When You're Trying to Conceive
Few things in life are more exciting than the prospect of having a baby. The good news is that having thyroid disease does not necessarily prevent you from having a child. In fact, most women who have thyroid disease conceive with little effort and have perfectly healthy pregnancies and babies.
Even women who have a history of thyroid cancer can still have a perfectly healthy pregnancy and normal baby. There is no evidence to show that thyroid cancer or its treatments causes birth defects or difficulties with pregnancy. The only caveat comes into play if you've had RAI treatment, which simply means you might need to wait a few months before conceiving. The exact amount of time depends on your doctor.
Women with subclinical hypothyroidism may have no problem getting pregnant. But they are generally at higher risk for miscarriage, stillbirth, and premature birth. Any woman with repeated miscarriages and problems carrying a baby to term should consider having her thyroid tested.
Other women with thyroid disease, however, wrestle with serious problems, especially if the condition goes undetected and untreated. For starters, you may not be able to even get pregnant. Others may get pregnant, but then suffer problems such as miscarriage, pre-eclampsia, and premature labor and delivery. And if you carry the baby to term, the baby may inherit your thyroid condition and experience problems with growth and development. Severe cases may lead to mental retardation and birth defects. (See Chapter 16 for more on children and thyroid disease.)
In reality, those are the exceptions. Plenty of women have battled thyroid disease and gone on to have perfectly healthy babies. The key is making sure that you are routinely monitored and that your condition is under control before you get pregnant.
As soon as you learn you're pregnant, it's important to tell your obstetrician-gynecologist if you've ever had, or currently have, a thyroid problem. You should also tell your doctor if you have a family history of thyroid problems.
You should also let your endocrinologist know about your plans to conceive, so that he will keep an eye on your TSH levels and make sure you're getting enough medication to keep your disease in check. Making the effort to take precautions will help ensure that you have a healthy pregnancy — and a healthy baby.
Before Getting Pregnant
Healthy women take it for granted that their thyroid glands are churning out the right amount of thyroid hormone. But if you're contemplating pregnancy and have hypo- or hyperthyroidism, it's essential to make sure you have the proper amount of thyroid hormone. That means getting the disease under control
Even if you don't have thyroid disease right now, you may want to have your thyroid checked if you have a family or personal history of thyroid disease. You may also want to check your thyroid if you have a family or personal history of conditions associated with thyroid problems such as type 1 diabetes, vitiligo, or celiac disease.
If your TSH test shows that you are hypo- or hyperthyroid, make sure to get treated and to follow up with your doctor to see if your TSH becomes normal. (We discuss both conditions and their treatments in detail in Chapters 4 through 9.)
You should also talk to your doctor about the best time for you and your partner to start trying to get pregnant. Different doctors will have different opinions about the ideal TSH for conceiving. But ideally, you should at least be close to having healthy thyroid function before you try to get pregnant.
You've gotten the green light, but months later, you're still not pregnant. For some women with thyroid disease, getting pregnant may be the biggest challenge of all. Many factors can make a couple infertile. Sexually transmitted diseases, cigarette smoking, and advancing age can all make it harder for a couple to conceive. Thyroid disease can also make conception difficult.
Women who have thyroid disease sometimes develop menstrual irregularities for numerous reasons. These problems include:
Lack of ovulation, so there is no egg released for conception to occur. This may occur in both hypo- and hyperthyroidism.
PCOS, a condition that causes cysts on the ovaries and inhibits pregnancy. PCOS is more common in women with hypothyroidism.
Irregular menstrual cycles that make pregnancy difficult. Menstruation can be affected by both hypo- and hyperthyroidism.
Excess prolactin, a hormone released by the pituitary gland that stimulates milk production after delivery and that may inhibit ovulation. This problem may occur in women with severe hypothyroidism.
In most cases, proper treatment of the underlying thyroid disease will resolve these problems. But if fertility is still a challenge, you or your partner may have another health problem that warrants medical attention.
How do I know if I'm ovulating?
An ovulation predictor kit is your best bet. The stick turns color the day before you ovulate in response to an increase in luteinizing hormone (LH), the hormone that triggers ovulation. You can also try charting basal body temperature first thing in the morning over a few months to figure out when you ovulate. An increase in body temperature usually indicates you're ovulating.
Women who have hyperthyroidism may have a hard time staying pregnant. Hyperthyroidism increases your risk for miscarriage, which is the premature loss of a pregnancy. Women who have repeated miscarriages and have signs or symptoms of hyperthyroidism should definitely have their thyroid function checked. Again, treatment for the thyroid disease can usually resolve the difficulties unless there is another underlying problem.