Your Thyroid Levels While Pregnant

 

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Two pregnancy-related hormones—human chorionic gonadotropin (hCG) and estrogen—cause higher measured thyroid hormone levels in your blood. The thyroid enlarges slightly in healthy women during pregnancy, but usually not enough for a health care professional to feel during a physical exam. Thyroid problems can be hard to diagnose in pregnancy due to higher levels of thyroid.

Thyroid function tests change during normal pregnancy due to the influence of two main hormones: human chorionic gonadotropin (hCG) and estrogen. Because hCG can weakly stimulate the thyroid, the high circulating hCG levels in the first trimester may result in a low TSH that returns to normal throughout the duration of pregnancy. Estrogen increases the amount of thyroid hormone.

You find out you’re pregnant and find out your TSH is 5.0. Your doctor starts you on 50mcg of levothyroxine thyroid medication and your TSH lowers to 2.6. 2.6 is outside of the recommended range of 0.1 to 2.5 which means your thyroid is not optimized.

Your doctor then increases your dose to 75mcg of levothyroxine and rechecks your TSH. Low thyroid levels during pregnancy, for example, can be caused by high levels of hCG. When this hormone is present, the result will be lower TSH levels, which can lead to hyperthyroidism. And the opposite can happen due to estrogen, resulting in the thyroid underperforming and causing you to gain weight (outside of normal pregnancy weight). When you’re pregnant, your body is constantly evolving—your belly is growing, your hormones are changing, and sometimes your thyroid goes haywire.

Because of these changes, pregnancy can trigger a thyroid problem. You may be more susceptible to a thyroid condition during pregnancy for genetic reasons, from pre-existing hypothyroidism that hasn’t been treated properly, or from previous damage. Hypothyroidism is one of several thyroid diseases in which the thyroid gland doesn’t make enough thyroid hormone so levels of the hormone levels become low.

When thyroid hormone levels are too low, it causes symptoms like tremors, weight loss and frequent bowel movements. Severe, untreated hypothyroidism during pregnancy may cause complications that affect the baby and lead to delayed development. In the first trimester, hCG — which is similar to TSH — stimulates production of thyroid hormones. And throughout pregnancy, increased estrogen levels produce a hormone that helps transports thyroid hormones in the blood.

By the third trimester, the thyroid’s volume may be 10-15 percent greater. All of this is normal. Thyroid function tests change during pregnancy due to the influence of two main hormones: human chorionic gonadotropin (hCG), the hormone that is measured in the pregnancy test and estrogen, the main female hormone. HCG can weakly turn on the thyroid and the high circulating hCG levels in the first trimester may result in a slightly low TSH. The thyroid makes hormones that help your body work.

If it makes too little or too much of these hormones, you may have problems during pregnancy. Untreated thyroid conditions during pregnancy are linked to serious problems, including premature birth, miscarriage and stillbirth. If you’re pregnant and already taking this medication for abnormal thyroid hormone levels, your doctor may recommend increasing your dose by about 30 to.

List of related literature:

During normal pregnancy, daily thyroid hormone requirements increase by approximately 30% to 40% above baseline beginning very early in gestation.

“The Brigham Intensive Review of Internal Medicine E-Book” by Ajay K. Singh, Joseph Loscalzo
from The Brigham Intensive Review of Internal Medicine E-Book
by Ajay K. Singh, Joseph Loscalzo
Elsevier Health Sciences, 2017

Figure 61.2 Relative changes in maternal and fetal thyroid function during pregnancy.

“Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice E-Book” by Robert Resnik, Charles J. Lockwood, Thomas Moore, Michael F Greene, Joshua Copel, Robert M Silver
from Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice E-Book
by Robert Resnik, Charles J. Lockwood, et. al.
Elsevier Health Sciences, 2018

During pregnancy, a 30–40% increased need for thyroid hormones is the result of increased placental uptake, higher thyroid-binding globulin levels, and greater blood volume.

“Treatment of Infertility with Chinese Medicine E-Book” by Jane Lyttleton
from Treatment of Infertility with Chinese Medicine E-Book
by Jane Lyttleton
Elsevier Health Sciences, 2013

Hypothyroidism during pregnancy is less frequent because many women with hypothyroidism are anovulatory or have high rates of first-trimester miscarriages.

