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Thyroid gland and pregnancy

27 September 2021 | News | Endocrinology | Nona H. Martirosyan

We talked to endocrinologist, PhD, Associate Professor, Deputy Director on Therapeutic Services of "Nairi" MC Nona Martirosyan, about thyroid function disorders, their direct impact on pregnancy and the fetus, and what you need to know before planning a pregnancy.

-What effect does the thyroid gland have on a woman's reproductive health?

-Thyroid hormones play a very important role in regulating the reproduction of a woman's body, especially the menstrual cycle and ovulation. Hormonal changes in the gland can cause a number of reproductive problems.

-How do thyroid functions change during pregnancy?

-During pregnancy, the body's entire metabolism, including the thyroid gland, changes to meet the growing demands of the embryo. At the beginning of pregnancy, in the first trimester, when the thyroid gland of the fetus is not yet formed, a pregnant woman experiences an increase in thyroid function - physiological hyperthyroidism. And in the third trimester, there may be a decrease in free thyroxine levels due to an increase in thyroid hormone-binding protein.

-It is important that from the planning of the pregnancy until the birth of the child, the pregnant woman is under the supervision of endocrinologist and gynecologist, in order to prevent possible bad developments and to have a healthy baby.

- Planning pregnancy what should a woman know?

- First of all, the functional state of a woman's thyroid gland, the presence of an autoimmune thyroid problem, and the presence of familial cases of malignant neoplasms are very important. Women with hyperthyroidism or hyperfunction should plan their pregnancies at the drug compensation stage. Women who have received radiotherapy for thyrotoxicosis (glandular hyperfunction) or differentiated cancer should plan their pregnancy at least one year after radiotherapy.

-What is the role of thyroid hormones in the development of the fetus?

-Thyroid hormones are very important in the process of fetal growth and normal development. The role of these hormones is especially important in the development of the nervous system, including the brain, musculoskeletal system, cardiovascular and genital systems.

It should be noted that the risk period is the first trimester of pregnancy, because the fetus does not have its own thyroid gland during that period, for the fetus the function is performed by the future mother's thyroid gland. The fetal thyroid gland is fully formed and begins to function independently after 14-16 weeks.

Let's talk about the amount of iodine in the body of pregnant women. Unlike non-pregnant women, the iodine requirement of pregnant women is twice as high, which must be met. There are investigations through which we find out whether iodine is sufficient or not, and, accordingly, appropriate medication is prescribed.

-Is the diagnosis and treatment of thyroid disease different at a pregnant woman?

-Thyroid examinations are diverse. There are some important hormones that must be tested in both pregnant and non-pregnant women. Antibodies are tested at the beginning of the diagnosis, as well as when planning a pregnancy. In both cases an ultrasound examination must be performed. In pregnant women, a joint determination of free thyroxine and thyrotropic hormone is mandatory. The latter are determined every quarter, and in case of receiving medicine, more often, every 4-5 weeks.

-What treatment is required?

-As I mentioned, when planning a pregnancy, it is necessary to undergo appropriate treatment, if there is a problem, and to compensate for the hormonal condition. If this is not done and we have a thyroid gland defect or hyperfunction, both of these manifestations, of course, have a negative impact on fetus development. These can lead to the development of birth defects or premature termination of pregnancy.

The first thing to do to avoid such bad scenarios is to start treatment immediately while recording the hormonal disorder.

Hormone replacement therapy is performed during dysfunction. The only problem in this case is the dosage due to the stricter requirements for pregnant women during the corresponding trimesters of pregnancy. You should not be afraid of this, because the whole course of treatment is supervised by the treating doctor.

In case of hyper function, it is important to choose a drug that suppresses thyroid function; the medicine that does not harm the fetus is also has to be chosen. Surgery in pregnant women is performed when a thin needle puncture biopsy reveals a malignant neoplasm or there is overactive thyroid gland with pronounced decompensation that does not respond to medication. In the latter case, the issue of abortion may even be raised.

The only preferred period for surgery is the second trimester, it is not allowed in the first and in the third trimesters.

Let's talk about hypofunction and hyperfunction of the gland.

There are certain clinical manifestations that are typical for this or that functional disorder. Signs of dysfunction are weakness, dry skin, fatigue, hair loss, memory loss, weight gain, may be constipation.

In case of hyperfunction - irritable behavior, accelerated heartbeat, increased sweating, weight loss, etc.

The feelings that accompany pregnancy can often be combined with clinical manifestations and symptoms of the thyroid gland, so it is difficult to determine whether we are dealing with hyper function or dysfunction. Therefore, it is obligatory to perform a hormonal examination, to detect the problem, and if necessary, to treat it.

-In which cases the pregnant women are included in the risk group?

-The risk group includes pregnant women who may have severe thyroid hyper- or hypofunction, unregulated and drug resistant problem.

At risk group are women who have a hereditary background of malignancies and have had thyroid disorders during previous pregnancies.

If a woman decides to terminate a pregnancy and at the same time she has a functional thyroid gland disorder, will it cause additional complications?

Glandular disease is not a contraindication to termination of pregnancy if the woman has made a decision. Regardless, the woman should be monitored by an endocrinologist to restore hormonal balance.

The thyroid gland and infertility

Thyroid disease is considered to be one of the possible causes of infertility. Couples who have problems with infertility should have a thyroid hormone test. As I have already mentioned, this gland is responsible for a woman's reproduction.
In case of such a problem, joint treatment by an endocrinologist and gynecologist is required. Often, a woman gets pregnant by regulating the hormonal problems of the gland.

In case of in vitro fertilization, the balance of these glandular hormones must be a priority to ensure a successful pregnancy.

To summarize, let's mention once again what a woman should do if she has an unplanned pregnancy and there is a gland disease.
You should immediately consult an endocrinologist and gynecologist to control the pregnancy together, to perform the prescribed examinations in all trimesters, to make adjustments to the dose of the medicine. With all this, it is possible to succeed in such a situation, to achieve the desired result, to have a healthy baby.

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