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Mary Shomon

Why Pregnant Women Need to Insist on a Thyroid Test

By February 11, 2010

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According to new research published in the Journal of Clinical Endocrinology and Metabolism, the current policy of limiting thyroid tests to women at high risk of thyroid disease overlooks most cases of thyroid disease during pregnancy, and undiagnosed, untreated thyroid disease in pregnancy carries a significant risk of an adverse outcome for both mother and baby.

For the purposes of the study, hypothyroidism in a pregnant woman was defined as having a TSH of 2.5 or higher, along with positive thyroid peroxidase (TPO) antibodies. Hyperthyroidism was defined as undetectable TSH concentration and elevated Free T4.

The research found that the "case finding" approach -- where patients are identified as hypothyroid or hyperthyroid based on symptoms -- leaves the majority of pregnant women with thyroid disease undiagnosed, as compared to universal screening, which would test all pregnant women.

The researchers found that compared to universal screening, case-finding carries a greater risk of thyroid-related adverse outcomes in pregnancy, including miscarriage, high blood pressure, preeclampsia, gestational diabetes, premature delivery, and low birthweight infants.

According to the researchers: "...treatment of identified thyroid hormonal abnormalities during pregnancy results in a significant decrease in adverse outcomes. Our study confirms that case finding fails to detect the majority of pregnant women with thyroid disease. A comprehensive cost-effectiveness analysis is required to resolve the debate of universal screening for thyroid disease in pregnancy."

What Should You Do?

The researchers and doctors will continue to debate whether or not universal thyroid screening is cost-effective, and whether or not it is cost effective to protect the health of mothers and babies with thyroid testing. While they continue debating, the critical message is this: if you are newly pregnant, insist on thyroid tests, including, at minimum, the TSH, Free T4, and thyroid antibodies blood tests.

If you'd like to view a short video on the subject, see Doctor's TVC for a 2-minute summary.

More Information on Pregnancy and Thyroid Disease

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Source: Negro, Roberto, Alan Schwartz, Riccardo Gismondi, Andrea Tinelli, Tiziana Mangieri, and Alex Stagnaro-Green. "Universal Screening Versus Case Finding for Detection and Treatment of Thyroid Hormonal Dysfunction During Pregnancy." Journal of Clinical Endocrinology and Metabolism, published February 3, 2010 online Rapid Publication

Comments
February 12, 2010 at 7:50 am
(1) Tamra says:

My preemie girl suffered from developmental delays, but she is finally caught up after six years.

I wish doctors would have tested my antibodies during pregnancy. I have been suffering from undiagnosed symptoms since I gave birth. Doctors ruled out thyroid because my TSH was never above a 2.74. After a lot of research, I asked a doctor to test my antibodies summer of ’09. I tested positive for Hashimoto’s. I am now on thyroid meds and doing much better. I still wonder if things would have turned out differently for my baby had I been on thyroid hormone then.

February 12, 2010 at 10:59 am
(2) crystal says:

During my pregnancy I had a really tough time with my weight. I had low thyroid symtoms, but wasn’t tested until 6 months after giving birth. My doctor thought I just ate too much and didn’t excercise enough. When my son was born he was 7 lbs and 5 ozs. He lost down to 6 lbs 3 ozs, but ate really good. The doctors never did figure out why he wasn’t gaining weight. He didn’t start gaining weight until he was 5 weeks old. Even though thats opposite from the trouble I was having, I wonder if it had anything to do with my thyroid complications. Since then I’ve been diagnost with hashimoto’s, and treated with medication, but still have symptoms.

February 12, 2010 at 11:10 am
(3) Liz says:

I have no thyroid and have had four miscarriages from what I believe was hypothyroidism.

I went to many specialist at top Boston hospital who found nothing wrong with me. All said the miscarriages had nothing to due with my thyroid.

Thank God for my midwife who noticed my TSH was high and increased my thyroid medication the third week of my pregnancy. I carried my baby to term and he was delivered by the same midwife.

Thank you midwife Janice D.

