Identifying and treating thyroid issues during pregnancy

Every woman experiences pregnancy differently, and for many it can be hard to know what is normal and what is not normal, especially for first-time mothers. Because drastic physical changes and sometimes uncomfortable symptoms are expected, many women may not realize that what they are experiencing is cause for concern.

So how does a woman know if what she feels is a sign of something more serious?

“I try to bring up common concerns that I hear from patients, especially things that patients may not feel comfortable bringing up on their own,” said Carolyn Cokes, M.D., MPH, a board-certified OB/GYN with Metropolitan OB-GYN a Baltimore-based OB-GYN practice affiliated with The Family Childbirth and Children’s Center at Mercy. Women can experience all kinds of new and unfamiliar symptoms during pregnancy, and Cokes wants to help her patients know what is typical, so they can speak up if something seems off.

“Always discuss any concerning symptoms with your doctor, because it is really hard to know what is normal and what is not, especially for a first time pregnancy,” she said. Thyroid issues are one of the issues that Cokes says can develop during pregnancy.

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The thyroid is a gland located in the neck, and its main function is to regulate metabolism, affecting energy levels, weight, and other systems. It is controlled by hormones in the brain, but pregnancy hormones can disrupt that system. Cokes asserts that pregnancy does not cause hypothyroidism or hyperthyroidism, rather it is a stage of life when the condition can present itself. But, the symptoms of thyroid disease can mimic common pregnancy symptoms, making it harder to identify when a woman is expecting.

“Symptoms of hypothyroidism, which is when the thyroid is not producing enough hormones, are similar to what women would normally experience during pregnancy, such as fatigue, constipation, or weight gain,” she said. “Hyperthyroidism is easier to distinguish because its symptoms are more obvious, like anxiousness, heart palpitations, trouble sleeping.”

According to the National Institute of Diabetes and Digestive and Kidney Diseases, hypothyroidism in pregnancy occurs in 2 to 3 of 100 pregnancies and is usually caused by Hashimoto’s disease. Hyperthyroidism is typically associated with Grave’s disease. Both are autoimmune diseases, in which the body’s immune system incorrectly attacks healthy tissues and organs.

Cokes commonly screens her pregnant patients for thyroid conditions, but she stated that pregnancy naturally increases thyroid hormone so evaluation of symptoms helps ensure the right diagnosis. She collaborates with other health care providers, such as endocrinology and maternal/fetal medicine to appropriately manage the health of the mother and baby. Conditions can usually be managed with medication, and post-pregnancy women can determine the best long-term treatment plan with their doctor.

If left untreated, thyroid issues could lead to other pregnancy complications, such as preeclampsia, pulmonary hypertension, and risks to the unborn baby. Cokes said that knowing your family history, along with early screening, and talking with your doctor about symptoms, are critical. Women should not be afraid to advocate for their health, especially if they have concerns.

“The most important thing in a doctor-patient relationship is remembering that you, the patient, are in charge,” she said, adding that not every doctor is right for every patient. If a woman feels as though her concerns are being brushed off or ignored, she should have a conversation with her doctor about the relationship. And, if that is not enough, then it may be time to find another doctor.

“The relationship with an OB-GYN is really personal,” said Cokes. “I get the honor of being with people during some of the happiest moments of their lives, and I want them to feel like they are in control.”