If your gland activity is below normal, you may feel fatigue, cold intolerance, constipation, dry skin, muscle spasms, weight gain and other symptoms. But if your thyroid gland is moderately inactive, you generally may not have obvious symptoms. That is why experts suggest that women who have an increased risk of thyroid disease – those who have been in the family is a disease, and those in which there are autoimmune diseases such as diabetes and lupus – should be regularly checked for thyroid subject. If you have thyroid insufficiency and if it is not treated as it should, there is a risk of miscarriage, late toxicosis, rupture of the placenta, birth of a baby with low birth weight or stillborn.
Hypothyroidism in pregnancy or a lack of hormones of the thyroid gland can lead to the birth of a child with pathologies: a decreased intelligence, an insufficiently developed nervous system. However, in most cases, hypothyroidism in women and pregnancy are incompatible concepts, since the lack of thyroid-stimulating hormones provokes oppression of sexual function and infertility. In this regard, the question disappears by itself, whether it is possible to become pregnant with hypothyroidism of the thyroid gland. In some cases, you can, but you always need to think about the consequences of such a decision.
The most common cause of hypothyroidism is the destruction of the thyroid gland as a result of autoimmune (postpartum) thyroiditis. Iatrogenic forms of primary hypothyroidism occur after operations on the thyroid gland, radioiodine therapy, or as a result of overdose of thyreostatic drugs in the treatment of diffuse toxic goiter. Relatively rare pituitary hypothyroidism can be associated with postpartum necrosis of the pituitary gland, its autoimmune lesion (autoimmune hypophysitis), removal or irradiation of the pituitary gland.
Congenital hypothyroidism is caused by either aplasia of the thyroid gland (congenital hypothyroidism without goiter), defects in enzyme systems that provide the synthesis of thyroid hormones, or a pronounced iodine deficiency (congenital hypothyroidism with goiter).
Hypothyroidism is primary and secondary. Primary is an independent disease that arises from the dysfunction of thyroid cells. Primary hypothyroidism during pregnancy occurs as a result of inflammation in the thyroid gland or problems in the immune system. Secondary hypothyroidism is the result of surgical intervention on the thyroid gland, a tumor or infectious disease in the hypothalamic-pituitary system.
When describing hypothyroidism in pregnant women, doctors use the terms “manifesting” and “subclinical”. In the first case, the level of TSH rises and T4 decreases. In the second – against a background of increased TSH, the hormone T4 remains normal. With the manifest form, it is necessary to compensate in the form of hormone replacement by a synthetic analog. Since thyroid hormone receptors are present in almost all tissues, the symptoms of hypothyroidism are numerous and varied. Their severity depends on the extent and duration of the thyroid hormone deficiency.
The clinical picture of hypothyroidism is caused by a decrease in the influence of thyroid hormones on metabolism, a decrease in the activity of all metabolic processes. With insufficient compensation for hypothyroidism, pregnant women complain of lethargy, decreased efficiency, sluggishness, drowsiness, weight gain, persistent constipation, apathy, decreased memory and attention, hearing impairment, dry skin, brittle nails, hair loss.
In conditions of a lack of thyroid hormones, energy is formed with less intensity, which leads to constant chilliness and a decrease in body temperature. Another sign of hypothyroidism may be a tendency to frequent infections, which is due to the lack of stimulating influence of thyroid hormones on the immune system.
Patients are concerned about persistent headaches, often – pain in the muscles and joints. Numbness in the hands is due to the compression of the nerves with edematous tissues in the carpal tunnel. Along with physical inhibition in patients, there is also mental retardation, and frequent forgetfulness. In hypothyroidism, due to the swelling of the tissues, the sensory organs are also affected. Patients are disturbed by vision disorders, hearing loss, ringing in the ears.
The voice due to edema of the vocal cords becomes low; often in a dream patients begin to snore because of the swelling of the tongue and larynx. It slows down digestive processes leading to constipation. One of the most serious signs of hypothyroidism is heart damage. In many patients, there is a slowing of the heart rate (less than 60 per minute). Other cardiovascular manifestations of hypothyroidism include an increase in the level of cholesterol in the blood, which can lead to the development of atherosclerosis of the heart vessels, ischemic disease and intermittent claudication.
There are no significant clinical differences between the expressed forms of primary, secondary and tertiary hypothyroidism.
Drinking alcohol, cooling, stress can cause the development of a hypothyroid (myxedematous) crisis: rapid deterioration of the condition, especially in the patient with myxedema. The crisis is manifested by hypothermia, increasing inhibition of the central nervous system, alveolar hypoventilation with hypercapnia, bradycardia, hypotension and death of the patient.
Subclinical hypothyroidism outside of pregnancy does not need treatment – only the observation of a doctor with hormonal control is shown. However, in pregnancy, in some cases, the doctor prescribes substitution therapy – especially in the first trimester, when the body is not able to meet the increased need for hormones. Approximately at the 20th-22d week hyperthyroidism with replacement therapy may manifest. This means that the dosage of the synthetic hormone should be reduced, possibly up to a complete cancellation with further periodic monitoring of the hormonal level of the body of the pregnant woman.
If a woman is pregnant, it is necessary to remember that in the first half of pregnancy the fetus does not have a thyroid. For the normal functioning of the child, it is important to control the level of thyroid hormones in the mother – the need for a pregnant woman in this hormone is high. If you do not compensate for it in the beginning of pregnancy – the consequences for the child (and for the mother too) with hypothyroidism of the pregnant woman will be irreversible.
Complications that may occur:
Normal fetal development requires good compensation of the disease. The need for medicines increases by 30-50%, as indicated by an increase in the concentration of TSH in the blood. Treatment continues throughout pregnancy, reaching a state of euthyroidism. The criterion of the effectiveness of treatment is the elimination of clinical symptoms of the disease and the restoration of the concentration of free T4 and TSH in the blood. Prevention and timely treatment of thyroid pathology in pregnant women can reduce the incidence of complications for both the mother and the fetus and will contribute significantly to improving the health and intellectual potential of the nation.
During pregnancy and breastfeeding, therapy with levothyroxine sodium, prescribed for hypothyroidism, should continue. During pregnancy, an increase in the dose of the drug is required due to an increase in the level of thyroxine-binding globulin. The amount of thyroid hormone secreted with breast milk (even when treating with high doses of the drug) is not enough to cause any disturbances in the child during breastfeeding.
The use in pregnancy in combination with thyreostatics is contraindicated, because taking levothyroxine sodium may require an increase in thyrotoxic doses. Since thyreostatics, in contrast to levothyroxine sodium, can penetrate the placenta, the fetus may develop hypothyroidism. The action category for fetus by FDA is A. During breastfeeding, the drug should be taken with caution, strictly at recommended doses, under the supervision of a doctor.