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When a woman is pregnant, her body needs enough thyroid hormone -- produced by the small,
butterfly-shaped thyroid gland located centrally at the base of the neck -- to support a developing
fetus and her own expanded metabolic needs. A healthy thyroid gland naturally meets this demand
for increased thyroid hormone. However, if a mother-to-be develops thyroid disease during
pregnancy, she may not produce the right amount of thyroid hormone, which can affect her health
and the outcome of her pregnancy.
Most pregnant women who develop hypothyroidism, a condition in which the thyroid gland does not
make enough thyroid hormone, have mild disease and experience minor symptoms or no symptoms
at all. However, women with an undetected thyroid problem before becoming pregnant may find
themselves with pronounced symptoms such as extreme fatigue after becoming pregnant.
have to be increased during pregnancy. They should contact their doctor, who should check their
blood level of TSH periodically throughout pregnancy to see if their medication dose needs
adjustment.
For those who are pregnant and hyperthyroid, a condition in which an overactive thyroid gland is
producing an excessive amount of thyroid hormones, a diagnosis based on symptoms can be
particularly challenging, as the two conditions share a host of features. For example, feeling a heart
flutter or suddenly experiencing shortness of breath (both symptoms of hyperthyroidism) can be
normal in pregnancy, but a patient's physician still may want to investigate these symptoms. Also,
some of the blood tests used to detect hyperthyroidism - high levels of thyroid hormones T3 and T4
and a low level of thyroid stimulating hormone (TSH) - are altered due to the pregnancy.
Once detected, the treatment of hyperthyroidism in pregnancy is limited because the safety of the
baby must also be considered. Usually, drugs such as propylthiouracil and methimazole are used.
While both of these drugs cross the placenta and can enter the baby's system, treatment is still
preferred because of the poor outcomes associated with not treating the condition. Medications to
slow the mother's heart rate down may also be necessary.
Hyperthyroidism during pregnancy, if left untreated, can lead to premature birth, still birth or low
birth weight for the baby. In a small number of cases it also can lead to fetal tachycardia, which is an
abnormally fast pulse in the fetus; fetal thyrotoxicosis, which is a fetus with hyperthyroidism; or
neonatal hyperthyroidism, in which the baby is born with hyperthyroidism. The mother can develop
anemia, preeclampsia, congestive heart failure and, rarely, a severe form of hyperthyroidism called
thyroid storm, which can be life threatening.
Despite the impact thyroid disease can have on a mother and baby, whether to test every pregnant
woman remains a subject of debate in medical circles. As it stands, physicians recommend that
women who are experiencing symptoms or are at risk for thyroid disease should have their thyroid
evaluated with blood tests. A woman is at risk if she has a history of thyroid disease, a family history
of thyroid disease, type 1 diabetes mellitus or any other autoimmune condition, such as celiac
disease or lupus. Anyone with these risk factors should be sure to tell their obstetrician or family
physician.
"Ideally, women should be tested prior to becoming pregnant at prenatal counseling and as soon as
they know they are pregnant," Dr. Garber says. "By becoming informed prior to and taking charge
early in the pregnancy, the patient can optimize the odds of a successful weight gain pregnancy."
ACE and AACE have created a comprehensive consumer website about thyroid awareness. For
addition information about thyroid disease and pregnancy, as well as hormone levels other diseases
affecting the thyroid, visit www.thyroidawareness.com.
About the American College of Endocrinology (ACE)
The American College of Endocrinology (ACE) is the educational and scientific arm of the American
Association of Clinical Endocrinologists (AACE). ACE is the leader in advancing the care and
prevention of endocrine and metabolic disorders by: providing professional education and reliable
public health information; recognizing excellence in education, research and service; promoting
clinical research and defining the future of Clinical Endocrinology. For more information, please visit
www.aace.com.