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AACE and ATA Thyroid Awareness Month Campaign 2007

Mary Shomon's Look at the "Top Ten Things You Should Know"

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Updated January 11, 2007

AACE and ATA Thyroid Awareness Month Campaign 2007

"7.) Changing brands and dosage that affect thyroid hormone levels should be followed by retesting."

This is good advice. Typically, retesting is recommended around 8 to 12 weeks after a medication change or dosage adjustment. Retesting is also recommended if you have started or stopped a high-fiber diet, or a drug containing estrogen. Retesting is recommended for pregnant women on thyroid hormone replacement early in the first trimester, and then at least once per trimester -- at minimum.

"8.) Do not change your dose of thyroid medication without guidance from your physician."

Patients definitely should follow this recommendation. At the same time, if your thyroid medication isn't doing its job, and your doctor won't discuss whether or not other dosages of thyroid medications may work better to treat your thyroid disease and symptoms, then it's time to find a new doctor.

"9.) Thyroid conditions in pregnancy warrant close attention."

Proper thyroid diagnosis and treatment is critical during pregnancy. The developing fetus is unable to produce its own thyroid hormone during the first trimester of pregnancy, and so the mother's thyroid typically enlarges, and produces extra thyroid hormone to first meet her baby's needs. Hypothyroidism in the mother, especially in early pregnancy, increases the risk of miscarriage, stillbirth and premature delivery, and puts the developing baby at risk of various developmental delays and even retardation. Three different situations can pose a problem:
  • A woman with normal thyroid function before pregnancy can become hypothyroid during early pregnancy.
  • A woman with undiagnosed and untreated hypothyroidism can become pregnant, and her thyroid condition remains untreated.
  • A woman with diagnosed and treated hypothyroidism can become pregnant. The pregnancy puts an increased strain on her thyroid gland, but her underactive gland is unable to produce the additional thyroid hormone needed. Without an increased dosage of medication, the woman is again hypothyroid.
Interestingly, in a consensus statement published in the The Journal of Clinical Endocrinology & Metabolism in 2005, the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society jointly recommended against routine screening for thyroid dysfunction in pregnancy.

Research has shown, however, that failing to routinely test for thyroid problems in pregnancy misses a substantial level of hypothyroidism. In fact, a recent study showed that if only those at high-risk are tested, as recommended by the Consensus Statement, that up to one-third of pregnant women with overt/subclinical hypothyroidism will not be diagnosed and treated, putting those women at risk of miscarriage or stillbirth, and putting the child at risk of prematurity, developmental delays and even mental retardation.

Some physicians -- including obstetricians -- are also unaware that among women with hypothyroidism, the majority will need an increase in their thyroid hormone replacement drug in order to protect the pregnancy. A respected study conducted at Brigham and Women's Hospital-Harvard Medical School in Boston, and reported in the New England Journal of Medicine in 2004, found that 85 percent of pregnant women with hypothyroidism require an increase in thyroid hormone replacement drug during pregnancy, with the need for increased dosage starting as early as the fifth week of gestation. Since obstetricians routinely tell patients to come in for their first visit starting at the eighth week of gestation, some hypothyroid women may already be in need of an increased dosage, endangering their baby's development, or even the pregnancy, by failing to receive thyroid evaluation early in pregnancy.

At the same time, when an appointment is made, office staff often suggest over the phone that the woman start right away taking a prenatal vitamin. Prenatal vitamins typically contain high amounts of iron. When taken in the same time frame (usually within 4 hours or less) of thyroid hormone drugs, the iron can reduce the effectiveness of the thyroid hormone, which could further worsen the hypothyroidism. This sort of counseling, however, is rarely offered. (It's also important to mention that many pregnant women use antacids that contain aluminum and/or magnesium, and these can also interfere with thyroid hormone. They should be taken 4 hours apart from thyroid medications.)

I believe that thyroid screening should be a standard part of a pre-conception workup, and should also be standard in early pregnancy for all women. And, ultimately, hypothyroid women must advocate for themselves, and be highly knowledgeable and highly proactive about their thyroid monitoring, treatment and management during pregnancy.

"10.) Thyroid cancer is one of the fastest growing cancers in America and one of the most curable."

This is true. It's important however, to put into perspective that despite being one of the "fastest-growing cancers," thyroid cancer is still quite rare. According to the American Cancer Society's "Cancer Facts & Figures 2006," an estimated 1,399,790 new cancer cases overall were expected in 2006. Among them, 212,920 new cases of breast cancer, and 234,460 new cases of prostate cancer, were predicted. At the same time, a total of 30,180 new thyroid cancers were predicted.

Mary Shomon, About.com's Thyroid Guide since 1997, is a nationally-known patient advocate and best-selling author of 10 books on health, including "The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age," "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know," "Living Well With Graves' Disease and Hyperthyroidism," "Living Well With Autoimmune Disease," and "Living Well With Chronic Fatigue Syndrome and Fibromyalgia." Click here for more information on Mary Shomon.

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