The Thyroid Disease Link with Pregnancy and Infant Loss Awareness Month

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October is Pregnancy and Infant Loss Awareness Month. Where does this tie in with thyroid disease? Well, just having a thyroid condition puts you at a higher risk for losing an unborn child. 

Why?

Thyroid function and your fertility are closely linked. Abnormal thyroid levels can lead to miscarriage, pre-eclampsia, anaemia, stillbirth and the baby developing congenital hypothyroidism itself, yet many doctors don’t think to check thyroid hormone levels in pregnant women. Women with even mild hypothyroidism have double the risk of miscarriage and premature birth.

This can be especially worrying for those feeling extremely tired, brain fogged or experiencing other common symptoms of hypothyroidism such as changes in mood, sleep, constipation, muscle aches and hair loss, because while a lot of these symptoms can be attributed to pregnancy itself, they can also be a sign of a thyroid problem, such as hypothyroidism and/or Hashimoto’s. So a lot of doctors don’t think to look in to these symptoms further and put them down to normal pregnancy complaints instead.

How Does The Thyroid Affect Fertility?

Thyroid hormones directly affect the uterine lining, causing infertility or miscarriages to occur when they are abnormal. As well as complications during pregnancy, some women with low thyroid levels may even struggle to fall pregnant at all or miscarry very early on.

In the first part of pregnancy, the fetus relies completely on the mother to provide the thyroid hormones for its development. For someone with a perfectly healthy thyroid gland and function, their body is able to meet that extra demand rather easily, but in a woman with hypothyroidism and/or Hashimoto’s, her body is often not as able to. And so complications such as miscarriages can occur.

If a woman is ‘subclinical’ or ‘borderline’ hypothyroid, her doctor may wish to start her on thyroid medication or increase it so that she’s well within range to reduce the risk of miscarriage. The risk of miscarriage is higher in women with subclinical hypothyroidism, compared to women with normal thyroid function (euthyroidism)[1].

According to the Endocrine Society’s 2007 Clinical Guidelines for the Management of Thyroid Dysfunction during Pregnancy and Postpartum, thyroid medication for those with hypothyroidism usually needs to be increased in dosage, by 4-6 week gestation and may well require a 30-50% increase in dosage. [2]

And so this is why it’s extremely important for any known thyroid patients to be monitored closely and tested regularly throughout pregnancy, often every 6-12 weeks, so that adjustments to their medication can be made accordingly.

But I feel it’s important for all pregnant women to have their thyroid levels monitored (and I hope that one day this will be the case), with pregnancy being one of the biggest triggers for Hashimoto’s and hypothyroidism, so some will develop it during pregnancy specifically or even have had it before getting pregnant, and by testing thyroid levels by default we could catch it early on to reduce the risk of pregnancy complications such as miscarriage. We need to be more proactive. We could save the lives of those who would otherwise be miscarried and save the heartache that so often ensues as a result.

A study presented in June 2012 at The Endocrine Society’s 94th Annual Meeting also recommended that all pregnant women should undergo thyroid screening in the first trimester of pregnancy. I quote:

 “The study found that even mild thyroid dysfunction could greatly increase the risk of serious problems. Women with mild thyroid dysfunction had double the risk of miscarriage, premature labor or low birth weight as compared to pregnant women with normal thyroid function. They also had seven times greater risk of still birth.”

And in the Journal of Medical Screening, researchers demonstrated that pregnant women with hypothyroidism had a second trimester miscarriage risk four times the risk of women who were not hypothyroid. [3]

How shocking is that?

What Are You Looking For?

The ATA recommends the use of the following TSH test ranges during pregnancy:

  • First trimester: 0.1-2.5
  • Second trimester: 0.2-3.0
  • Third trimester: 0.3-3.0

But maintaining optimal thyroid levels for all of the thyroid panel is important.

I really don’t want to think about the amount of complications and miscarriages in pregnancy that will have resulted from a missed or mismanaged thyroid condition, but I do want to make others aware of its existence. I just wish all pregnant women were screen for a thyroid condition routinely to avoid any issues caused by one going undetected. Miscarriage and the loss of a child is a heartbreaking experience for many and a lot of sorrow could be saved if more attention was paid to that little butterfly shaped gland in the neck that has an influence over so many bodily functions. Including fertility.

You can click on the hyperlinks in the above post to learn more and see references to information given, but more reading and references can also be found at:

1.Haixia Liu, Zhongyan Shan, Chenyan Li, Jinyuan Mao, Xiaochen Xie, Weiwei Wang, Chenling Fan, Hong Wang, Hongmei Zhang, Cheng Han, Xinyi Wang, Xin Liu, Yuxin Fan, Suqing Bao, and Weiping Teng, November 2014, Maternal Subclinical Hypothyroidism, Thyroid Autoimmunity, and the Risk of Miscarriage: A Prospective Cohort Study, https://www.liebertpub.com/doi/10.1089/thy.2014.0029

2. The Endocrine Society. Management of Thyroid Dysfunction During Pregnancy and Postpartum: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology & Metabolism 2007; 92(8)(Supplement):S1-S47.

3. Endocrine Society (2012, June 23). Mild thyroid dysfunction in early pregnancy linked to serious complications. Newswise. Retrieved July 3, 2012 from http://www.newswise.com/articles/mild-thyroid-dysfunction-in-early-pregnancy-linked-to-serious-complications.

4. Allan, W.C., J.E. Haddow, G.E. Palomaki, J.R. Williams, M.L. Mitchell, R.J. Hermos, J.D. Faix, R.Z. Klein. Maternal thyroid deficiency and pregnancy complications: implications for population screening. J Med Screen 2000; 7:127-130.

https://www.theinvisiblehypothyroidism.com/2017/04/25/fertility-with-hypothyroidism/

https://www.theinvisiblehypothyroidism.com/2016/06/26/pregnancy-and-hypothyroidism/

https://www.healio.com/endocrinology/thyroid/news/in-the-journals/%7B261992c4-bf53-4119-bb4b-9d554a7671d1%7D/thyroid-function-antibody-positivity-associated-with-ovarian-reserve-in-infertility

https://www.healio.com/endocrinology/thyroid/news/in-the-journals/%7B07372290-6afb-457f-8969-28b4ac1b59a8%7D/mild-thyroid-dysfunction-may-lead-to-unexplained-infertility

https://www.btf-thyroid.org/information/leaflets/38-pregnancy-and-fertility-guide

https://hypothyroidmom.com/hypothyroid-moms-story-of-hope-her-miracle-babies/

If you found this article beneficial, please take a moment to share it so we can help others get better with hypothyroidism and Hashimoto's, whilst also raising awareness. "Be Your Own Thyroid Advocate."

Written by Rachel, The Invisible Hypothyroidism

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