SOURCE: American Association of Clinical Endocrinologists

January 02, 2008 11:33 ET

Expectant and Pregnant Mothers: Get Your Neck Checked

An Untreated and Malfunctioning Thyroid May Lead to Serious Complications for Mother and Child Alike

JACKSONVILLE, FL--(Marketwire - January 2, 2008) - Pregnancy can be an exciting, joyous and rewarding time for a woman. It is also the time a thyroid condition may surface or become more difficult to control in an expecting or pregnant mother.

January is Thyroid Awareness Month, and the American Association of Clinical Endocrinologists (AACE) are encouraging women who are considering pregnancy or are already pregnant to have their thyroid checked. Doing so can help ensure the safe delivery of a healthy child.

"Although many thyroid disorders that affect pregnancy can be treated easily, early detection is critical," AACE President Richard Hellman MD, FACP, FACE said. "Even before conception, an untreated thyroid may encumber a woman's ability become pregnant or even lead to a miscarriage."

The thyroid is a small, butterfly-shaped gland that makes thyroid hormone which affects the function of many of the body's organs including the heart, brain, liver, kidneys and skin. A malfunctioning thyroid that has gone unnoticed and untreated in a woman's body can be dangerous for her and the child.

"It's certainly something to consult with an endocrinologist about," Hellman said. "As experts on the thyroid, we are able to treat women with a thyroid condition and help them to deliver a happy and healthy child."

AACE, in observance of January's Thyroid Awareness Month: "Treating Your Thyroid: It Deserves the Best Care," has developed an important list of "Things Every Mother Should Know" that is critical for the health of a newborn child. More information is available at www.thyroidawareness.com.

Importance of adequate iodine intake in pregnancy

--  Thyroid hormone is necessary for normal brain development. In early
    pregnancy, babies get thyroid hormone from their mothers. Later on as the
    baby's thyroid develops it makes its own thyroid hormone. An adequate
    amount of iodine is needed to produce fetal and maternal thyroid hormone.
    The best way to ensure adequate amounts of iodine reach the unborn child is
    for the mother to take a prenatal vitamin with a sufficient amount of
    iodine. Not all prenatal vitamins contain iodine, so be sure to check
    labels properly.
    

Hyperthyroidism & pregnancy

--  Hyperthyroidism, if untreated, can lead to stillbirth, premature
    birth, or low birth weight for the baby. Sometimes it leads to fetal
    tachycardia, which is an abnormally fast pulse in the fetus. Women with
    Graves' disease have antibodies that stimulate their thyroid gland. These
    antibodies can cross the placenta and stimulate a baby's thyroid gland. If
    antibody levels are high enough, the baby could develop fetal
    hyperthyroidism, or neonatal hyperthyroidism.
    
    A woman with hyperthyroidism while pregnant puts her at an increased risk
    for experiencing any of the signs and symptoms of hyperthyroidism. And
    unless the condition is mild, if it is not treated promptly a woman could
    miscarry during the first trimester; develop congestive heart failure,
    preeclampsia, or anemia; and, rarely, develop a severe form of
    hyperthyroidism called thyroid storm, which can be life threatening.
    

Hypothyroidism & pregnancy

--  Thyroid hormone is critical for the brain development of a fetus,
    because it depends solely on its mother for its thyroid hormone for most of
    the first trimester of pregnancy. When deprived of thyroid hormone, a baby
    is at an increased risk for neural development, which may lead to mental
    retardation.
    
    Most women who develop hypothyroidism during pregnancy have mild disease
    and may experience only mild symptoms or sometimes no symptoms. However,
    having a mild, undiagnosed condition before becoming pregnant may worsen a
    woman's condition. A range of signs and symptoms may be experienced, but it
    is important to be aware that these can be easily written off as normal
    features of pregnancy. Untreated hypothyroidism, even a mild version, may
    contribute to pregnancy complications. Treatment with sufficient amounts of
    thyroid hormone replacement significantly reduces the risk for developing
    pregnancy complications associated with hypothyroidism.
    

