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Send Email| The Butterfly Effect: Thyroid Problems |  |
| conceive's library - reproductive threats | |
The thyroid is a butterfly-shaped gland in your neck. You probably don’t even know it’s there. But if it’s not working properly, you might not be able to get pregnant.Mary Shomon was one of the lucky women who got pregnant within the first few months of trying. But when she called an obstetrician’s office to make an appointment, the office staff told her it wasn’t necessary for her to see a doctor until her eighth week. “I told them I needed to come in earlier because I have a thyroid problem. And they didn’t know what I was talking about,” she remembers.
Mary insisted on seeing the doctor sooner, and when she did, she found out her thyroid hormone levels were already nearly outside the normal range. If her medication hadn’t been adjusted immediately, Mary would have risked losing the baby. Instead, she had a healthy pregnancy and delivered a baby girl, Julia, who is now a healthy eight year old.
Mary has since become a patient advocate, disseminating information via books and the Web on the under-recognized problem of thyroid disease, especially in women of reproductive age. “Women are all told to take folic acid before getting pregnant, but no one tells you to get your thyroid checked,” she says.
According to The Thyroid Foundation of America, there are as many as 8 million women in America with untreated thyroid disorders. For those of reproductive age, infertility or miscarriage may be the first sign that something is wrong.
When Things Go Too Slow. . .Hypothyroidism, the condition of having an underactive thyroid, is the most common thyroid disorder. The slowed-down metabolism associated with it can manifest as constipation, heavier periods, weight gain, decrease in appetite, lethargy, depression, cognitive problems, fatigue, dry skin, cold intolerance, or muscle aches. “But individual patients have different symptoms that vary with severity,” explains Carolyn Coulam, M.D., a reproductive endocrinologist with The Rinehart Center for Reproductive Medicine in Chicago.
Hypothyroidism can cause infertility by preventing ovulation—even when menstrual periods are occurring regularly. Women with undiagnosed hypothyroidism who do conceive have an elevated risk of miscarriage. And even hypothyroid women who’ve already been diagnosed, treated, and stabilized with medication—like Mary Shomon—need to be monitored closely. “Metabolism increases during pregnancy and often the thyroid can’t keep up,” explains Dr. Coulam. “Doses may need to be increased during pregnancy for some women.”
Some women with an underactive thyroid may experience elevated levels of prolactin, the hormone that induces the production of breast milk in postpartum women. Excess prolactin can have a negative impact on fertility, again by preventing ovulation. Hypothyroidism’s effects on metabolism can also bring on a condition known as luteal phase defect. The luteal phase is the second half of the monthly cycle, lasting from ovulation to menstruation. It is normally 12 to 16 days long. But if the luteal phase chronically runs shorter than ten days, then the uterine lining can’t build up sufficiently for the embryo to implant, and it will be flushed from the body with the next menstrual period.
. . .Or Too FastThe opposite scenario is hyperthyroidism, in which the thyroid gland becomes overactive and the body’s metabolism runs too fast. Signs of hyperthyroidism include more frequent bowel movements, weight loss, irregular periods, increased appetite, insomnia, nervousness, heat intolerance, hand tremors and heart palpitations.
One common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder which tends to run in families and affects the entire thyroid gland. Another cause of an overactive thyroid are so-called “hot nodules” that can form on the gland. In this case, most of the gland continues to perform normally, but the nodule contains cells that produce too much of the T4 hormone.
Whatever the cause of the hyperthyroidism, the result is that the condition can sometimes prevent ovulation. But the bigger problem, according to Celia Dominguez, M.D., of Atlanta’s Emory Clinic, is that when a woman with hyperthyroidism conceives, her metabolism may be so out of balance that miscarriage or fetal death may result.
Simple Blood TestsThyroid disorders are easily detected by a couple of simple blood tests that measure levels of the thyroid hormones T4 (thyroxine) and TSH (thyroid stimulating hormone). TSH works like a thermostat; it’s produced by the pituitary gland to regulate thyroid function. Levels of this hormone may also become too high or too low, as the pituitary gland attempts to compensate for an over- or underactive gland. Together, these blood test results let doctors know whether the thyroid is functioning normally or not.
There’s also a blood test that checks for the presence of anti-thyroid antibodies. High levels of these antibodies are typical of a thyroid disease called Hashimoto’s Thyroiditis (Mary Shomon’s eventual diagnosis), which always results in hypothyroidism. Hashimoto’s Thyroiditis is classified as an autoimmune disease, because the body has essentially turned against itself, forming antibodies that attack the cells in the thyroid and slow down production of thyroid hormone. The gland itself may compensate by becoming enlarged.
Preconception PlanningIf your thyroid is underactive, your doctor will prescribe some form of a synthetic version of the T4 hormone. Your body will respond to it the same way it would to the real thing. While establishing the correct dose can be quite easy in some individuals, others will fluctuate up and down before stabilizing. During pregnancy, your doctor should do blood tests every month or two, then at least yearly once you’re stabilized.
With hyperthyroidism, or overactivity, some treatments are designed to slow down the thyroid’s secretion of hormones. This can be done with anti-thyroid drugs, or with radioactive iodine that essentially kills part of the gland to slow down its hormone production. Radioactive iodine cannot be used in women who are already pregnant, however, and Dr. Dominguez stresses there should be a six-month waiting period after treatment before attempting to conceive.
Normal laboratory TSH ranges are generally considered to be .3 to 5.5. For women who are already managing a thyroid disorder, experts generally agree that preconception planning is a must, and that medication should be adjusted until TSH levels are between 1 and 2 before a woman conceives. During pregnancy, an endocrinologist or an obstetrician that’s familiar with thyroid issues should monitor blood levels closely.
Among the various threats to fertility, thyroid disorders are arguably the easiest to identify and treat. With a little extra attention on the part of your doctor, women with thyroid disorders—whether too slow or too fast—are very likely to have problem-free conceptions, normal pregnancies, and healthy babies.
Thyroid TheoryThe thyroid is a large, butterfly-shaped gland located in the base of the neck. It manufactures a host of hormones, the most important being thyroxine (T4), which acts as a metabolism master. As more T4 is produced, virtually every cell in the body increases the rate at which it does its job—including those in the heart, which beats faster under the influence of T4. Conversely, when T4 levels fall, metabolism slows down. Ideally, the body maintains the perfect level of T4 hormone, and the perfect rate of metabolism.
The most common thyroid disorders are marked by either too much T4 (hyperthyroidism) or too little T4 (hypothyroidism) in the body. The symptoms reflect the effects of a too-fast or too-slow metabolism. Depending on how severe the imbalance is, the symptoms may be so subtle that the condition goes unrecognized for years. Even worse, doctors may dismiss or discount a woman’s account of her symptoms. This happened to Mary Shomon: Even though she repeatedly visited her family doctor because of unexplained weight gain and heavy fatigue (classic symptoms of a slow thyroid), her doctor didn’t test her thyroid for several months.
 This article originally appeared in the Fall 2006 issue of conceive magazine. | |
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