High Tsh In Pregnancy Indicates What?

High Tsh In Pregnancy Indicates What
Background – Thyroid diseases are common endocrine disorders among women of reproductive age, and the serum concentration of thyroid-stimulating hormone (TSH) is the most commonly used index for evaluating thyroid function during pregnancy. However, the normal range for serum TSH concentrations during pregnancy is not the same as that for nonpregnant women,

The increased serum concentration of human chorionic gonadotropin (HCG) along with the synthesis of thyroxine-binding globulin (TBG) may lead to the alteration of maternal thyroid hormone levels during early pregnancy, with the maternal serum TSH level being generally lower in the first trimester than in non-pregnancy and then increasing gradually.

The American Thyroid Association (ATA) guideline (2011) recommends upper limits for healthy serum TSH concentrations of 2.5 mIU/L in the first trimester and 3.0 mIU/L in the second and third trimesters, Based on these diagnostic criteria, subclinical hypothyroidism (SCH), which defined as an elevated TSH concentration with a normal serum FT4 concentration, is estimated to affect up to 15% of pregnant women in the United States and 28% of pregnant women in China,

However, many studies have demonstrated that SCH may be over-diagnosed in a large proportion of pregnant when the universal thresholds of 2.5 and 3.0 mIU/L TSH are used, Such diagnoses may worry patients and thus add to their psychological stress. A significantly elevated TSH concentration is indeed associated with adverse maternal and neonatal outcomes, including gestational diabetes mellitus (GDM), preeclampsia, placental abruption, and preterm delivery,

However, whether a mildly elevated TSH concentration increases adverse pregnancy outcomes, especially in thyroid peroxidase antibody (TPOAb)-negative pregnant women, has been debated in recent years, Accordingly, a more liberal upper limit for the healthy TSH range in healthy pregnant women has been proposed, and the 2017 ATA guideline was updated with an upper reference limit of 4.0 mIU/L TSH during pregnancy,
View complete answer

Contents

What happens if TSH level is high during pregnancy?

Discussion – The current study was performed to gain insight into the impact of TSH levels on spontaneous miscarriage. We found that TSH levels between 2.5 and 4.87 mIU/L were correlated with increased risk of miscarriage (OR = 1.47). In addition, TSH levels above the upper limit of the gestation-specific reference range (≥4.87 mIU/L) increased the risk even further (OR = 1.97).

  • This is an important finding to discuss, because according to the upper limit of TSH (which was 2.5 mIU/L), 27.8% pregnancies would be diagnosed with SCH in our study ( 8, 17 ).
  • Whether these women suffered from other adverse obstetric outcomes, such as fetal growth restriction and postpartum hemorrhage, requires further analysis.

Although the correlations between TSH levels and spontaneous miscarriage have been reported worldwide, the conclusions are controversial ( 8, 9, 12, 13, 14, 20, 21 ). Inter-study differences may be caused by study design, sample size or varying demographics.

The majority of these studies were derived using a gestational age of 7–12 weeks; however, spontaneous miscarriage could occur before 7 weeks. Given the previous one-child-per-family policy in China, many pregnant women visit clinics before 8 weeks of gestation for prenatal care, some even before 6 weeks.

Therefore, we chose pregnant women whose first visit was between 4 and 9 gestational weeks, and thus, we were able to evaluate whether high early-pregnancy TSH levels would increase the risks for spontaneous miscarriage. Early levothyroxine treatment, then, may reduce the risk of miscarriage ( 16 ).

This study was a nested case–control study, and data were obtained before the occurrence of disease, so there had less recall bias. Members in the cohort had the same exposure time, so the statistical and test effectiveness were higher than those in the traditional case–control study. Furthermore, we matched the control and case groups with residence, number of gestational weeks, age and BMI in order to increase the effectiveness of the study.

HYPOTHYROIDISM DURING PREGNANCY AND HOW TO MANAGE IT.

