Thyroid Problems During and After Pregnancy - Are You At Risk?
Introduction
If you or a close relative have ever had an over- or underactive
thyroid you should tell your obstetrician so you can be sure your
thyroid function is checked before, during, and after pregnancy.
Abnormal thyroid levels before pregnancy can make it more difficult
to conceive. Your baby relies in part on your supplying thyroid
hormone, especially before your baby's thyroid begins to develop
at about the tenth week of pregnancy.
If you have ever had the form of hyperthyroidism known as Graves'
disease, your obstetrician should test your blood for thyroid stimulating
immunoglobulins (TSI's), thyroid antibodies which caused your thyroid
to become overactive and could have the same effect on your baby
during pregnancy if your antibody levels are still increased. This
could be your situation even though you feel completely well, even
if you are taking thyroid hormone tablets once a day to treat an
underactive thyroid.
There is another reason for re-testing your thyroid by means of
a TSH test as pregnancy progresses. During pregnancy a mother's
thyroid function gradually increases. If your thyroid is underactive,
it cannot make more hormone during pregnancy. Therefore, your obstetrician
will use TSH tests to tell whether your thyroid hormone dose needs
to be increased as pregnancy progresses.
Thyroid Problems After Pregnancy
The birth of a baby is a joyous occasion. However, in the postpartum
period you will experience many changes in your life. These may
include physical problems of fatigue, anemia, pain (from an episiotomy
or cesarean section) and breast soreness. Fatigue is especially
common because of late night feedings and the continuous responsibilities
of a new baby. The "blues" of postpartum depression are
common.
These complications usually occur soon after the baby is born,
and by the third month after delivery most women are feeling well
again. Unfortunately, that is not always the case, and some women
do not enjoy a rapid return to good health. For many of these mothers,
the cause may be a change in thyroid function after delivery.
Why Does It Happen?
During pregnancy your immune system is suppressed as a protection
for your baby. After delivery there is a marked rise in immune activity
and sometimes a worsening of immune conditions such as rheumatoid
arthritis and thyroid disease. Although thyroid dysfunction may
occur anytime after pregnancy, it is most common about two to three
months after delivery. By that time, your visits to your obstetrician
may have ended if you had an uneventful pregnancy and delivery.
Therefore you may be more likely to visit your family physician
or even the baby's pediatrician. Don't hesitate to discuss your
thyroid condition with these caregivers.
How Will I Feel?
If your thyroid levels rise (hyperthyroidism) your whole system
may feel speeded up. Your heart may race and you may feel nervous
with shaking hands, increased sweating, insomnia, and anxiety. If
your thyroid levels fall you could feel sluggish, tired, run down,
depressed, and experience muscle cramps and constipation. In either
instance your thyroid gland in the front of your neck may enlarge
slightly and may feel mildly tender though extreme pain is uncommon.
Who Should be Tested?
Anyone with the symptoms of an overactive or underactive thyroid
or postpartum depression should have a TSH test to tell whether
thyroid levels are normal. Thyroid hormone levels do not need to
be checked unless the TSH is high (indicating hypothyroidism) or
low (indicating hyperthyroidism).
Since the symptoms of a change in thyroid function may be so mild
as to be missed or mistaken for other health problems, your doctor
may also choose to check your TSH level about two to four months
after delivery if you or a close relative have ever had a thyroid
problem. You may also have a TSH test after pregnancy if your doctor
suspects that you are at increased risk for thyroid dysfunction.
This could be your situation if you or close relatives have other
disorders or physical traits suggesting an increased risk for thyroid
problems. These include juvenile (Type I) diabetes, rheumatoid arthritis,
pernicious anemia due to a lack of vitamin B12, colitis, and prematurely
gray hair. There is even new research which suggests that if you
or a close relative are either left-handed or ambidextrous you may
have an increased risk for thyroid dysfunction and other immune
problems.
If your close relatives have these thyroid or related conditions,
your doctor may order a TSH test to be sure your thyroid is normal
even if you feel well. This is because mild changes in thyroid function
often don't appear to cause symptoms, but once treated you may find
yourself healthier as symptoms you thought were due to other problems
disappear. If you are found to have a thyroid problem, it's likely
that you will recover and be able to stop treatment in a few months.
However, not all patients get completely well. About one-third of
the women who experience changes in thyroid function after pregnancy
never fully recover and need thyroid treatment lifelong.
What About My Next Pregnancy?
If you have experienced a change in thyroid function in one pregnancy
it is likely that your thyroid levels will change after subsequent
pregnancies as well. In fact, your obstetrician is likely to order
a TSH test to check your thyroid before and during your pregnancy,
and after delivery too.
What About My Baby?
Here the news is good. Most babies have completely normal thyroid
function even if a mother has a thyroid problem during the pregnancy
or after delivery.
There is more good news. Every baby in the United States, Canada,
and most developed countries is checked at birth to be sure thyroid
function is normal. This is because babies with a thyroid problem
may look normal for two to three months and a delay in treatment
of a baby born without a thyroid or with a poorly-functioning thyroid
gland may have long-term effects on the baby's health and mental
function. Be happy that your baby gets a check automatically. Above
all, don't hesitate to talk with your obstetrician about your thyroid,
especially if you or one of your relatives has a thyroid or related
immune disorder.
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