“Primary Care E-Book: A Collaborative Practice” by Terry Mahan Buttaro, Patricia Polgar-Bailey, Joanne Sandberg-Cook, JoAnn Trybulski
from Primary Care E-Book: A Collaborative Practice
by Terry Mahan Buttaro, Patricia Polgar-Bailey, et. al.
Elsevier Health Sciences, 2019

Figure 60-2 Relative changes in maternal and fetal thyroid function during pregnancy.

“Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice” by Robert Resnik, MD, Robert K. Creasy, MD, Jay D. Iams, MD, Charles J. Lockwood, MD, MHCM, Thomas Moore, MD, Michael F Greene, MD
from Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice
by Robert Resnik, MD, Robert K. Creasy, MD, et. al.
Elsevier Health Sciences, 2013

Although the thyroid gland increases in size by approximately 15% during pregnancy, this is not usually detectable on clinical exam.

“Swanson's Family Medicine Review” by Alfred F. Tallia, Joseph E. Scherger, Nancy Dickey
from Swanson’s Family Medicine Review
by Alfred F. Tallia, Joseph E. Scherger, Nancy Dickey
Elsevier Health Sciences, 2008

and T Increased 4 levels while iodine largely demand unchanging during pregnancy free lev­can cause both a 15% increase in sonographic thy­roid size in normal women, and a 25% increase in the pre­pregnancy levothyroxine requirement once a hypo­thyroid woman becomes pregnant.

“Swanson's Family Medicine Review E-Book” by Alfred F. Tallia, Joseph E. Scherger, Nancy Dickey
from Swanson’s Family Medicine Review E-Book
by Alfred F. Tallia, Joseph E. Scherger, Nancy Dickey
Elsevier Health Sciences, 2012

During pregnancy, the thyroid gland tends to become slower.

“Brighton Baby: a Revolutionary Organic Approach to Having an Extraordinary Child: The Complete Guide to Preconception & Conception” by Roy Dittmann
from Brighton Baby: a Revolutionary Organic Approach to Having an Extraordinary Child: The Complete Guide to Preconception & Conception
by Roy Dittmann
Balboa Press, 2012

Week of pregnancy Fig. 3.10 Relative Changes in Maternal Thyroid Function During Pregnancy.

“Obstetrics: Normal and Problem Pregnancies E-Book” by Mark B Landon, Henry L Galan, Eric R. M. Jauniaux, Deborah A Driscoll, Vincenzo Berghella, William A Grobman, Sarah J Kilpatrick, Alison G Cahill
from Obstetrics: Normal and Problem Pregnancies E-Book
by Mark B Landon, Henry L Galan, et. al.
Elsevier Health Sciences, 2020

During pregnancy, the thyroid hormone requirements in the majority of patients may increase up to 50% compared to the patient’s prepregnancy L-thyroxine dose.

“Surgery of the Thyroid and Parathyroid Glands E-Book: Expert Consult Premium Edition Enhanced Online Features” by Gregory W. Randolph
from Surgery of the Thyroid and Parathyroid Glands E-Book: Expert Consult Premium Edition Enhanced Online Features
by Gregory W. Randolph
Elsevier Health Sciences, 2012

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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7 comments

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  • Hello! My tsh is 3.08, t3 is 0.87 and t4 is 6.62. I have been trying to conceive for the last 3-4 months. Should I take any medicine for improving my fertility?

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  • Hi, very interesting video. I’m trying to get pregnant and my husband and I are waiting for help since we’ve been trying for a while. I’ve recently done some bloodtest on tsh and they showed I have 3,1. But because it’s considered within the normal range the doctors don’t want to help me with that issue, despite me noticing several symptoms of low thyroid function (already before I started trying to get pregnant I noticed this). What should I do? The doctors won’t help me and I just know that so many of my problems stem from me having such a high tsh…

  • Mam..my wife is having thyroid problems & she’s taking 50mg thyroxine sodium tablets from last 6months…now she’s 11weeks pregnant.Her TSH level is 4.7 at present. Is it normal? Doctor told us to continue with 50 mg tabs…Should we continue with 50 mg or higher dose??

  • Dr does taking low thyroid medication can treat PCOS, I assume that my PCOS caused by low thyroid which appears in my childhood?

  • Hi, my tsh, t3, t4 have been in normal range during my pregnancy until this last week. I’m 22 weeks pregnant, my Dr. Wants me to start taking levothyroxine for low tsh which read to be.26, does that sound reasonable? And she got my results back the next day which seemed weird to me.