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Thyroid hormones are crucial for conception because they regulate the development and metabolism of the reproductive system, uterus and placenta. Thyroid disorders affect fertility by causing issues like delays or irregularities in ovulation and menstrual cycles.
Thyroid hormones are also important for the development of the baby’s brain and nervous system.
There are two types of thyroid disorders, hypothyroidism and hyperthyroidism. Women are more likely to have a thyroid disorder than men.
Impact of Thyroid Disorders on Fertility and Conception
Thyroid disorders can cause complications during pregnancy if left untreated.Hypothyroidism
Hypothyroidism is caused by an underactive thyroid gland. The condition occurs when the thyroid gland does not produce enough thyroid hormones. Symptoms of hypothyroidism include fatigue, weight gain, dry skin, dry thinning hair, joint and muscle pain, less sweating, trouble tolerating cold weather, puffy face and constipation.- Menstrual issues: Hypothyroidism can affect the menstrual cycle in several ways, starting with ovulation. Low levels of thyroid hormones can prevent the ovaries from releasing eggs, thereby impairing fertility. Hypothyroidism can also cause irregular or heavy periods, while sometimes the periods are missed entirely.
- Infertility: Hypothyroidism can cause infertility if it is left untreated. However, it is possible to conceive with hypothyroidism if you manage and treat the condition.
- Miscarriage: Women with hypothyroidism, especially those with higher TSH (thyroid-stimulating hormone)have a higher chance of miscarriage.
Hyperthyroidism
Hyperthyroidism is caused by an overactive thyroid gland. This condition occurs when the thyroid gland produces too much thyroid hormone. This can speed up the body’s metabolism and lead to symptoms like unintended weight loss, increased appetite, irregular heartbeats, anxiety, sleep issues, excessive sweating, irritability, brittle hair and swelling of the thyroid gland.- Menstrual issues: Hyperthyroidism can cause an increase in prolactin levels, which prevents ovulation. Hyperthyroidism can also disrupt ovulation and cause irregular menstrual cycles.
- Infertility: If hyperthyroidism is left untreated, it can cause infertility and issues conceiving.
- Miscarriage: Women who have untreated hyperthyroidism are more likely to miscarry in the first trimester.
Importance of Screening for Thyroid Disorders in the Preconception Phase
Undiagnosed and untreated thyroid disorders can have a massive impact on both the mother and the foetus. Here are some important tests to get done before conceiving, to to check if you have a thyroid disorder.- TSH (Thyroid Stimulating Hormone) Test: TSH is a hormone produced by the pituitary gland to signal the thyroid gland to produce and release thyroid hormones. The TSH test measures TSH levels in your body using a blood test. This is the first test conducted to screen for thyroid disorders. Normal levels should be below 5 and in pregnancy, it is usually below 2.5, however, it is best to check with your doctor.
- Free T4 Test: A free T4 test helps determine how well the thyroid gland is functioning. It measures the amount of thyroxine (T4) in your blood that is not attached to proteins. Doctors recommend this test if you have symptoms of an underactive thyroid gland.
- T3 Test: A T3 test, also known as triiodothyronine test, is used to measure the amount of T3 in your blood to diagnose thyroid disorders.
- Thyroid Antibody Tests: A thyroid antibody test is used to measure the amount of thyroid antibodies in your blood. High amounts of antibodies are a sign of hypothyroidism.
Managing Hypothyroidism Before Conception
It is very important to manage hypothyroidism before conception to prevent complications that could affect fertility, conception, pregnancy or the baby’s development. Let us look at some of the ways you can manage hypothyroidism before you conceive:Medication (Levothyroxine)
- The standard treatment for hypothyroidism includes levothyroxine. It is a synthetic version of thyroxine (T4) that is used to restore normal levels of the thyroid hormone.
- If you are planning to get pregnant, it is important to stick to your dosage schedule. Skipping dosages or being inconsistent with them can lead to missed ovulation or hormonal fluctuations.
- Medication should ideally be taken on an empty stomach for better absorption. Avoid taking calcium or iron supplements within four hours of levothyroxine as these can interfere with the medication.
- If you are newly diagnosed with hypothyroidism right before conception, your doctor may ask you to wait for thyroid levels to stabilise before you try to conceive.
