Preeclampsia and hypothyroidism

[alviarin]

Does everyone with hypothyroidism need to see an endocrinologist? We are thinking of TTC soon and I am trying to cover all my bases.

Not everyone with hypothyroidism needs to see an endocrinologist, but my personal experience has been that endocrinologists and MFMs (maternal fetal medicine docs) tend to know more about the effects of thyroid disease on pregnancy. And as a specialist an endocrinologist should be more updated about the latest guidelines regarding thyroid management during pregnancy.

There are exceptions to every rule though. I saw a bad endocrinologist once (who never even bothered to "check my neck"), then saw an awesome one who had done thyroid related research, and picked the last one based on his age/graduation date. I figured the youngest endo in my area was probably more up to date on all the thyroid related research that has come out in the last decade. Unfortunately, some endos seem to focus more on diabetes than thyroid issues.

My first OB and current GP are actually great dealing with thyroid stuff too though. However, it can take a while for the latest guidelines to trickle down to care providers, and different docs have different definitions of what is "normal" thyroid-wise. So I always ask for a copy of my blood results and try to read the latest pregnancy reccomendations.

Here are links to some recent guidelines regarding management of thyroid and pregnancy:
2011 American Thyroid Association (ATA) guidelines:
http://thyroidguidelines.net/sites/thyr ... 1.0087.pdf
2007 clinical guidelines from The Endocrine Society (co-sponsered by American Association of Clinical Endocrinologists):
http://www.endo-society.org/guidelines/ ... partum.pdf

Personally, before choosing a doctor to manage my thyroid levels I would ask some questions. Such as:
"What should my target TSH be pre-conception and during pregnancy?" (If they don't say below 2.5 mIU/L, I would print them out a copy of the latest thyroid guidelines & move on).
My favorite endo's goal for TSH was 1-2 mIU/L, but she also made sure to check free T3 and free T4 levels during pregnancy.

"How often should my thyroid levels be tested during pregnancy?" (If they say once a trimester and not more frequent checks in first half of pregnancy, again I would educate them or move on). Right now my thyroid levels are being checked every month, will be checked again at least once in third trimester, and will be checked again postpartum. Most hypothyroid women need their thyroid dose upped in first half of pregnancy, and if so it is common to drop back down to a pre-pregnancy dose postpartum.

Hope this helps, please let me know if you have any more questions!

[amjon]

I just found out I may be hyperthyroid after my second loss. I have to go to the endo to be evaluated (and treated). We're still planning to go ahead with conceiving for now. I only looked up hyper, but it did say it could cause pre-e (as well as fetal death and miscarriage - why don't they test these things after the first death!).

[jjdavis7]

I have hypothyroidism as well. I basically diagnosed myself a few years before I got pregnant. I went to the doctor and told him to test me and he said "well, lots of people who are overweight think they have thyroid problems, but they don't". I told him to humor me and do the test. Most people are upset to find out they have a disease and have to take medicine for the rest of their lives. I was ecstatic! The hypothyroidism diagnosis explained so much.

Anyway, I only had my level checked once during my pregnancy, and it was pretty early on. I was diagnosed with pre-e at 32 weeks and delivered at 32+6. My OB didn't refer me to an endocrinologist, nor did he recommend I get my level checked at all. The more I learn, the more I am thinking I need a new OB... I had my level rechecked after I delivered and my meds actually needed to be lowered (I was on the same dose for years before pregnancy). Does everyone with hypothyroidism need to see an endocrinologist? We are thinking of TTC soon and I am trying to cover all my bases.

[MayaImen]

Hi there,

I do too think the two are related, i had two pre eclampsia, mild once and i am lucky to have had two happy out comes with my two beautiful daughters. To cut a long story short, i was dignosed with hypothyroidism before my pregnancy, in a different country that i live in. On holiday back home in France i went for a full check up thinking all would come back okay i did not make much of it at the time. The results came back and it was bad, not that bad that i should fear for my life an other kind of bad. But living in the UK i thought it would be easier for me to get treatment hear, i stupid of me this was, when i got back from my holidays i went to my GP explaining what had happen, at first he seems upset that i had something done abroad, but he orederd a blood test that came back all normal, 10 days apart from the test in France i had trouble to understand he just told me to trust him. I did not but i had just lost my mother and this was a fight i was not ready to take on. Two months after that i got pregnant, at week 26 the big word PE was out, at week 36 was admited to hospital on observation until i was induced at week 37. My daughter was born and everything was fine, it took me 2 month to get back to a normal BP..... I started to read aboutt pre eclampsia and came across Pe and hypothyroide during pregnancy, and started to think it could have been related. At that point i am not doing anything about the hypothyroide, the way i had been treated when i first mentioned it in England made me think that maybe there was nothing wrong, although i seem to have all the symptoms of hypothyridism. And plus My dad passed away too... so that's a bit too much to have to deal with, my both parents gone, first time mum.... but hey life goes on, i get pregnant again and hey week 24 PE the word is out again, but this time i know what pre eclampsia is and right until i finally gave birth i was so worried, but i did mention my doubt about the hypothyoridism to the obstetricient , he too ordered a blood test, like the GP did 2 years ago, they both tested for T3 and T4 level, they both came back fine. Anyway call me stuborne but i did mention again my doubt to the GP i saw at the 8 weeks mum and baby appointment. Because my blood pressure is still a bit of a concern he gives me a blood test for all sort of check up and while we are it why not chck you thyroide he says, but this time he does order a thyroide function test as well, and guess what????

