 2006 Nov 1;108(5):1283-92.
- Dhanwal DK, Bajaj S, Rajput R, et al. Prevalence of hypothyroidism in pregnancy: An epidemiological study from 11 cities in 9 states of India. Indian J Endocrinol Metab. 2016; 20(3):387-90.
- American Thyroid Association. Clinical Thyroidology for Patients. Hypothyroidism and pregnancy [Internet]. Available at: https://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-6-issue-7/vol-6-issue-7-p-3/. Accessed on Sep 3, 2020.
- Alexander EK, Pearce EN, Brent GA, Brown RS, Chen H, Dosiou C, et al. 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017 Jan 6;27(3):315–89.
- NIH. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Thyroid Disease & pregnancy [Internet]. Available at: https://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease#:~:text=Thyroid%20hormones%20are%20crucial%20for,comes%20through%20the%20placenta%20link. Accessed on Sep 3, 2020.
- The Children’s Hospital of Philadelphia. Thyroid disorders and pregnancy [Internet]. Available at: https://www.chop.edu/pages/thyroid-disorders-and-pregnancy. Accessed on Aug 16, 2020.
- American Thyroid Association. Hypothyroidism in pregnancy [Internet]. Available at: https://www.thyroid.org/wp-content/uploads/patients/brochures/hypothyroidism_pregnancy_brochure.pdf. Accessed on Aug 16, 2020.
- Maternal Health Division. Ministry of Health & Family Welfare. Government of India. National Guidelines for Screening of Hypothyroidism during Pregnancy [Internet]. Available at: http://www.nrhmorissa.gov.in/writereaddata/Upload/Documents/National_Guidelines_for_Screening_of_Hypothyroidism_during_Pregnancy.pdf. Accessed on Aug 16, 2020.
- John Hopkins Medicine. Hypothyroidism and pregnancy [Internet]. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/staying-healthy-during-pregnancy/hypothyroidism-and-pregnancy. Accessed on Aug 16, 2020.
- 2019 recommendations for the management of thyroid dysfunction in pregnancy.