After controlling for these factors, the effects of TSH levels on spontaneous miscarriage were obvious. We also took into consideration alcohol consumption, smoking status, history of miscarriage and TPOAb positivity status, as TPOAb-positive pregnant women are generally considered to have a higher risk for premature delivery and miscarriage ( 22, 23, 24, 25 ), and elevated serum TPOAb levels are associated with higher TSH and lower T 4 values ( 26 ).

An increasing number of studies suggest that SCH is associated with spontaneous abortion. However, the underlying mechanism is not clear. Despite the normal serum FT 4 in SCH patients, thyroid hormone shortage in the tissues may be the cause of miscarriage. TSH can increase the expression of LIF and its receptor LIFR in endometrial stromal cells, stimulation expression of glucose transporter (GLUT1) in the Ishikawa cell line, which is further involved in endometrial glucose transport ( 27 ).

Other studies have found the mirror-image symmetry relation between thyrotropin (TSH) and human chorionic gonadotropin levels. A decrease in HCG concentration can lead to miscarriage. However, this study has several limitations. First, it lacks data on some potential confounding factors such as environmental toxins, irregular menstruation, family history of miscarriage and anti-phospholipid antibodies.

Second, chromosomal anomalies and HCG values were not evaluated. Third, matched case–control study wastes some data and reduces the amount of statistical information. Fourth, this study may lead to measurement bias or omission. In conclusion, we found that pregnant women with elevated TSH levels had an increased risk of miscarriage in early pregnancy.

In fact, TSH levels between 2.5 and 4.87 mIU/L increased the risk for miscarriage, with TSH greater than 4.87 mIU/L increasing the risk even further.
View complete answer

You might be interested:  How To Eat Dry Fig In Pregnancy?

Can high TSH affect baby?

BACKGROUND Thyroid hormone has an important role in brain development of the baby during pregnancy. It is clear that overt hypothyroidism (increased TSH levels and low thyroid hormone levels) in the mother, especially early in pregnancy, can affect the baby’s brain development or cause other problems with the pregnancy.

  1. It is not clear if subclinical hypothyroidism (increased TSH levels and normal thyroid hormone levels) would have similar adverse effects.
  2. Previous studies that have been done on this topic have shown mixed results.
  3. In the current study, the authors studied the effect of subclinical hypothyroidism detected before pregnancy on complications of pregnancy.

THE FULL ARTICLE TITLE: Chen S et al. Preconception TSH levels and pregnancy outcomes: a population-based cohort study in 184,611 women. Clin Endocrinol (Oxf ). March 25, 2017, SUMMARY OF THE STUDY Between 2010 and 2012, 248,501 patients were enrolled in this study in 30 different provinces in China.

  • A free exam is offered in rural china to couples planning pregnancy within 6 months.
  • Before pregnancy, health related information and a blood test for TSH were obtained.
  • In the study period, 194,154 pregnancies occurred, but subjects with pregnancy loss or twin and triple pregnancies and with TSH (obtained before pregnancy) level less than 0.48 and more than 10 mIU/l were excluded from the study.

A total of 184,611 pregnant women who had a TSH level between 0.48 to 10 mIU/l before pregnancy were selected. These patients were divided into 3 groups: TSH level of 0.48 to 2.49 mIU/L (considered normal), TSH 2.5-4.29 mIU/L and TSH 4.3-10 mIU/L. The rate of pregnancy complications like miscarriage, premature delivery and caesarean delivery, as well as birth weight of their newborn compared between these groups.
View complete answer

Does high TSH mean miscarriage?

  • CLINICAL THYROIDOLOGY FOR THE PUBLIC A publication of the American Thyroid Association
  • Summaries for the Public from Clinical Thyroidology (from recent articles in Clinical Thyroidology)
  • THYROID AND PREGNANCY Thyroid status and risk of miscarriage
  1. ABBREVIATIONS & DEFINITIONS
  2. TSH: thyroid stimulating hormone – produced by the pituitary gland that regulates thyroid function; also the best screening test to determine if the thyroid is functioning normally.
  3. Miscarriage: this occurs when a baby dies in the first few months of a pregnancy, usually before 22 weeks of pregnancy.

