How Thyroid Affects Pregnancy

My patient is a 30-year-old mother of two who presented with symptoms of fatigue, cold intolerance, and tearfulness. She was later diagnosed with Hashimoto’s Thyroiditis six months after the birth of her second child. With the addition of a thyroid hormone, prescribed by her doctor, the patient is doing well and living an active life with her husband and two children.

Based on the levothyroxine dosing guidelines for hypothyroidism in adults, the patient’s initial starting dose would be 100 micrograms per day. The patient is instructed to take the medication once daily wither thirty minutes before eating in the morning or at bedtime or two hours post last meal ate. The patient is advised not to take calcium or iron supplements within four hours of taking levothyroxine because it can alter the absorption of thyroid hormone. The patient should start feeling better within two to three weeks of starting the levothyroxine, if not she is advised to contact the clinic for a reevaluation. The patient will have a scheduled reevaluation appointment along with laboratory work (redraw of TSH) in six weeks. Depending on the patient’s reevaluation laboratory work and presenting condition, there will be additional adjustments to the medication regimen followed by another six-week reevaluation or she will have a six-month reevaluation to assure proper maintenance dose has been achieved. The patient is advised that if there is any change in patient’s status as far as weight loss/gain, pregnancy, surgery, or new additional medications that may alter the thyroid hormone level, there will be a need to reassess plan of care (Danzi; Garber; Ross,

Pathogenesis: both hyperthyroidism and hypothyroidism can lead to amenorrhea, though most commonly it present as primary amenorrhea in patients with hypothyroidism. Low levels of thyroid hormones, T3 and T4, stimulate the hypothalamus to produce thyrotropin-releasing hormone (TRH), which stimulates both thyroid stimulating hormone (TSH) and prolactin production in the anterior pituitary. High prolactin levels inhibit GnRH production in the hypothalamus, which is needed for LH and FSH activation in the anterior pituitary. Without LH and FSH, ovarian follicles cannot mature and menstruation does not occur.

Thyroid levels can change during pregnancy and lactation, even with mothers who never had thyroid irregularities before.

Postpartum Thyroiditis : The thyroid gland located in the lower front of neck is a butterfly- shaped endocrine gland. It produces thyroid hormones which help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally. Postpartum thyroiditis is caused by anti – thyroid antibodies that attack the thyroid and cause inflammation. In United States, postpartum thyroiditis affect 5 -10% of women. Any women with autoimmune disorders, history of previous thyroid dysfunction, family history of thyroid dysfunction, history of previous postpartum thyroiditis are at risk of developing postpartum thyroiditis. The clinical course of postpartum thyroiditis includes thyrotoxicosis followed by hypothyroidism. The

There are many causes of hyperthyroidism, but the symptoms of hyperthyroidism are the same no matter what causes the over expression of thyroid hormones. The main symptoms of hyperthyroidism are fatigue, shortness of breath, weak muscles, anxiety, difficulty sleeping and heart palpitations. Interestingly, even with an increase in appetite the patient will have weight loss.

Graves’ disease is a precursor to hyperthyroidism. Named after the man who first discovered the condition, Robert Graves, this disease shares many immunologic features with autoimmune hypothyroidism (17). The most common symptoms that come with this disease are weight loss, fatigue, nervousness, and irregular heartbeats. This particular condition can be affected by a person’s age. Statistics show that the severity of different symptoms can increase as a person diagnosed with Graves’ disease grows older. This condition also makes people more susceptible to other autoimmune diseases and women who are diagnosed with Graves’ disease should refrain from becoming pregnant until their thyroid problems have been sufficiently treated.

These hormones have a critical role in cell differentiation during development and help maintain thermogenic and metabolic homeostasis in the adults.12 Thyroid disorders are highly prevalent in the population and mostly affect women in childbearing age.13 In pregnancy, thyroid gland displays mild to moderate enlargement because of increased physiological demands. Thyroid function is altered by 4 factors in pregnancy: i) the transient increase in human chorionic gonadotropin (hCG) during the first trimester, which cross-reacts with thyroid-stimulating hormone (TSH) receptor; ii) the estrogen-induced rise in thyroxine-binding globulin (TBG) which is the major transport protein for thyroid hormone; iii) increased autoimmunity; and iv) increased urinary iodide clearance, which can cause impaired thyroid hormone production in areas of low iodine supply.12,14-17 Consequently, the levels of both T3 and T4, the major hormones released by the thyroid, increase by ~50% and serum TSH levels decrease in the first trimester and increase in the second and third

