Types of Thyroid disease
Hypothyroidism is defined as high thyroid stimulating hormone level (TSH) and low thyroid hormones (T3 and/or T4).
It can cause ovulation problems, infertility and is also associated with recurrent pregnancy loss.
Hypothyroidism is due to an autoimmune reaction, and when goiter (enlargement of the thyroid gland) is present, it is called Hashimoto’s thyroiditis.
Hyperthyroidism is defined as a suppressed/low TSH level and elevated thyroid hormones (T3 and/or T4).
Two causes of hyperthyroidism are Graves’ disease (toxic diffuse goiter) and Plummer’s disease (toxic nodular goiter).
Plummer’s disease is encountered in postmenopausal women who have had a long history of goiter.
Graves’ disease is defined as hyperthyroidism, exophthalmus (protrusion of eyes) and pretibial myxedema (swelling in the legs), and is believed to be caused by autoantibodies.
Treatment of Thyroid disease
We screen patients for thyroid disease and recommend treatment based on the type of the disorder.
Treatment should be started before pregnancy to improve outcome and minimize obstetrical complications.
Hypothyroidism is commonly treated with levothyroxine (Synthroid, Lovolet, Levoxyl, L-Thyroxine) and hyperthyroidism with propylthiouracil (PTU) or methimazole (Tapazole).
TSH and thyroid hormone levels are checked at regular intervals to sustain normal thyroid function.
Thyroid hormone requirement increases in pregnancy and the dose of supplemental thyroid hormone needs to be increased in patients with hypothyroidism.
Close follow up and adequate treatment will optimize outcome.
Once thyroid disease is under good control, patients can attempt to conceive spontaneously or by using assisted reproductive technologies.