Miscarriage and thyroid disorders

--  A woman with untreated hypothyroidism is at the greatest risk for a
    miscarriage during her first trimester. Unless the case is mild, women with
    untreated hyperthyroidism may miscarry during the first trimester.
    

Care of a child with congenital hypothyroidism

--  All newborns in the United States are routinely tested for congenital
    hypothyroidism. Children with this condition are deficient in thyroid
    hormone, which is critical for the development of the nervous system.
    Untreated, congenital hypothyroidism can lead to mental retardation and
    stunted growth. Thanks to testing, every child born with congenital
    hypothyroidism is promptly treated with thyroid hormone, allowing them to
    develop normally and go on to live a normal, healthy life.
    

For those taking thyroid hormone, what to do before becoming pregnant

How much and which thyroid hormone to take before conception

--  Levothyroxine sodium pills are completely safe for use during
    pregnancy. They are prescribed in dosages aimed at replacing the thyroid
    hormone the thyroid isn't making.  Once a woman begins taking this
    medication, she will be monitored to ensure TSH levels have normalized.
    After normalization, a doctor will want to check these levels every six to
    eight weeks until normalization and less frequently thereafter. They may
    also counsel women to take thyroid hormone pills at least one-half hour to
    one hour before or at least three hours after taking iron-containing
    prenatal vitamins or calcium supplements, which can interfere with the
    absorption of thyroid hormone.
    
    High levels of thyroxine (T4) appear to be required for normal brain
    development early in the pregnancy. A combination of T4 and T3
    (triodothyronine) as well as desiccated thyroid hormone do not provide
    an adequate amount of T4 and therefore should be avoided in a woman
    planning pregnancy or a woman that is already pregnant.
    

How to achieve and maintain excellent control throughout pregnancy

--  For a woman being treated for hypothyroidism, it's imperative to have
    her thyroid checked as soon as the pregnancy is detected so that medication
    levels may be adjusted. TSH levels may be checked one to two weeks after
    the initial dose adjustment to be sure it's normalizing. Once the TSH
    levels drop, less frequent check-ups are necessary during the pregnancy, as
    they tend to stabilize by the middle of pregnancy. Although thyroid hormone
    requirements are likely to increase throughout the pregnancy they tend to
    eventually stabilize by the middle of pregnancy. The goal is to keep TSH
    levels within normal ranges which are somewhat different than proper levels
    in a non-pregnant woman. After giving birth, the doctor should adjust
    dosage to the preconception level.
    

Role of the endocrinologist

--  An endocrinologist is a physician or medical scientist who researches
    and treats patients with diseases relating to the endocrine system. Their
    advanced and specialized training make them experts in the care of
    endocrine disease, such as thyroid disorders.
    

In an effort to educate expecting mothers and those that suspect they may suffer from a thyroid condition, AACE has developed ways for people to seek out additional information. The website, www.thyroidawareness.com, is a resource dedicated entirely to good thyroid health. Patient handouts covering hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, thyroid nodules, thyroid cancer, radioiodine therapy, the thyroid, pregnancy and infancy are available in the offices of AACE endocrinologists.

For more information on the thyroid and the AACE Thyroid Awareness Month campaign, visit: www.thyroidawareness.com.

About AACE

AACE is a professional medical organization with nearly 6,000 members in the United States and 85 other countries. Founded in 1991, AACE is dedicated to the optimal care of patients with endocrine problems. AACE Clinical Endocrinologists advanced, specialized training enable them to be experts in the care of endocrine disease, such as diabetes, thyroid disorders, growth hormone deficiency, osteoporosis, cholesterol disorders, hypertension and obesity. For further information about AACE visit www.aace.com. For more information about the AACE Thyroid Awareness Month, visit www.thyroidawareness.com.

About ATA

Founded in 1923, the ATA is a professional society of 900 U.S. and international physicians and scientists who specialize in the research and treatment of thyroid diseases. The ATA is the North American professional society for physicians and researchers specializing in diseases of the thyroid gland. The ATA promotes excellence and innovation in clinical care, research, education, and public advocacy.

Thyroid Awareness Month is sponsored by AACE and supported through an unrestricted educational grant from Abbott Laboratories.

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