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Your thyroid gland is a butterfly-shaped gland that is located at the front of your neck. The job of the thyroid gland is to produce thyroid hormones, which help to regulate your metabolism. These hormones affect many organs in your body. Having too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormone can cause problems during pregnancy. Knowing the signs of hyper- and hypothyroidism can be helpful to those women who are trying to conceive or are already pregnant.

Hyperthyroidism 

Hyperthyroidism is when the thyroid gland produces an excessive amount of thyroid hormone. Symptoms include: 

• Fast heart rate 
• Unintentional weight loss
• Heat intolerance and/or sweating
• Palpitations
• Insomnia
• Hypertension. 

You may also feel jittery and nervous. 

Unfortunately, many of these symptoms sound like changes you would expect to see during a typical pregnancy anyway, which can make diagnosing a genuine thyroid problem challenging. In general, the symptoms of hyperthyroidism are more pronounced and stronger than those experienced during a normal pregnancy. A woman might also have a lump on her neck known as a goiter, which is when the thyroid gland becomes enlarged.

Hyperthyroidism can affect the developing baby as well. If left untreated, it can lead to a premature delivery, low birth weight, and miscarriage. It can also be a cause of infertility. 

Treatment involves medication that blocks the production of thyroid hormone.

Hypothyroidism 

This is when the thyroid gland produces too little thyroid hormone. The symptoms are generally the opposite of those of hyperthyroidism: 

• Weight gain
• Fatigue, 
• Constipation
• Feeling cold
• Hair loss
• Dry skin. 

Without treatment, pregnancy complications can arise, including infertility, miscarriage, preterm birth, preeclampsia, and stillbirth.

Treatment is usually prescription of a synthetic thyroid hormone.

How to diagnose these disorders 

Screening for thyroid disease is not a part of routine prenatal tests and is usually only done if a woman has symptoms, has a history of thyroid issues, or is being evaluated for other issues such as infertility. Diagnosis is via blood tests, which measure the levels of the different thyroid hormones. If a problem is identified, these tests will be repeated regularly throughout pregnancy to make sure the treatment is adequate.

Often a multidisciplinary approach will be adopted to manage thyroid disease in pregnancy. You may see an endocrinologist who specialises in hormone disorders, as well as an obstetrician trained in high-risk pregnancies. Fortunately, for many women with thyroid disorders, provided they are adequately identified and treated, the likelihood is they will have a normal, healthy pregnancy.

Sources:

• The American College of Obstetricians and Gynecologists
• Practice Bulletin #148: Thyroid disease in pregnancy.

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