The but­ter­fly ef­fect

Sunday Herald Sun - Body and Soul - - Try It Out - with Dr Cindy Pan

You prob­a­bly won’t know much about this small gland un­til some­thing goes wrong with it. The thy­roid gland is a but­ter­fly-shaped gland sit­u­ated in your neck, just in front of your throat. It pro­duces hor­mones that af­fect var­i­ous as­pects of your me­tab­o­lism such as en­ergy ex­pen­di­ture, ap­petite and growth. Thy­roid disor­ders are rea­son­ably com­mon, with around one in 20 peo­ple ex­pe­ri­enc­ing some form of thy­roid dis­or­der in their life­time.

Thy­roid prob­lems are more com­mon in women than in men, with two to five per cent of all women and one to two per cent of women of re­pro­duc­tive age be­ing af­fected. Women who de­velop thy­roid prob­lems be­fore, dur­ing or af­ter preg­nancy need par­tic­u­lar care since their dis­ease may af­fect not only their abil­ity to con­ceive and main­tain a healthy preg­nancy, but also the well­be­ing and de­vel­op­ment of the baby.

What sorts of ef­fects can thy­roid dys­func­tion have on fer­til­ity?

Mild to mod­er­ate hy­pothy­roidism ( de­creased thy­roid hor­mone pro­duc­tion) can cause in­creased men­strual fre­quency, but se­vere hy­pothy­roidism can ac­tu­ally cause ces­sa­tion of men­stru­a­tion. Hy­per­thy­roidism ( in­creased hor­mone pro­duc­tion) can re­sult in ir­reg­u­lar or ab­sent pe­ri­ods. Ei­ther way, there may be as­so­ci­ated fer­til­ity prob­lems. For­tu­nately, if ei­ther con­di­tion is recog­nised and ad­e­quately treated, fer­til­ity should be re­stored.

How do women with ex­ist­ing thy­roid prob­lems plan for a preg­nancy?

If a wo­man has pre-ex­ist­ing hy­pothy­roidism, the main thing is to en­sure the on­go­ing ad­e­quacy of her thy­roid hor­mone re­place­ment dur­ing and af­ter preg­nancy. This min­imises any risk to her or the baby. If a wo­man with hy­per­thy­roidism wishes to fall preg­nant it is best to en­sure that her thy­roid con­di­tion is treated and un­der con­trol be­fore con­ceiv­ing, oth­er­wise there is an in­creased risk of still­birth and mis­car­riage. Ra­dioac­tive io­dine scans and ra­dioac­tive io­dine treat­ment can­not be given to preg­nant women but there are med­i­ca­tions that can be used to con­trol thy­roid func­tion with min­i­mal risk to the baby.

In some cases, where there is a se­ri­ous prob­lem with tak­ing med­i­ca­tion ( for ex­am­ple se­vere al­lergy), it may be nec­es­sary to op­er­ate dur­ing preg­nancy to re­move part of the thy­roid, but this is rare.

What if thy­roid dys­func­tion de­vel­ops dur­ing preg­nancy?

The most im­por­tant thing is to recog­nise that the prob­lem ex­ists since some of the symp­toms and signs of thy­roid dys­func­tion, such as sweat­ing, in­creased heart rate or pal­pi­ta­tions, feel­ing tired, re­duced con­cen­tra­tion or brain fog, ap­petite changes, anx­i­ety, con­sti­pa­tion, weight changes and heat in­tol­er­ance, may oc­cur quite com­monly even in nor­mal preg­nant women. It is nor­mal for the meta­bolic rate to be raised in preg­nancy, so it is not un­usual for peo­ple to sus­pect hy­per­thy­roidism. Sim­i­larly, the weight gain and slug­gish­ness, lethargy, puffi­ness and brain fog­gi­ness of preg­nancy may in some ways seem to mimic hy­pothy­roidism.

If you have any con­cerns, your doc­tor can talk to you about your symp­toms, ex­am­ine you and do a sim­ple blood test to as­sess your thy­roid func­tion. For­tu­nately, once recog­nised and di­ag­nosed, most prob­lems can be an­tic­i­pated and ef­fec­tively treated to al­low a healthy out­come for mum and bub.

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