Thyroid Disorder May Mean Tough Pregnancy

[helvella]

If you have any interest in thyroid and pregnancy, this looks like a "must read" article.

Only two bits are quoted below - go to the full article for more. (The underlined bit is my emphasis.) I felt it would not be right to copy the whole text.

Thyroid Disorder May Mean Tough Pregnancy

By Kristina Fiore, Staff Writer, MedPage Today

Published: May 29, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

"Our results indicate that thyroid diseases are associated with significant increases in morbidity during pregnancy," they wrote. However, they cautioned that they lacked information on treatment during pregnancy and thus were "unable to explore whether inadequate treatment was the cause or whether some of the risk is due to thyroid disease itself."

AND

Action Points

Thyroid diseases, and hypothyroidism in particular, increase the risk for problematic pregnancy outcomes.

Point out that the study lacked information on treatment during pregnancy and the authors were unable to determine whether the pregnancy-related complications were due to inadequate treatment or from the thyroid disease itself.

medpagetoday.com/Endocrinol...

(I am not sure if registration is required. If so, it will be free.)

My second ever blog here was on the increased likelihood of breech presentation in hypothyroidism. Somewhat surprisingly that is not mentioned in the above article.That blog is here:

thyroiduk.healthunlocked.co...

Rod

[PinkNinja]

That's interesting. My son was breech and I had problems with both pregnancies, not including the two miscarriages. I also had marginal placental abruption with both my son and daughter, had A&E visits and was kept in with my daughter for several days (although longer than necessary due to my arrhythmia and ridiculous bradycardia).

I thought I was just unlucky, although actually very lucky in the most important of ways because I now have two wonderful children It could have turned out very differently so I count myself very lucky!

[hooper]

My second son was breech and my 4th pregnancy miscarried.

[PR4NOW]

Rod, I don't suppose you still might have the reference to the paper you mentioned in your second post about smoking causing raised FT3 by any chance? PR

[helvella Administrator in reply to PR4NOW]

I will try to remember! Am pretty sure it was in PubMed but I could be wrong.

[helvella Administrator in reply to PR4NOW]

Here you go (I think this is the right one - if not, there are another 77 or so by searching PubMed for "smoking triiodothyronine").

J Endocrinol Invest. 2010 Dec;33(11):815-8. doi: 10.3275/7168. Epub 2010 Jul 13.

Free triiodothyronine is associated with smoking habit, independently of obesity, body fat distribution, insulin, and metabolic parameters.

De Pergola G, Ciampolillo A, Alò D, Sciaraffia M, Guida P.

Source

Internal Medicine, Endocrinology, Andrology, and Metabolic Disease, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Via Putignani 236, Bari, Italy. [e-mail]

Abstract

BACKGROUND:

The aim of this study was to examine the relationship between thyroid hormones and smoking and several other parameters like age, gender, insulin, and anthropometric and metabolic parameters in subjects with a wide range of body mass index (BMI).

PATIENTS AND METHODS:

A total of 931 euthyroid normal weight (BMI<25.0 kg/m2), overweight and obese subjects (BMI =25.0 kg/m2), 663 women and 268 men, aged 18-68 yr, were investigated. Fasting TSH, free T3 (FT3), free T4 (FT4), insulin, glucose, and lipid serum levels were determined. Waist circumference was measured as an indirect parameter of central fat accumulation.

RESULTS:

Smokers were younger (p<0.001) and showed higher FT3 (p<0.01), and triglyceride (p<0.01) levels and lower glucose (p<0.01) and HDL (p<0.001) concentrations than non smoking subjects. FT3 levels were directly associated with BMI (p<0.001), waist circumference (p<0.001), insulin (p<0.001), and triglyceride (p<0.01) levels and negatively correlated with age (p<0.001) and HDL-cholesterol levels (p<0.001). When a multiple regression analysis was performed with FT3 levels as the dependent variable, and smoking, age, gender, and TSH, insulin, triglyceride, and HDL-cholesterol serum concentrations as independent variables, FT3 levels maintained an independent positive association with smoking (p<0.05), age (p<0.001), male sex (p<0.001), waist circumference (p<0.05), and insulin levels (p<0.001).

CONCLUSIONS:

Smoking increases FT3 levels independently of age, gender, obesity, body fat distribution and metabolic parameters.

PMID:

20634638

[PubMed - indexed for MEDLINE]

ncbi.nlm.nih.gov/pubmed/206...

Rod

[PR4NOW in reply to helvella]

Thank you very much. PR

[summer01]

Thanks Rod, that's very interesting. I was diagnosed a year after having my daughter but convinced I had problems during pregnancy. I ended up having a c section as My daughter was undiagnosed breach. Yep they told me her head was engaged when it was her foot! It's

[VanessaB]

I was diagnosed after 2nd son he was breach although he was turned by the midwives.I didn't have any other problems though as despite my worries he's perfect I am biased though.I too had two miscarriages.

[vajra]

HI guys. I did some digging last year on this topic on behalf of my 27 year old daughter who with care with her diet etc is doing well, but who has a definite tendency towards food sensitivities and related thyroid issues. (i'm hoping it's been caught early enough)

Hypothyroidism and related conditions during pregnancy seem potentially to impact not just about every aspect of not just foetal development, but also the lifetime health of the child.

Not only does it gives rise to risks to the pregnancy, and to the child - low thyroid also (see the third paper linked which is a pay per copy deal - hope i have the right one) gives rise to some risk that the child will go on to develop hypothyroidism. It effectively transmits from mother to child.

This because the foetus relies on the mother for supply of an elevated level of thyroid hormone - especially during a key period around 12 weeks in to drive the development of the various glands and regulatory mechanisms concerned. (this peak can be seen in the chart in the first paper, although it doesn't mention this specific issue)

The first paper is a good overview, the second if i have the right one includes discussion of the issue of hypothyroidism being passed from mother to child, and the third links some other papers which may or may not be of interest:

vivo.colostate.edu/hbooks/p...

nature.com/nrendo/journal/v...

bioportfolio.com/resources/...

What's especially frustrating about all of this is that despite all of this (and lots more on other aspects of hypothyroidism being well known and accepted) the de facto style of handling handling of hypothyroidism and other metabolic issues in medical practice is as we all know scarily offhanded and ineffective. That's at the level of simple response to symptoms in pateients - before the issue of the reliability of the blood tests hits the table....

ian

[helvella Administrator in reply to vajra]

The American Thyroid Association guidelines for pregnancy, whilst very much imperfect, do at least recognise a lot of issues. And yet, as you so rightly point out, these issues are then ignored and/or poorly implemented (if at all) too often

thyroidguidelines.net/pregn...

Thanks Ian.

Rod

[vajra]

PS Sorry - to be a bit more explicit. Taken together it all seems to suggest that if pregnancy is a possibility it'd make a lot of sense to check out the thyroid and related metabolic status first...

ian

[helvella Administrator in reply to vajra]

100% agreed. Preferably years before...

Rod

[vajra]

Ta to you too Rod. I'll pass your paper on to my daughter.

ian

[helvella Administrator in reply to vajra]

If she wants to print it, send her a ream of paper...