Monitoring
- Monitoring TSH regularly is crucial since even a small imbalance can increase the risk of a miscarriage.
- Doctors recommend TSH levels to be checked every 4-6 weeks, especially during the preconception phase.
Managing Hyperthyroidism Before Conception
Managing hyperthyroidism is very important if you are planning to conceive. Untreated hyperthyroidism can interfere with fertility and increase the risk of pregnancy complications. It is best to stabilise hormone levels before conception.Medications
- Anti-thyroid medications like Methimazole (MMI) or Propylthiouracil (PTU) are the most common medications used for hyperthyroidism
- Radioiodine therapy may be used at times to destroy overactive thyroid tissue. This often leads to hypothyroidism causing the person to require levothyroxine supplementation
- PTUs may have side effects like liver toxicity, hence, constant monitoring is recommended.
Monitoring
- To ensure stable levels of thyroid hormone, frequent testing is recommended.
- Doctors will adjust your medication based on your requirements since thyroid hormone requirements can change frequently
Autoimmune Thyroid Disorders and Fertility
An autoimmune thyroid disorder is an autoimmune disease that occurs when the body’s immune system attacks the thyroid gland.- Hashimoto’s disease: This is the most common type of autoimmune disease. In this disease, the immune system attacks the thyroid cells, causing the gland to become inflamed. Hashimoto’s disease can make it harder for a woman to get pregnant since it causes irregular periods and disrupts ovulation.
- Grave’s disease: In this disease, the immune system produces an antibody that targets the thyroid gland, causing the body to produce too much thyroid hormone. Grave’s disease can cause irregular or missed periods, leading to fertility issues.
Seeking Medical Help
Being able to successfully manage thyroid disorders for conception requires a lot of coordination between you and your doctors.- Endocrinologist: An endocrinologist specialises in the management and treatment of thyroid disorders and will help you maintain optimal levels of TSH, T3 and T4. They might adjust the dosage of your thyroid medication if you are planning to get pregnant.
- Gynaecologist: The gynaecologist will assess your fertility levels and make sure your reproductive health is in optimal conditions for conception. The gynaecologist will also inform you of the potential risks of a pregnancy with thyroid disorders.
- Preconception counselling: With the help of preconception counselling, you can establish a clear plan for managing your thyroid problems and address fertility issues, if there are any.
Mental and Emotional Well-Being
It can be daunting to manage thyroid disorders before trying to conceive, knowing that these disorders often come with fertility issues. Additionally, these disorders cause depression and anxiety. Here are some ways you can manage your mental health.- Therapy: Seeking therapy is a very good way to manage your feelings related to stress about conceiving with a chronic condition
- Cognitive behavioural therapy(CBT): CBT is a type of therapy that focuses on your present emotions, instead of delving into the past too much. CBT can help you navigate your negative thoughts and reframe them into positive ones.
- Mindfulness and meditation: Practicing mindfulness and meditation can help you alleviate stress. You could also try yoga and breathing exercises.
- Build a support system: Speak to a trusted friend, family member or anyone else you can trust about your emotions. Ask for help and support when you need it.
Adjusting Expectations
Trying to conceive when you have a chronic condition can be challenging. It is important to manage your expectations to prevent feelings of frustration.- Timeline: Your doctor will ask you to wait for thyroid hormones to stabilise before you attempt to conceive. If you have just been diagnosed and started treatment, this can take a few months. Even if you have been diagnosed earlier, your dosage may need to be adjusted, which can also be a time-consuming process.
- Manage expectations: Since thyroid disorders often affect fertility, conception can take some time. It is important to manage your expectations based on this knowledge and be patient.
- Mental preparation: When you do manage to conceive, remember that the pregnancy may have complications, for which you might need to get checked more often. Being mentally prepared for frequent doctor’s appointments is especially important.
FAQs on Managing Chronic Conditions: Thyroid Issues Before Conception
- Can I get pregnant with hypothyroidism?
Yes, you can get pregnant if you have hypothyroidism. You will need to speak to your doctor about adjusting treatments or starting them if you have not done it yet. - How do thyroid issues impact fertility?
Thyroid issues can delay ovulation and cause irregular periods. This can cause issues with fertility.
