Thyroid disease is common in women, especially during pregnancy and immediately thereafter, in the post-partum period. The causative factors are related to the immunological modifications in pregnancy and preexisting disorder. Graves’ disease during pregnancy needs proper management by specialist like Best Gynecologist in Karachi or it can result in complications as severe as pregnancy loss.
Read on to know how to deal with Graves’ disease during pregnancy:
Role of Thyroid Hormones in Pregnancy
Thyroid gland is located in the neck and produces thyroid hormone. This hormone is needed for the normal metabolism in the mother and development of the baby’s brain and nervous system. During the first trimester, the mother’s thyroid hormone crosses the placenta and reaches to fetus for brain development. During the second trimester, the thyroid gland of the baby starts to produce hormone, but the quantities are insufficient. The baby starts to produce sufficient hormone around 18 to 20 weeks of pregnancy.
During pregnancy, the free or unbound amount of thyroid hormones remain the same, but the two hormones—estrogen and hCG—give a false high reading of the total amount of thyroid in the body. This makes it harder to diagnose thyroid disease in the pregnancy. For this reason guidelines of the American Thyroid Association recommends to assess the results of thyroid-function tests (TFTs) differently, during pregnancy and post-partum.
Another type of thyroid disorder is common in women after delivery, and this is called postpartum thyroiditis.
Hyperthyroidism in Pregnancy: Symptoms
Graves’ disease occurs when the immune system attacks its own thyroid through mediators called autoantibodies. These antibodies cause the gland to enlarge and produce too much thyroid hormone. Most women with Graves’ disease already know they have it before getting pregnant.
During pregnancy, Graves’ disease presents with symptoms of hyperthyroidism like:
Feeling hot: patients with Graves’ disease complain of feeling too hot, even when others are comfortable. This is because thyroid hormones increase the metabolic processes of the body which generate heat.
Anxious: patients of Graves’ disease often complain of anxiety and feeling irritable.
Weight loss: the basal metabolic rate (BMR) of the Graves’ disease patients is high and they experience weight loss even if they consume age-recommended calories. Such patients also feel hungry more often. In pregnancy, such women fail to have normal pregnancy weight.
Trembling: hand tremors are common in patients of Graves’ disease.
Tachycardia: thyroid hormones cause the heart rate to rise, causing hypertension and palpitations.
Insomnia: patients often have trouble falling asleep and complain of tiredness.
Hyperthyroidism in Pregnancy: Effect
Untreated Graves’ disease in pregnancy can cause: low birth weight baby, thyroid storm, pre-eclampsia, miscarriage and even congestive heart failure.
Sometimes, the high TSH in the mother reaches the baby and causes too much thyroid to be produced. In the baby, too much thyroid can cause poor weight gain, irritability, fast heart rate which can result in heart failure and early closure of skull.
Hyperthyroidism in Pregnancy: Management
Women with Graves’ disease should be counselled prior to conception. Ideally, such women should be in euthyroid state to make conception safer, or postpone conception until they are in stable condition.
When or if Graves’ disease appears during pregnancy, experts recommend the lowest possible dose of anti-thyroid drug called propylthiouracil to keep the thyroid hormone level at the upper limit of normal, and the serum TSH low. Higher TSH in the mother can impact thyroid levels in the fetus, thus they should be kept on the lower side in the mother.
In mothers taking anti-thyroid medication, the baby is monitored by the specialist like Best Gynecologist in Islamabad or endocrinologist to make sure the dose is right and the baby is safe.