BACKGROUND Inadequately treated hypothyroidism has been associated with negative pregnancy outcomes. Thyroid hormone requirements increase with pregnancy and many women with pre-existing hypothyroidism need an increase in their thyroid hormone doses in the first trimester of pregnancy. The Endocrine Society recommends that TSH levels be maintained between 0.2- THE FULL ARTICLE TITLE: Taylor PN et al. TSH levels and risk of miscarriage in women on long-term levothyroxine: a community-based study. J Clin Endocrinol Metab. July 24, 2014, SUMMARY OF THE STUDY This study was an analysis of a historical primary care database of women treated with thyroid hormone during pregnancy in the United Kingdom. Women were included in the analysis if they were between the ages of 18-45 years and had thyroid hormone treatment started for primary hypothyroidism at least 6 months before pregnancy. A total of 1013 pregnancies were identified in 7978 women treated with thyroid hormone for primary hypothyroidism. Approximately 63% of pregnant women on thyroid hormone replacement had TSH levels above the recommended level of 2.5mU/L during the first trimester. These women had a higher risk of miscarriage during pregnancy than women whose TSH values were below 2.5mU/L. The risk of miscarriage increased with increasing TSH. Women with a TSH between 4.5-10 mU/L or TSH greater than 10 mU/L had an increased risk of miscarriage of 1.8 or 3.95 times respectively, compared to women who had a normal TSH (0.2-2.5mU/L) during early pregnancy. Women with a TSH between 2.51-4.5mU/L did not appear to have an increased risk of miscarriage. WHAT ARE THE IMPLICATIONS OF THIS STUDY? Many women with hypothyroidism on thyroid hormone replacement therapy have TSH levels above the desired 2.5 mU/L level in early pregnancy. Higher TSH levels (TSH levels > 4.5 mU/L) are associated with increased risk for miscarriage and should be avoided in early pregnancy.

  • —Whitney Woodmansee, MD
  • Hypothyroidism:
  • Thyroid and Pregnancy:

:
View complete answer

How serious can a thyroid be in pregnancy?

How does hyperthyroidism affect pregnancy? – Uncontrolled hyperthyroidism has many effects. It may lead to preterm birth (before 37 weeks of pregnancy) and low birth weight for the baby. Some studies have shown an increase in pregnancy-induced hypertension (high blood pressure of pregnancy) in women with hyperthyroidism.

  1. A severe, life-threatening form of hyperthyroidism, called thyroid storm, may complicate pregnancy.
  2. This is a condition in which there are extremely high levels of thyroid hormone that can cause high fever, dehydration, diarrhea, rapid and irregular heart rate, shock and death, if not treated.
  3. It is always best to plan for pregnancy and to consult with your physician to ensure your thyroid status and treatment are optimized prior to becoming pregnant and monitored throughout your pregnancy.

However, if this does not happen and you find out you are pregnant, you should contact your physician immediately to arrange for increased testing of your thyroid functions and a potential change in your medication.
View complete answer

You might be interested:  How To Check Pregnancy After Ovulation?

When do you treat high TSH during pregnancy?

WHO SHOULD BE TREATED FOR HYPOTHYROIDISM DURING PREGNANCY? Women found to have a TSH level greater than 10 mIU/L in the first trimester of pregnancy should be treated for hypothyroidism. Conversely, women with a TSH of 2.5 or less, do not need levothyroxine treatment.
View complete answer

Can stress increase TSH levels?

How stress affects your thyroid – There is some evidence that thyroid problems and stress are linked, but the nature of the link is less clear. Some studies, discussed further in this article, have suggested that stress may cause thyroid issues, and it’s also plausible that thyroid problems can make a person more vulnerable to stress.

  • To learn more about the link between thyroid problems and stress, we first spoke with Dr.
  • Stefano Guandalini, MD, Professor Emeritus at University of Chicago Medicine.
  • Dr Guandalini tells us that having a thyroid condition does make you more vulnerable to stress: “When you have either hypothyroidism or hyperthyroidism, you become more sensitive to both mental and physical stresses, as the excessively high or low levels of thyroid hormones affect how the whole body reacts to stress,” said Dr Guandalini.

