Should Pregnant Women Be Routinely Tested for Thyroid Problems?

I came across this article today:


It's pretty compelling, and after reading it I think it would be a good idea for pregnant women to be tested for thyroid problems.  I've never had any thyroid problems personally that I'm aware of, but I haven't been tested either.  The article states that thyroid problems have been linked to such complications as miscarriage, high blood pressure, preeclampsia, gestational diabetes, premature delivery and low birth weight babies.  These are common complications, and I'm always looking for ways to help women stay low risk.

I'm skeptical about unnecessary testing and screening during pregnancy, and I think each woman should weigh her options carefully before deciding which to do.

I'm curious if any of you have had thyroid problems and how it's affected your pregnancy if at all.  Do you think routine thyroid tests during pregnancy would be a good thing?

Tags: pregnancy, routine, screening, test, thyroid

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I think if they added it to the regular "routine" blood tests, they might have less babies born prematurely. I was unknowingly hypo for my 4th pregnancy (and possibly longer than that) which we believe caused premature labor at 27 weeks, which required me to be on bedrest for 11 weeks. I now have 2 days until my due date with #5 and no problems this time either. I do believe also that there may be a link between GD and thyroid problems as I had GD with babies 3 and 4, but not this time. It really surprised me what is all affected if your thyroid is not working properly! After being diagnosed with Hashtimotos Syndrome, my numbers have been kept where they should be and I've been feeling a lot better. :)
Thank you Sara. While I don't like all the routine testing that's done in pregnancy, I tend to agree with you that this could help prevent serious complications. Even if it's not something they do routinely, I think it's something that should be considered on a case by case basis.
I guess that depends on what case by case means. I had NO idea that having thyroid problems could cause premature labor, GD or any of the other symptoms... The problem is that most of them were brushed off as pregnancy related. I even told my dr of family thyroid problems and it still took nearly 6 months post partum to be diagnosed properly. Had I been screened earlier, I wouldn't have suffered PPD nearly as bad either. I guess if you have family history and even a few symptoms (whether they CAN be pregnancy related or not) I think getting your TSH, T3 and T4 checked could help a lot.
Sara, you have some really good points. Somehow women need to know these things, and I'm just not sure what the best way is to get the word out. Whether it's by routine testing or a more thorough prenatal visit including more questions about possible symptoms, or both, we need to raise awareness of the risks that thyroid problems can cause in pregnancy.
"...we need to raise awareness of the risks that thyroid problems can cause in pregnancy."

Absolutely. It would probably even make a dent in the c-section rate!
I didn't have any pregnancy problems with my hypothyroid, just OB problems LOL, and even with the increased risk of placental abruption with this condition (and w/twins!!) they will keep upping the pit ;( . Yet another reason to go with midwifery care. My midwife just asked me to test every trimester to make sure I was on the right dose, and the L&D went well and was at term.

If I hadn't already known I had hypothyroidism I probably would ask to be tested since some women develop it during pregnancy. Another interesting tidbit is that thyroid issues can affect the timing of your period, so it ought to be factored into the EDD, especially if the EDD is by ultrasound and after 14 guesstimated weeks. It would make an induction/section before 41 weeks especially dangerous for baby.

"In North America, maternal hypothyroidism is mainly due to autoimmune thyroid disease. Untreated hypothyroidism is associated with several complications, most notably preeclampsia and low birth weight, but also abruptio placentae and increased risk of spontaneous miscarriage and perinatal mortality. Treatment with L-thyroxine reduces the complications substantially (23).

Although effects of maternal hypothyroidism on fetal brain development are not well defined, several recent reports indicate that IQ is modestly affected (24, 25, 26). These studies have increased the concern that even mild hypothyroidism can interfere with normal brain development. Indeed, several authors have proposed screening programs for thyroid dysfunction during or even before pregnancy. The economic impact is not inconsequential, and so it is important to understand not only the underlying potential problems but also the goals of intervention."

http://jcem.endojournals.org/cgi/content/full/jcem;86/6/2349
Thank you Susan!
I didn't do any research on this subject until after the boys were born in '07. I just had my levels tested regularly.

