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Autoimmune Thyroid Disease and Pregnancy

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Autoimmune thyroid disease can cause both hyperthyroidism and hypothyroidism in pregnant women. Read to know about its causes, prognosis, and management.

Medically reviewed by

Dr. Shaikh Sadaf

Published At November 24, 2022
Reviewed AtDecember 22, 2023

What Is Autoimmune Thyroid Disease in Pregnancy?

Normal pregnancy-related physiological changes cause complicated endocrine and immune reactions in the mother. Thyroid problems are the second most prevalent endocrinologic problem in pregnancy. Pregnancy-related hyperthyroidism and hypothyroidism continue to be often caused by autoimmune thyroid dysfunctions. Over 85 % of all cases of hyperthyroidism are caused by Graves disease, while Hashimoto's thyroiditis is the most typical reason for hypothyroidism. In addition, severe issues like early birth, miscarriage, and stillbirth are associated with untreated thyroid abnormalities during pregnancy.

What Is Thyroid and Its Disorders?

The thyroid is a tiny, butterfly-shaped hormone-producing gland located in the neck. The thyroid produces hormones that have many functions in the body and also impact metabolism and heart rate. The thyroid gland occasionally produces excess or insufficient amounts of particular hormones. When this occurs, a thyroid condition is present. Some women have a thyroid issue that develops before getting pregnant (also called a pre-existing condition). Others could experience their first thyroid issues during pregnancy or soon after giving birth. A thyroid ailment may not cause any issues during pregnancy if treated. However, untreated thyroid issues can lead to problems for the mother and her unborn child both during pregnancy and after delivery.

There are two basic categories of thyroid disorders,

  • Hyperthyroidism - This occurs when the thyroid produces excessive thyroid hormone. Many bodily processes may speed up as a result of this disease. An autoimmune condition called Graves’ disease is typically responsible for hyperthyroidism during pregnancy. In Graves' disease, the thyroid produces an excessive amount of thyroid hormone as a result of immune system antibodies. Rarely hyperthyroidism is associated with hyperemesis gravidarum (extreme nausea and vomiting during pregnancy). Thyroid nodules may, in rare instances, also contribute to hyperthyroidism. The thyroid nodules produce an excessive amount of thyroid hormone.
  • Hypothyroidism - Many bodily functions slow down when the thyroid is underactive and produces insufficient thyroid hormones. Normal causes of hypothyroidism during pregnancy include Hashimoto's disease, an autoimmune condition. The thyroid is attacked by antibodies produced by the immune system in Hashimoto's disease, damaging it and preventing it from producing thyroid hormones.

How Are Autoimmune Thyroid Diseases Diagnosed During Pregnancy?

In most cases, doctors would not test a woman's thyroid before or during pregnancy unless she is at a high risk of developing a thyroid disorder or exhibits symptoms or signs of one. The indications and symptoms of a thyroid issue in women can include rash, coughing, sore throat, and dizziness. Thyroid disorders can cause signs and symptoms to develop gradually over time. The doctor performs a physical examination and orders a blood test to look for thyroid issues. The thyroid hormone and thyroid stimulating hormone (commonly known as TSH) levels in the body are determined by a blood test.

Who Is at Risk of Developing Autoimmune Thyroid Diseases During Pregnancy?

The following conditions can increase the risk of developing autoimmune thyroid diseases during pregnancy,

  • The pregnant woman is already undergoing thyroid disorder treatment.

  • She has a goiter (an enlarged thyroid gland that can give the appearance of a bloated neck) or thyroid nodules.

  • She possesses a thyroid disorder or if she had a child with a thyroid disorder.

  • Has an autoimmune condition or autoimmune thyroid disease in her family, such as Graves' disease or Hashimoto's disease.

  • Has type 1 diabetes.

  • Has undergone therapy for hyperthyroidism or high-dose neck radiation.

What Are the Various Autoimmune Thyroid Disorders During Pregnancy?

The following conditions are seen during pregnancy,

1) Hyperthyroidism- Untreated or improperly treated hyperthyroidism has been connected to issues for pregnant women and their unborn children.

Women may experience issues such as,

The baby may experience issues such as,

  • Goiter.

  • Premature birth (baby birth before 37 weeks of pregnancy).

  • Low birth weight.

  • Miscarriage or stillbirth.