“Stress increases production of the hormone cortisol, which is produced by the adrenal glands. Cortisol can inhibit secretion of TSH (thyroid stimulating hormone) from the pituitary gland, leading to partial suppression of thyroxine, the main hormone produced by the thyroid gland,” Dr.
View complete answer

What foods should I avoid if I have hypothyroidism during pregnancy?

Cruciferous Vegetables Like Broccoli and Cauliflower – Cruciferous vegetables, such as broccoli and cabbage, are full of fiber and other nutrients, but they may interfere with the production of thyroid hormone if you have an iodine deficiency, So if you do, it’s a good idea to limit your intake of Brussels sprouts, cabbage, cauliflower, kale, turnips, and bok choy, because research suggests digesting these vegetables may block the thyroid’s ability to utilize iodine, which is essential for normal thyroid function.
View complete answer

Does TSH rise during pregnancy?

High Tsh In Pregnancy Indicates What ROCHESTER, Minn. — When a woman becomes pregnant, many changes occur in her body. One of those changes is in the levels of various hormones produced by the body. In the case of thyroid-stimulating hormone (TSH), pregnant women typically produce a lower level than normal (0.4–4.0 milli-international units per liter).

Some international guidelines recommend levels be no higher than 2.5–3. milli-international units per liter during pregnancy. When their TSH levels rise above this, they may experience subclinical hypothyroidism, or mildly underactive thyroid, which can cause a number of health problems if left untreated.

Today, Mayo Clinic researchers report that one of those results could be pregnancy loss. Researchers further suggest a course of action that could positively impact as many as 15 of every 100 pregnancies. In a study published in The BMJ, they show that treating subclinical hypothyroidism (not quite the level that would be treated in a nonpregnant woman) can reduce pregnancy loss, especially for those with TSH levels on the upper end of normal or higher.

  1. A recent analysis of 18 studies showed that pregnant women with untreated subclinical hypothyroidism are at higher risk for pregnancy loss, placental abruption, premature rupture of membranes, and neonatal death,” says Spyridoula Maraka, M.D., an endocrinologist and lead author of the study.
  2. It seemed likely that treating subclinical hypothyroidism would reduce the chance of these deadly occurrences.

But we know that treatment brings other risks, so we wanted to find the point at which benefits outweighed risks.” Using the OptumLabs Data Warehouse, Dr. Maraka and her team examined the health information of 5,405 pregnant women diagnosed with subclinical hypothyroidism.

Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated. MEDIA CONTACT: Sharon Theimer, Mayo Clinic Public Affairs, 507-284-5005, [email protected] Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss.

However, they were more likely to have a preterm delivery, or experience gestational diabetes or preeclampsia, The team also looked at the levels of pretreatment TSH to determine if there was a point when treatment would have the most positive overall effect.

  • Unsurprisingly, we found that women with higher levels of pre-treatment TSH—between 4.1 and 10 milli-international units per liter —benefitted most from treatment,” says Dr. Maraka.
  • This group’s much lower likelihood of experiencing pregnancy loss was what brought the average down – and creates a good argument for updated clinical guidelines.” The researchers found that, for women with lower levels of TSH (2.5–4.0 milli-international units per liter), the risk of gestational hypertension (which can lead to preeclampsia ) was significantly higher for treated women than for untreated women.

There was no difference between treated women who had the higher levels of TSH (4.1–10 milli-international units per liter) and untreated women. “Our findings lead us to believe that overtreatment could be possible,” says Juan Brito Campana, M.B.B.S., a Mayo Clinic endocrinologist and study co-author.

  1. If the TSH levels are in that 2.5–4.0 range, it may be best to leave subclinical hypothyroidism untreated.” The team found no other adverse outcomes that appeared affected by different pretreatment TSH levels and subsequent thyroid hormone use. Dr.
  2. Brito Campana further says that the association of levothyroxine therapy (drug used to treat hypothyroidism) and the risk of pregnancy-related adverse outcomes (e.g., preeclampsia or gestational diabetes) should be seen as preliminary findings and should call for additional studies evaluating the safety of levothyroxine therapy in pregnant women with subclinical hypothyroidism.
You might be interested:  How To Pose For Pregnancy Photo Shoot?

