Thyroid Disease in Pregnancy and After Delivery

This chapter discusses issues for distinct groups of women: pregnant women with unrecognized or subclinical thyroid disease, pregnant women with preexisting thyroid disease, women who only first discover (or develop) a thyroid problem during pregnancy, and women who only first discover (or develop) a thyroid problem within the first six months of delivery. In the latter situation, this frequently takes the form of postpartum thyroiditis, classically misdiagnosed as postpartum depression.

Autoimmune thyroid diseases, such as Hashimoto's disease (see Chapter 5) or Graves' disease (see Chapter 6), frequently strike during the first trimester of a pregnancy or within the first six months after delivery. That said, you should note that preexisting autoimmune thyroid disease as well as other autoimmune diseases tend to improve during a pregnancy but can worsen after delivery. Although the reasons for this are not known, these changes parallel the changes in estrogen levels in the pregnant woman; high levels of estrogen are associated with improvement in the thyroid problem. Thyroid nodules and thyroid cancer can also be first discovered during a pregnancy, and in those cases, there are particular management strategies we'll discuss.

One of the aims of this chapter is to educate you and your doctor on the potential dangers of untreated thyroid disease during pregnancy. All women planning pregnancy and their prenatal health-care team should be aware of the following facts:

• Pregnant women with hypothyroidism (overt or subclinical) are at an increased risk for premature delivery.

• Pregnant women who have antibodies for autoimmune thyroid disease are at an increased risk for miscarriage, postpartum thyroiditis, Graves' disease, and hypothyroidism.

• Children born to mothers with hypothyroidism or high TSH levels are at higher risk of intellectual or motor impairment.

For these reasons, all women should be screened for thyroid disease prior to pregnancy and at regular intervals throughout their pregnancy as appropriate. This translates into TSH tests and thyroid antibody tests upon the discovery of the pregnancy, and monthly TSH tests if the thyroid antibody tests are positive. (See Chapter 2 for details on these tests.) Although not yet common practice, routine thyroid function tests, meaning TSH tests, ought to be done at regular intervals on all fertile women who could become pregnant, because they might not seek medical care until well into their pregnancy.

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