  • Thyroid Issues- During pregnancy, Graves' disease-causing antibodies pass through the placenta. Pregnant women who have Graves' disease run the risk of having thyroid problems both during and after delivery for their unborn children.

2) Hypothyroidism- Untreated hypothyroidism during pregnancy has been connected to issues for mothers and their unborn children.

Women may experience issues such as,

  • Preeclampsia.

  • Anemia.

  • Gestational hypertension.

  • Placental abruption.

  • Postpartum hemorrhage (PPH)- This happens when a woman bleeds excessively after delivery. It is a severe yet rare condition. It typically occurs within a day of giving birth. However, it can sometimes occur up to 12 weeks later.

  • Heart failure.

  • Myxedema.

The baby may experience issues such as,

  • Infantile myxedema- Intellectual difficulties, dwarfism, and other issues may result from it.

  • Low birthweight

  • Impaired growth.

  • Abnormalities in the brain and nervous system development.

  • Thyroid issues.

  • Stillbirth or miscarriage.

3) Postpartum Thyroiditis- Postpartum thyroiditis is an autoimmune condition. In this condition, the thyroid swells within the first year of giving birth. The thyroid may become hyperactive, underactive, or even exhibit a combination of the two.

What Is the Management of Thyroid Conditions During Pregnancy and Breastfeeding?

Numerous medications used to treat thyroid issues during pregnancy are safe for the unborn child. Thyroid medications can support maintaining the body's proper thyroid hormone levels. In order to ensure that the dosage of the medication is correct, the physician performs blood tests throughout pregnancy to assess the levels of TSH and T4. The thyroid creates the hormone T4.

1) Treatment of Hyperthyroidism -

If a woman is pregnant and has moderate hyperthyroidism, therapy may not be necessary. She might need antithyroid medication if the condition is more serious. The thyroid produces less thyroid hormone as a result of this medication.

The majority of healthcare professionals treat pregnant women with an overactive thyroid with Methimazole in the second and third trimesters and Propylthiouracil in the first trimester. When and how to take these medications is crucial. After the first trimester, Propylthiouracil can cause liver issues. And using Methimazole during the first trimester may make birth abnormalities more likely. Birth defects can affect a person's overall health as well as how their body develops and functions.

Doctors occasionally use radioactive iodine to treat hyperthyroidism. However, pregnant women should not use this medication because it can result in thyroid issues for the unborn child.

The majority of healthcare professionals treat pregnant women with an overactive thyroid with Methimazole in the second and third trimesters and Propylthiouracil in the first trimester. When to take these medications is crucial. After the first trimester, Propylthiouracil can cause liver issues. And using Methimazole during the first trimester may make birth abnormalities more likely. Birth defects are illnesses that start developing at birth.

Low doses of antithyroid medications are safe to use during breastfeeding.

2) Treatment of Hypothyroidism -

The most popular medication for treating an underactive thyroid during pregnancy is Levothyroxine. The thyroid hormone T4 is replaced with Levothyroxine because her own thyroid either doesn't make any or not enough of it. This medication can be used safely during pregnancy. T3 hormone-containing thyroid medications should not be taken during pregnancy.

If a pregnant woman had hypothyroidism before getting pregnant, she would probably need to take additional medication during the pregnancy. As soon as she learns she is pregnant, she must discuss the medicines with the healthcare professional. By monitoring TSH levels while pregnant, a provider can ensure that the patient receives the proper dosage.


Women of reproductive age frequently suffer from thyroid disorders, particularly of autoimmune origin. These disorders are profoundly impacted not just by a number of changes in thyroid function that occur during a typical pregnancy but also by the enhanced immunological state that develops during pregnancy. Therefore, particular pregnancy ranges that are not often available are needed for the interpretation of thyroid function tests during gestation. Adequate screening programs should be implemented in order to avoid the adverse effects of thyroid dysfunction during pregnancy being delayed or incorrectly diagnosed, which could have a considerable negative impact on both the mother and the unborn child. The optimal method for diagnosing and treating thyroid dysfunction during pregnancy necessitates monthly monitoring of the fetus and mother, which must continue throughout the postpartum period when it is reasonable to anticipate the beginning of postpartum thyroid disorders.

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Dr. Shaikh Sadaf
Dr. Shaikh Sadaf



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