The thyroid gland is an important endocrine organ that regulates the body’s metabolism and also affects the reproductive function of women. Abnormal thyroid function is more common in people of childbearing age, and the incidence is about 4-5 times higher in women than in men. When women have abnormal thyroid function, they are prone to menstrual disorders, reduced chances of conception, and unfavorable outcomes of pregnancy. Recently, I visited the obstetrics and gynecology department, and three patients in the ward, two with preterm miscarriage and one with ectopic pregnancy, all three had abnormal thyroid function, which is alarming!
Some data show that nearly 1/10 women in China have had thyroid disorders during pregnancy in the first half of pregnancy, such as the common clinical hypothyroidism, subclinical hypothyroidism, hyperthyroidism during pregnancy, etc. So, mothers-to-be, are you ready to have a healthy and active baby?
I. Who needs to check thyroid function?
The presence of thyroid disorders during pregnancy in expectant mothers can cause miscarriage, premature birth, perinatal fetal death and even affect the intellectual development of offspring. Therefore, it is best for women with childbearing plans to undergo screening for thyroid indicators before pregnancy. Once the disease is diagnosed, pregnancy can be selected after effective treatment before pregnancy. After pregnancy, blood should be drawn before 8 weeks of gestation to check thyroid function, with special attention to serum thyroid stimulating hormone (TSH), free thyroxine (FT4) and thyroid peroxidase antibodies (TPOAb). Abnormal thyroid function should be of high concern in all of the following groups.
1. have had abnormal thyroid function, or have had thyroid surgery.
2. have a family history of thyroid disease.
3. have a goiter, or have positive thyroid antibodies
4. having symptoms of hypothyroidism such as fear of cold, drowsiness, weakness, dry skin, false swelling of the cheeks and thinning of hair.
5, pregnant women who are patients with type 1 diabetes or autoimmune diseases.
6, having a history of miscarriage or preterm delivery
7, a history of infertility.
8, history of head and neck radiation therapy, especially women with a relatively high number of treatments.
9, BMI ≥ 40, or age 30 years or older.
10, patients who have taken amiodarone or lithium preparations.
11, have used iodine-containing contrast agents within 6 weeks.
II. Management of thyroid function control goals during pregnancy?
In 2012, China’s Guidelines for the Diagnosis and Management of Thyroid Diseases in Pregnancy and the Postpartum Period (2012) (hereinafter referred to as “the Guidelines”) were officially introduced to further promote the screening of thyroid diseases in pregnancy. The Guidelines recommend that: according to China’s national conditions, hospitals and maternal and child health care departments in China that are in a position to do so should be supported to screen women for thyroid disease in early pregnancy, and the timing of screening should be chosen before the 8th week of pregnancy. It is best to screen for thyroid indicators before pregnancy, and once the disease is diagnosed, pregnancy can be chosen after effective treatment before pregnancy to ensure the maximum health of mother and child.
New recommendations for TSH value control during pregnancy are as follows.
Early pregnancy: between 0.1 and 2.5
Mid-term pregnancy: between 0.2 and 3.0
Late pregnancy: between 0.3 and 3.0.
The Guidelines also state that hospitals and maternal and child health departments that are in a position to do so should support screening for thyroid disease in women in early pregnancy, with serum TSH, FT4 and TPOAb as the screening indicators of choice.
So, for those who are preparing to become mothers, understand that women with abnormal thyroid function are prone to menstrual disorders, reduced chances of conception, and unfavorable outcomes to pregnancy. In particular, women who have suffered from abnormal thyroid function or had thyroid surgery, have symptoms of hypothyroidism such as fear of cold, drowsiness, weakness and thinning hair, have a detected goiter, or have positive thyroid antibodies are at higher risk of abnormal thyroid function and should pay special attention to screening for thyroid disease when they become pregnant.