Hyperthyroidism has a varying group of signs and symptoms. Because the thyroid has an effect on all functions of the body and metabolism, many things occur through They can range from nervousness to exophthalmos. The most important symptom is tachycardia. If there is an unexplained or persistent bout of tachycardia, it should be monitored carefully for any signs of other disorders or diseases. One sign of hyperthyroidism seen often is exophthalmos or proptosis, the protrusion of a single or both eye. This is an opthalmyopathy that can go along with lid lag, photophobia, diplopia and irritation (Hinkle & Cheever, 2014¬). This is due to edema in the tissues surround the eyes. Other symptoms of hyperthyroidism are palpitations, tremors, shortness of breath and dyspnea, muscle weakness, flushing, diaphoresis, irregular menstruation (amenorrhea or oligomenorrhea), hyperventilation, and increased body temperature or heat

Out of all the different types of thyroiditis, Hashimoto’s disease (or chronic thyroiditis) is the most common. Thyroiditis is often a cause for hypothyroidism and goiter. Since Hashimoto’s disease is the most common form of thyroiditis, it is then concluded that it is also the most frequent cause of hypothyroidism and goiter. Those who have the highest chances of suffering from Hashimoto’s disease are middle-aged women who have a family history of thyroid dysfunctions. Some of the symptoms of chronic thyroiditis are enlarged neck, presence of goiter, constipation, mild weight gain, hair loss, and intolerance to colder temperatures.

Hyperthyroidism occurs when the thyroid gland, a butterfly shape in front of the neck, overproduces thyroid hormone. The thyroid gland is abundant with blood vessels and it secretes thyroid hormone (Kumar 22). Thyroid hormone influences many different internal body functions such as, metabolism, growth, development, turning food into energy, and increases body temperature. Thyroid hormone is very important for brain development and normal growth during infancy; furthermore, a newborn’s blood drawn from their heel and sent for screening determines of level of thyroid-stimulating hormone (Samuels 2). However, when the thyroid gland over produces thyroid hormone a lot of things in the body development can go wrong. The over produced thyroid hormone forces the body to expedite. It is important to know that one has hyperthyroidism, because it can result in heart, bone problems, and thyroid storm; which heart rate, blood pressure, and the increase in body temperature can be fatal. Hyperthyroidism is more common in females than males and the older a person is the more likely they will have it. Around 27 millions of American have thyroid disease, however only 14 million receive treatment. Also, stress is the main aspect that affects the thyroid gland in either over producing or under producing thyroid hormone (Kumar 22).

brain and eyes can be damaged when hypertension is secondary to hyperthyroidism. Signs of the disease are hyperexcitability, vomiting, diarrhea, increased thirst, increased urination, and weight loss even with increased appetite. The hyperthyroidism is diagnosed by clinical signs, symptoms, and blood tests to check hormone levels and chemistry panels.

The symptoms that are prevalent with infants include jaundice, frequent choking, a large protruding tongue, and a puffy appearance to their face. As hypothyroidism continues to progress many infants experience constipation, poor muscle tone, and excessive sleepiness. Also, as it progresses infants may experience trouble feeding and could affect the overall growing and development of the infant. If it is goes untreated there is even a likely chance that that physical or mental disabilities will present themselves. Also, a person can experience life-threatening depression, heart failure, or coma if it goes untreated (Norman). One complication that arises from hypothyroidism is goiter, which is caused by to over production of thyroid stimulating hormone (TSH) from the pituitary gland. With goiter the thyroid gland becomes enlarged and requires

The thyroid is a butterfly shaped gland that is located in the front of your neck. This glands purpose is to act as the control center for your body and secrete hormones that help sustain the organs. Two conditions that can affect the thyroid to become overactive or underactive are called hyperthyroidism and hypothyroidism. The main difference between hyperthyroidism and hypothyroidism is the thyroid’s hormone production. Hyperthyroidism is a disorder where your thyroid gland creates too much of the hormone thyroxine and this is known as throtoxicosis. Thyroxine is the primary hormone secreted into the bloodstream and is vital in heart and digestive functions, regulating metabolic rate, and maintaining bone, just to name a few. Hyperthyroidism

Grave’s disease is uncommon in pregnancy. It occurs in 0.5 to 3.0% of pregnancies. Grave’s disease is an autoimmune disease that causes the thyroid gland to produce too much thyroid hormone (hyperthyroidism). Common signs and symptoms of hyperthyroidism are nervousness, tachycardia, tremor, sweating, dyspnea, weight loss, goiter, and ophthalmopathy (Alamdari et al., 2013, p. 1-2). Poorly treated or untreated hyperthyroidism during pregnancy may cause preeclampsia, preterm delivery, intrauterine growth restriction, low birth weight, and miscarriage. Other complications may include congestive heart failure, thyroid storm, and postpartum bleeding. In addition, the fetus of hyperthyroid mother is at risk because the stimulating maternal TRAb passes the placenta and may cause fetal hyperthyroidisms. The fetus will experience