Underactive thyroid and pregnancy

Underactive thyroid and pregnancy


What is subclinical hyperthyroidism?
How is subclinical hypothyroidism diagnosed in pregnancy?
What are the signs and symptoms of subclinical hypothyroidism in pregnancy?
Stay tuned to learn more about subclinical hypothyroidism and subclinical hypothyroidism during pregnancy.
Here's what you need to know about subclinical hypothyroidism in simple language.


What is the definition of subclinical hypothyroidism?
Does subclinical hypothyroidism require treatment?
What causes subclinical hypothyroidism?
Who is at high risk?
Treatment of subclinical hypothyroidism
Side effects
Subclinical hypothyroidism in pregnancy
Is thyroxine treatment necessary in pregnant women with subclinical hypothyroidism?
Are pregnant women who have subclinical risks?



Subclinical hypothyroidism or subclinical hypothyroidism is actually a mild form of thyroid insufficiency and can affect 3 to 8% of the population. One of the conditions in which subclinical hypothyroidism occurs is pregnancy.
In general, subclinical hypothyroidism is much more common in women than men. Interestingly, this problem becomes more prevalent as you get older. In fact, the main significance of this problem is that it is likely to progress to hypothyroidism and clinical thyroid.
Next we want to talk about hypothyroidism or subclinical hypothyroidism in pregnant women.


What is the definition of subclinical hypothyroidism?

Subclinical hypothyroidism is defined as a laboratory condition in which a person with high blood TSH levels is above the normal upper limit.



Credible studies the prevalence of subclinical hypothyroidism in the global population among women is seven and eight and a half percent among all women in the world and 4.4 percent in the male population.
The disorder is more common in women as they get older, meaning that women are at higher risk of developing the disorder as they get older, and it is seven to eight percent more common in older women and two to five percent more common in older men.
According to other statistics, about 2 to 20% of different forms of hypothyroidism develop subclinical hypothyroidism at least once in a while.
What is referred to in medicine as hypothyroidism is when the level of tsh hormone is higher than 10mlu  /  L.
This laboratory finding can be found in 5.9% of women over the age of 60 and 2.4% of men.


Does subclinical hypothyroidism require treatment?

Treatment is needed when there is a condition where the TSH is more than ten.
However, if the TSH level is less than this, subclinical hypothyroidism is considered mild and the appropriate strategy for physicians at this time is to follow the patient.
A very important point that is emphasized in many scientific references is that if a person has subclinical hypothyroidism and has risk factors for cardiovascular disease, it is better to be treated.
The subject of this article will be about subclinical hypothyroidism in pregnancy



Subclinical hypothyroidism is said to be a very mild form of hypothyroidism and is a condition in which the body begins to produce and inadequate thyroid hormone.
The most common manifestations that people with hypothyroidism experience are the following:
Mood swings and depression are common in these people
Unexplained fatigue
Weight Gain
Hair loss and cold intolerance
In the definition of goiter, should we say that swelling of the front part of the neck, which occurs due to the enlargement of the thyroid gland, is called goiter.


What causes subclinical hypothyroidism?

The pituitary gland, located in the base of the skull, secretes a hormone that stimulates thyroid cells to secrete thyroid hormone. This pituitary hormone has TSH.
A hormone called thyroid stimulating hormone, or TSH, is secreted by the pituitary gland, which is located in the base of the skull, and its job is to stimulate the cells that make thyroid hormone and are present in the thyroid gland to produce and secrete thyroid hormones.
Two basic hormones are produced by the human thyroid gland:
T3 and T4

In fact, when hypothyroidism is diagnosed subclinical, the condition is present only in laboratory findings and the person does not have many symptoms. In the test, these people have normal levels of thyroid hormones and are in their normal range, but TSH is slightly increased.
In subclinical hypothyroidism, what is important is that people with this complication are more likely to develop clinical hypothyroidism in the near future.
The causes that cause subclinical hypothyroidism are almost the same as the causes that cause clinical hypothyroidism, including the following:
Suitable Genetics Many people with subclinical hypothyroidism come from families with a family history of thyroid disease, and these families have a higher incidence and prevalence of thyroiditis called Hashimoto's.
Another cause is damage to the thyroid gland. For example, people who have a part of their thyroid gland removed for any reason. The third reason is that a person has a history of receiving radioactive iodine. Usually, people who need to be treated for radioactivity due to hyperthyroidism or Graves' disease may also develop subclinical hypothyroidism in the future.
Another reason for taking medications from taking medications that contain lithium or iodine can make the thyroid gland prone to hypothyroidism, whether subclinical or clinical.


Who is at high risk?

There are a variety of risk factors that we will address below

The first risk factor is gender

Studies show that women are much more likely to develop subclinical hypothyroidism than men. The true cause of this difference is still unknown, but it is possible that female hormones, including estrogen, play an important role.

the second risk factor is age

This complication, subclinical hypothyroidism, is said to be more common in the elderly because the thyroid-stimulating hormone TSH, which is secreted by the pituitary gland, tends to increase with age.

The third risk factor is receiving iodine
People with subclinical hypothyroidism Many of them are people who have been exposed to iodine before, such as people with hyperthyroidism, who have received radioactive treatment.



When a person has normal thyroid function where the level of thyroid stimulating hormone is within the normal range of the laboratory, each laboratory offering its range according to that laboratory reference is usually said to be above four and a half mIU  /  L or 5 ' ,It counts as above.
Again, sometimes the upper limit of normal range and different references can be slightly different
People whose blood tsh is higher than normal and whose thyroid hormone levels are normal are considered subclinical hypothyroidism sacs.
Another point is that doctors say that the levels of thyroid stimulating hormone or TSH in the blood fluctuate a lot, so it is necessary to repeat this test again after a few months.