The results and recommendations in this study seem somewhat prophetic. On Jan.6, 2017, the American Thyroid Association published updated care guidelines with treatment recommendations for women experiencing thyroid disease during pregnancy. “These guidelines can help women and their doctors decide together what will be best for them,” says Dr.

Brito. “We are pleased to see them and remain committed to further medical research and refinement of available information to assist in shared decision-making and improved health.” This research was made possible by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, using the OptumLabs Data Warehouse.

This data consists of retrospective administrative claims data, including medical claims and eligibility information from a large national U.S. health insurance plan, as well as electronic health record data from a nationwide network of provider groups.

  1. It is a resource of OptumLabs, a collaborative research and innovation center cofounded by Mayo Clinic and Optum in 2013.
  2. The research was conducted in collaboration with Mayo Clinic’s Knowledge and Evaluation Research Unit,
  3. This unit focuses much of its efforts on developing and validating shared decision aids across all of health care.

Dr. Maraka is a research collaborator in the unit. In addition to her work at Mayo Clinic, Dr. Maraka works in the Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.
View complete answer

Does high TSH need treatment?

High Tsh In Pregnancy Indicates What What to do about mild hypothyroidism is a subject that has been studied and debated for years. Mild hypothyroidism is also called subclinical hypothyroidism. It doesn’t meet the standard definition of overt hypothyroidism. You may have no symptoms, and your thyroid function blood tests show a mixed picture.

  1. Your free T4 level is normal, meaning your body is getting enough thyroid hormone.
  2. It is your TSH (thyroid stimulating hormone) level that is above the normal range, which indicates your thyroid gland has to work harder to pump out that thyroid hormone.
  3. One worry about mild hypothyroidism is the potential link between untreated subclinical hypothyroidism and coronary artery disease,

Results of research on whether subclinical thyroid disease causes heart problems have been conflicting. However, the condition has been associated with heart and blood vessel abnormalities, and some studies suggest that treating mild hypothyroidism can improve various markers of heart structure and function.

  • However, there are potential downsides to treating subclinical hypothyroidism.
  • There is the risk of overtreatment, which might cause symptoms, such as feeling jittery and insomnia.
  • Also, long-term overtreatment can lead to loss of bone density.
  • If your TSH level is elevated to between 5.5 and 10 mIU/L and your T4 is still in the normal range, you and your doctor will consider starting thyroid medication or repeating the TSH later on.

If you have symptoms of hypothyroidism or you have a positive test for anti-thyroid antibodies, you might want to start thyroid pills right away. If you aren’t treated, your doctor should continue to monitor your thyroid function with blood tests every six to 12 months.

  1. If your TSH level is higher than 10 mIU/L, you should start treatment, because you will very likely develop symptoms of an underactive thyroid, even if you don’t have them now.
  2. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
  3. Please note the date of last review or update on all articles.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
View complete answer

Can thyroid pass through breastmilk?

Thyroid autoantibodies – Mothers who have the autoimmune forms of thyroid disease will usually have thyroid autoantibodies present in their blood. Hypothyroidism is most commonly caused by Hashimoto’s Thyroiditis, an autoimmune thyroid disease in which the immune system attacks and destroys the thyroid gland, resulting in underproduction of thyroid hormone.

  • Another common autoimmune thyroid disease is Grave’s Disease, which is a leading cause of hyperthyroidism; in this disease the antibodies attacking the thyroid gland cause growth of the gland and overproduction of thyroid hormone.
  • Some mothers may be worried that these antibodies may pass into breastmilk and harm baby, however this is not a concern.

The thyroid autoantibodies are IgG immunoglobulins, which are too large to pass into breastmilk. Continuing to breastfeed will only benefit your baby, as babies who are artificially fed are at increased risk of developing autoimmune thyroid disease themselves.
View complete answer