I was under the impression that they were incorporating thyroid testing into the normal battery of tests. It seems like it would be more than, or just as, important as the routine HIV screens they'd like everyone to consent to during pregnancy. The more I know about OB the less *common* sense it makes.
As far as I know, it hasn't been incorporated into the normal battery of tests. There's a concern in the medical side of things in considering how cost effective it would be to include thyroid testing as routine, particularly during pregnancy.
Considering the complications that untreated thyroid disease can cause, and the benefits associated with treatment, it seems a small price to pay.

"most notably preeclampsia and low birth weight, but also abruptio placentae and increased risk of spontaneous miscarriage and perinatal mortality."

I wonder if women who experience these problems are tested? If they aren't, and there is a - result, and later it's shown that the women has thyroid disease, could the practitioner be held responsible for negligence?

There are a lot of c/s for the above reasons, and for breech position. If thyroid testing and treatment reduces cesareans, would the cost of the testing be equal to, or less than the cost of the extra cesareans associated with failing to diagnose thyroid disease? Also, reducing primary c/s would save $$ both short and long term. Even more important is the human cost of miscarriage and perinatal demise.

I think you've really hit on an important subject here Cherylyn. Women should at the very least have the info. in front of them in order to request being tested if they choose.
Thyroid testing is extremely important in pregnancy, especially if you already have/had thyroid issues or you are 'borderline'.

Please remember that with everything going on in your body during pregnancy, your thyroid is also going through changes. A lot of times your doc may need to increase your dosage of thyroid medication during pregnancy because your hypothyroidism gets worse.

Also, keep in mind that the normal TSH range is 0.3 - 3.0.
(This was updated in 2003 from the old range of 0.5 - 5.0) A lot of docs/labs are not using the new guidlines, and they may say that you are within normal range if you have say a 3.5, or a 4, etc. when really you are hypothyroid.

I have also heard that if you are TTC or pregnant it's best to have your TSH around 1 or 2.

http://www.thyroid-info.com/

Why Pregnant Women Need to Insist on a Thyroid Test
I am so happy you have shed some light on this Cherylyn!

I have been studying hypothyroidism and its effects for about a year now, as I am trying to heal my own thyroid naturally, through diet and supplementation. It's tough and fully understanding the effects of hypothyroidism and its causes is a little like journeying through Alice and Wonderland!

The biggest problem the medical industry has right now is the archaic standard TSH test. This test is from the 1940's and by itself, highly insufficient. TSH tests only ONE function of the thyroid and there are many more players involved that should undergo testing.

A full panell test includes:

TSH: the high sensitivity version (thyroid stimulating hormone)

Free T4 and Free T3

Thyroid antibodies, including thyroid peroxidase antibodies and anti-thyroglobulin antibodies (this helps determine if your body is attacking you thyroid, overreacting to its own tissues; auto-immune reaction. Physicians almost always leave this test out.

TRH (thyroid releasing hormone) which is a stimulation test which helps identify hypothyroidism caused by inadequacy of pituitary gland.

Your thyroid also produces T2, yet another hormone which is lto date one of the east understood components of thyroid function.

Our thyroid produces the master metabolism hormones that control every function in our bodies. Thyroid hormones interact with all other hormones including insulin, cortisol and sex hormones estrogen, progesterone and testosterone. Our thyroid hormoes work in a feedback loop with our brain...particularly the pituitary and hypothalamus..in regulating the release of thyroid hormone. Our pituitary is responsible for makikng TRH and our hypothalamus makes TSH. These two hormones (T3 and T4) are what controls the metabolism of EVERY CELL in your body.

It makes sense to me why women are experiencing problems during pregnancy and birth....because we need our thyroid to help us with every aspect of it.

www.stopthethyroidmadness.com is a great website to get the entire thyroid picture and the climate in the current medical system today.

Never ignore your symptoms. infact, thyroid issues used to be treated based on symptoms alone...before TSH testing came along. Drs also used to treat thyroid symptoms with dessicated thyroid and iodine. It was big pharma that came along with synthroid as a treatment which led to doing away with iodine...a most necessary nutrient!

I could go into it further but if you are interested in iodine, www.iodine4health.com is a great website to look at.

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