My nurse has given me the result today but i have to wait to see the doctor to make it official, i finally have been dignosed here with an hypothyroidie, so my answer to you original question is a big YES, they are related...... I am going to have a long chat with this doctor that finally did listen to me and ask him if had i been listened to early 2009, had i been treated, would both my pre eclampsias been avoided....... and i let you know what he tels me, i feel i have found a good GP he listens and explains things so well, not surprised he always have a bunch of students in with him

[alviarin]

Hi and welcome to the forums.

Just chiming in to agree that thyroid hormone drugs are considered "safe" for pregnancy (pregnancy risk category A). Not only are they considered safe, they can be essential for a healthy pregnancy and a healthy baby. Untreated, hypothyroidism increases the risk of miscarriage and cognitive and developmental delays.

Thyroid disease is also considered a risk factor for preeclampsia, and preeclampsia may raise the risk of developing hypothyroidism.

Most (but not all) hypothyroid women need their thyroid dose increased by roughly 30-50% during early pregnancy. The Endocrine Society also recommends getting the TSH below 2.5 mIU/L pre-conception and the AACE recommends TSH testing for pregnant patients every six weeks.

My endocrinologist had me come in for thyroid testing immediately after I became pregnant (first missed period/positive pregnancy test). She would repeat testing every month for the first two trimesters, then at least once during the third trimester and once again post-partum. My thyroid dose was upped twice during my second pregnancy, including shortly after I found out I was pregnant. Her goal was to keep my TSH between 1-2 mIU/L with my free T3 and free T4 in-range.

Let us know how the appointment with the peri goes, and good luck with whatever you decide!

[rebecca2]

quote:Originally posted by Sheri-ct

Thyroid medication is very safe during pregnancy. The biggest risk with a thyroid condition and pregnancy is not being properly treated. Are you seeing an endocrinologist?


I agree with Sheri regarding the medications used to treat HYPOthyroidism during pregnancy. (There are some mediations used to treat HYPERthyroidism that shouldn't be taken.) Based on what I've read an untreated condition can cause problems with the baby & possibly increase the risk of m/c. My MFM said my TSH should be tested at least oncer per trimester.

I was diagnosed with hypothyroidism a few years before I got pregnant. My personal opinion is that the hypothyroidism didn't cause my PE b/c it was well controlled with meds, but the underlying condition that caused the hypothyroidism could contribute to the PE. Again, that is just my own personal thoughts

[mfred]

Hi Sheri,

Yes, I am seeing an endocrinologist. My levels are good now on the medication and I only see him a few times a year now. I'm thinking if I do get pregnant again, I will have to see my endo more often just to make sure my levels are okay. Is that true?

[sheri-ct]

Welcome the boards! Yes, I was diagnosed with a thyroid condition after having pre-e. I have Hashimoto's, so I had the thyroid issue for a while before it was diagnosed. It's not that uncommon for women to experience thyroid issue post-pregnancy. Pregnancy can put a lot of stress on the thyroid.

Thyroid medication is very safe during pregnancy. The biggest risk with a thyroid condition and pregnancy is not being properly treated. Are you seeing an endocrinologist?

Sheri

[mfred]

Does anyone know if the two are connected? With my first, I was diagnosed with PE at 32 weeks and was induced at 37 weeks. My son was born completely healthy (he is 2 now) with no complications. Shortly after his birth, I was diagnosed with hypothyroidism. I wonder if I had an underlying thyroid disorder which caused the PE, OR, if the PE caused the thyroid disorder. It just seems too coincidental to have PE and then get a thyroid disorder shortly thereafter. I wonder what my body went through. Has anyone else had this happen as well after PE?

Anyway, we are thinking of possibly concieving again. I am still extremely undecided because I feel we are so blessed to have a healthy baby after the first pregnancy and I am afraid we wouldn't be as lucky the second time around. I'm also worried because now I am on medication for my thyroid and would have to take that during the pregnancy if I were to get pregnant. I take Armour Thyroid and I know they say it is extemely safe, but I would still be worried. I have an appt coming up with a perinatologist to discuss all of this.