Treatment of subclinical hypothyroidism

References and various articles and articles write different opinions about the treatment of this disorder.
One of the things that is most considered is that if the level of thyroid stimulating hormone in these people is less than 10 million units per liter, it is better to seek treatment.
One of the reasons for this recommendation is that it has been shown that high levels of thyroid-stimulating hormone in the blood can trigger the process of harming the body.
Credible studies over the past 10 years have provided evidence that if a person has had TSH levels between 5.1 and 10 and has been treated, there are many benefits to treatment.
So we can summarize that the need for treatment of a person with subclinical hypothyroidism depends on several factors, some of which are mentioned below:
The most important thing is the amount of blood tsh
Presence or absence of antithyroid antibodies in the body
Presence or absence of goiter
Symptomatic and asymptomatic, and how much of your life has been affected by the symptoms of the clinical manifestations of the disorder
Patient age as well as medical history and general health of the patient
When treatment is needed, the drug prescribed is levothyroxine, which is actually a synthetic thyroid hormone that is given in pill form, and when this treatment is done, the person can tolerate the pill well.


side effects

Side effects include the following:
Heart problems
There is a close link between subclinical hypothyroidism and cardiovascular problems
However, there are a number of doctors who are skeptical about this. Most studies suggest that when the thyroid-stimulating hormone in the blood rises, the process of damage to the heart and blood vessels begins.
Risks of pregnancy
Studies show that pregnant women with blood levels of the hormone 4.1 and untreated are more likely to lose the pregnancy product.
But women who had the same condition and suffered from the same hormone levels and were treated experienced significantly less pregnancy loss.
Non-pregnant people who are left untreated can develop problems such as high blood pressure and high blood vessel cholesterol levels. Studies show that if the level of this hormone is above seven, the risk of cardiovascular complications is doubled. 
During pregnancy, the mother's blood levels of the hormone tsh rise
TSH will be higher in the third trimester than in the first trimester, and it is said that adequate and normal levels of thyroid hormone are essential for the development of fetal brain and nervous system development.
Therefore, women with subclinical hypothyroidism and high anti-thyroid antibodies are more likely to experience unpleasant pregnancy outcomes.
If a woman has a positive anti-TPO and the tsh is higher than two and a half
She has a higher risk of complications and high-risk pregnancies
It is interesting to say that if this woman has a negative titer of anti-thyroid antibody and her blood TSH level is 5 to 10, the probability of pregnancy complications is less than acceptable.


Subclinical hypothyroidism in pregnancy

It is safe to say that there are international guidelines for lowering thyroid stimulating hormone in pregnant women.
The important point is that treatments for hypothyroidism in pregnancy are necessary if there is overt hypothyroidism in human pregnancy because it can have a huge impact on the development of the brain and nervous system of the fetus.
It is said that it is best to maintain two to three blood levels of tsh in the first trimester.


Is thyroxine treatment necessary in pregnant women with subclinical hypothyroidism?

If a woman has thyroid-stimulating hormone above two and a half during pregnancy, in order for us to be able to deliver this hormone to our goal, which is a level below two and a half, various solutions are recommended that are experimentally women who have previously had hypothyroidism and are now experiencing subclinical hypothyroidism during pregnancy start their own thyroxine treatment, which is wrong.
Pregnant women who have had primary hypothyroidism and their thyroid stimulating hormone concentration was 3 to 4 before pregnancy do not need to increase their dose in the first trimester of pregnancy. It is said that increasing the dose of thyroxine during pregnancy reduces the average concentration of thyroid stimulating hormone.
Pregnant patients who did not have a thyroid gland needed higher cumulative amounts of thyroxine to make their TSH acceptable.
The important point is that experimental increase in thyroxine dose in pregnancy should not be done because it can have many theoretical risks, so if you want to increase thyroxine dose in pregnancy, you must see a doctor And follow thyroid tests.


Are pregnant women who have subclinical in danger?

Maternal hypothyroidism is said to impair neuropsychological development and neonatal brain development in the fetus, and there are studies that could support this theory.
On the other hand, there are studies that have shown that there was no significant difference between fetal mental, physical and psychological development in mothers whose thyroid stimulating hormone levels were higher than two and a half compared to women whose levels of tsh were below this level.
There are studies that have examined the association between subclinical hypothyroidism and complications in high-risk pregnancies and the studies are both retrospective and prospective. These studies include maternal subclinical hypothyroidism and its association with pregnancy complications.
Pregnancy loss and hypertension were assessed during pregnancy and fetal death.
Can treatment of subclinical hypothyroidism in pregnancy improve pregnancy outcome?
In a group of studies, there was no significant difference in pregnancy outcomes. It is said that the moderate concentration of thyroid stimulating hormone in which thyroxine administration will make a significant difference in pregnancy outcome is 3.8
So with these uncertainties, how should we treat pregnant women with subclinical hypothyroidism?
It is recommended that subclinical hypothyroidism of pregnancy be diagnosed and treated based on the tsh level above the upper limit of the native reference.
It is recommended that thyroxine be considered during pregnancy and that the possibility of additional treatment during pregnancy should always be considered by a physician. In other words, the level of thyroid stimulating hormone should be repeated every month for one and a half months after each change in thyroid dose, and if necessary, thyroxine treatment should be increased.
And the bottom line is that the majority of women who have had subclinical hypothyroidism during pregnancy will need to be treated with thyroxine after delivery.

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