February 12, 2010 at 11:46 am
(4) Rod says:

It’s during pregnancy that the mothers body needs higher levels of nutrients, especially iodine. During pregnancy, these are pulled from every organ in the body, including the thyroid gland to build the baby. As the growing fetal brain requires 2x the amount of iodine needed as an adult. And since most of the population is iodine deficient, most women develop or are borderline hypothyroid before they start their pregnancy. The pregnancy just illuminates an even greater need for iodine in teh body. The best bio-available source are brown kelps like Kombu or Alaria, those are used in Korea by expecting mothers and after pregnancy during lactation. This fills the breast milk with healing polysaccharide sugars found in seaweeds and tranfers to the infant to build a strong immune system. More mothers in the US need to understand what they do in Korea with seaweed. They are taught of the connection between the ocean and our bodies at a very early age. They also have the lowest incidence of breast cancer in the world because of the seaweed they use in their diet.

February 12, 2010 at 5:33 pm
(5) Nancy Cramer says:

I had 2 miscarriages after my first child, and after a successful delivery of my second child I went into a “hyperthyroid” mode and lost so much weight that I had no body fat. Really weird! I went on to have 2 more children, but then had a 3rd miscarriage. I was not diagnosed with Hashimoto’s until 2 yrs ago. I will always wonder if that was the cause of my miscarriages. My endocrinologist seems to think so.

February 15, 2010 at 7:25 am
(6) Ciura says:

Please be extremely careful with the use of supplemental iodone excpet under medicla supervision – Especially in pregnancy, as, in hashimotos hypothyroidism (auto-immune) this can cause thyrotoxic shock (thyroid storm) which can be extremely dangerous among the non-pregnant and therefore of the utmost seriousness in pregnant women.

February 15, 2010 at 9:24 am
(7) Sarah Blogg says:

Thank you for raising this important issue. It’s important too to treat undiagnosed thyroid disease in pregnancy because it may prevent some incidents of dyslexia/specific learning difficulties and/or hyperactivity for the child or make them less severe.

My beloved son is doing well despite having severe dyslexia. He was hyperactive until about 7 years old. These kids deserve a good health service for their mums in pregnancy and mums deserve it too becuase untreated hypothyroid mums and hyperactive kids are not the best combination. We need energy to play!

Love and Light and Very Best Wishes to All Pregnant Women and Their Lovely Babies and to all kind good doctors who listen, Thank You xxx

March 9, 2010 at 9:26 am
(8) denise says:

is there research somewhere that shows the links between hypothyroidism and dyslexia? if so, can anyone provide that information and/or link?

May 5, 2011 at 7:29 am
(9) Sharon says:

Two years after having my 1st daughter in 1997 I kept feeling dizzy.I was sent away from the docs with tablets.No blood tests were carried out.I carried on, put on weight, felt tired all the time and was on anti-depressants (years of taking can cause under active thyroid).I had a miscarriage in 2001.Why? I got pregnant in 2002.I put on tons of weight and was so so tired.I specifically told the doc”I know I am pregnant but I have never felt so tired in my life!”I was told to have an afternoon nap! My son was born in Oct 2002.He cried constantly.I tried to breast feed.I couldn’t stand up after.I felt ill but carried on.My son constantly vomited, had diarrhoea, his chest rattled, cried constantly and only smiled on one side of his face and he had really bad eczema.No health visitor ever came.My husband took him the docs with all his symptoms age 3 months.He diagnosed facial palsy which can be caused by a brain tumour.He sent him hospital.We stayed in hospital for 24 hours where he continued to vomit & have diarrhoea.We were sent home with no explanation.I was exhausted as he NEVER slept.Age 9 months he saw a paeditrician. He said all his symptoms point to a lactose or milk intolerance. All milk was taken out of his diet. He slept all night age 10 months.I wanted to sleep 24 hours.When my son was age 18months I was so dizzy I was falling over.The doc sent me for a blood test.They said your BORDERLINE for underactive thyroid.Have another blood test in 3 months.I did and they prescribed 50mg thyroxine.Took years to get medication right as they will only increase it after a 3 month or 6 month blood tests.I take 175mg.Lactose/milk intolerance is a autoimmune disease which can be caused by fetal maternal underactive thyroid! My son is hyperactive and has a lower IQ! I think I had underactive thyroid prior to getting pregnant. My son still has facial palsy (he can only move one side of his face) but he hasn’t got a brain tumour.

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