Your Pregnancy Matters

What women need to know about thyroid conditions

Your Pregnancy Matters

Thyroid problems can make it difficult for women to become pregnant and negatively impact a developing fetus.

It’s estimated that about 12 percent of Americans will develop a thyroid condition during their lifetime, and women are five to eight times more likely to have thyroid problems than men.

We’re not entirely sure why this is, but it means we need to make sure women are well-educated about the symptoms of these conditions and how to treat them effectively, particularly if they’re pregnant or planning to become pregnant.

Take a moment to learn about the symptoms of thyroid disorders, precautions women should take regarding family planning, and common thyroid medication mistakes.

The vague symptoms of thyroid disorders

Thyroid hormone regulates metabolism and helps many of our organs to function. Because of this, thyroid problems can cause a wide range of vague symptoms:
These symptoms are non-specific and similar to those of a number of other conditions. Some of them also can be related to the rigors of a woman’s everyday life. You’re busy with family, work, friends, etc. Of course you’re tired at times. When there’s so much to do that working out or making healthy meals seems impossible, your weight can creep up.

I sometimes see patients who – when their thyroid hormone test comes back normal – admit that they sort of hoped they had a thyroid disorder. It could have been a simple explanation for fatigue and weight gain. Taking a pill may seem easier than making lifestyle changes when they’re so busy already.

But, of course, we don’t want you to suffer needlessly. Thyroid conditions often can be diagnosed with a blood test to measure thyroid hormone levels. See a doctor if your symptoms:
Aside from making you feel sluggish and generally unwell, thyroid disorders can affect family planning as well.

  • Abnormal bowel function (constipation or loose stools)
  • Changes in mood
  • Changes in heart rate
  • Fatigue
  • Hair loss
  • Irregularities in the menstrual cycle
  • Trouble regulating body temperature
  • Weight gain or loss
  • Occur in combination
  • Have no identifiable cause
  • Are out of proportion to what you think they should be; for example, if you’re more tired than you normally would be in your daily activities
  • Don’t go away

How thyroid disorders affect pregnancy and conception

Thyroid problems can make it harder to get pregnant. If your condition isn’t diagnosed or is poorly managed, it can result in irregular ovulation or no ovulation. Some studies suggest that underlying thyroid disease also may increase your risk for miscarriage.

If your thyroid condition is well-managed, meaning your thyroid hormone levels are normal, it shouldn’t affect your ability to become pregnant. However, it’s important to understand the changes your thyroid will undergo during pregnancy.

A woman’s thyroid production increases by 30 percent during pregnancy. This is because the baby is completely dependent on mom for production of thyroid hormone until its own thyroid is fully developed and functioning, which occurs about halfway through the pregnancy.

Thyroid hormone is essential for brain development, and women with untreated or undertreated hypothyroidism, in which the thyroid does not make enough hormone, may have babies who are at higher risk for neurological or developmental problems. Meanwhile, women with hyperthyroidism, in which the thyroid makes too much hormone, may be at increased risk for preeclampsia and giving birth before 37 weeks.

If you have a thyroid condition, I strongly encourage you to have a preconception counseling visit with your thyroid doctor and Ob/Gyn before becoming pregnant or immediately after you find out you’re pregnant. We’ll evaluate your thyroid hormone and begin adjusting your medication to support the baby’s healthy development. Request an appointment today.

We also need to monitor your thyroid levels frequently – at least every month during the first half of pregnancy – to make sure your thyroid hormone levels remain where they should be. After giving birth, we’ll likely begin reducing your medication dosage to pre-pregnancy levels.

Common mistakes with thyroid medication

Medication to treat hypothyroidism increasingly is becoming one of the most commonly prescribed drugs in the U.S. In fact, one 2016 survey showed levothyroxine, a common medication to treat hypothyroidism, to be the second most-filled prescription, just behind a drug to treat high cholesterol.

If you have hypothyroidism, hormone replacement medication is the standard treatment. But, as with any medication, you have to take it the right way for it to work.

I often see patients who have in their medicine cabinets virtually every dosage of thyroid hormone ever marketed, and they’re frustrated because they can’t get their thyroid levels under control. The reason often is that they simply aren’t taking their medication correctly, through no fault of their own. It’s the responsibility of doctors and pharmacists to ensure our patients understand how to take any medication they’re prescribed in a safe, effective way.

My team and I sit with every patient to explain how to properly take thyroid medication. With thyroid replacement medications, the instructions are basically the opposite of most other drugs: You must take thyroid hormone replacement medication on an empty stomach with water only. Don’t take it with food, juice, coffee, or milk. Just water.

You have to be consistent because thyroid hormone is a poorly absorbed medication. If you take the medication on an empty stomach one day and with food the next, your thyroid hormone levels may vary.

Also, you shouldn’t take it with other medications or multivitamins, especially those that include calcium or iron. The hormone can bind to other drugs and become insoluble, which means it will go right through you and won’t be absorbed into the bloodstream.

Make sure you understand how to take your thyroid medication, and be honest with your doctor if you’re unsure. If you’re not taking it properly and we don’t know that, we may try a new medication or dosage when, in fact, the best solution is the medication and dosage already prescribed.

Women already have a lot to think about day to day. We don’t want a thyroid condition to be another hassle or source of stress. A little planning for your health and getting into a good routine with your medication will help keep your thyroid symptoms manageable so you can keep up with the demands of your busy life.