Monday, 19 August 2013

How can thyroid affect fertility, conceiving and pregnancy ?

Concerned your thyroid is having an impact on your fertility? Solving thyroid problems before conceiving is more important than you think! The thyroid is an important gland for fertility. Hormonal imbalance can act as a trigger for thyroid problems. Before we begin to learn different ways thyroid issues may affect your fertility, it is important to know how the thyroid functions.

The thyroid is a small butterfly shaped gland. It is located just below the larynx, in the lower part of the neck. The purpose of the thyroid gland is to take iodine from foods we consume and convert them into thyroid hormones: thyroxin (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine. The thyroid combines iodine and the amino acid tyrosine to make T4 and T3. T4 and T3 once released into the blood stream control our metabolism. The thyroid is also responsible for proper growth, development and repair of the body. It is extremely important for the development of the central nervous system. The metabolism of every single cell in our body is dependent on thyroid hormones. The thyroid produces about 80% T4 and 20% T3, but T3 has four times the strength of T4.

The thyroid is controlled by the pituitary gland. The pituitary gland is controlled by the hypothalamus. When thyroid hormones drop too low, the pituitary gland releases Thyroid Stimulation Hormone (TSH). The release of TSH stimulates the thyroid to release more T3 and T4. Healthy regulatory release T3 & T4 signal the pituitary to decrease the release of TSH. The hypothalamus stimulates the pituitary gland to release TSH through the release of TSH Releasing Hormone (TRH). All of this can be confusing. To break it down into simpler terms, imagine it like this: The hypothalamus is like you, a person who can control the thermostat in your home. The thermostat is the pituitary, and the heat is thyroid hormones. As the heat rises (thyroid hormones) it signals the thermostat (pituitary) to shut off. As the heat decreases, it signals the thermostat to run again. The control person (hypothalamus) sets the thermostat (pituitary) to regulate the heat (thyroid).

Thyroid Disease, Pregnancy and Fertility
Thyroid disease is not common during pregnancy. This is because the immune system, which plays a role in thyroid disease, is suppressed during pregnancy in order to protect the developing fetus. As a result of the loss of this protective effect at the end of pregnancy, there is a tendency for thyroid disease to occur after delivery in those women who have had previous thyroid disease or who are at risk for developing thyroid disease. Silent autoimmune thyroiditis is particularly common after pregnancy. This "post partum thyroiditis" tends to get better after a few weeks although recurrence in subsequent pregnancies and progression to permanent hypothyroidism is possible. It is important to recognize thyroid disorders during pregnancy as untreated hypothyroidism may impair full and normal development of the fetus, to some degree, and may increase maternal complications. Iodine intake should be increased during pregnancy and breastfeeding of 150 micrograms to 250 micrograms per day, but should not exceed 500 micrograms per day.

Infertility
Patients with either hyper or hypothyroidism can have fertility problems although it is certainly possible to have these diseases and still get pregnant. Once the diseases have been treated, it is important to recommence birth control (if desired), since fertility is restored quickly once the patient’s thyroid function is normal. Sub-clinical hypothyroidism can sometimes cause infertility and miscarriages and is, thus, usually treated in women of childbearing age that desire to become pregnant.
In addition, both men and women with untreated thyroid disease often have decreased sexual desire (libido). Hyper- or hypothyroidism is also a cause for male infertility since sperm development requires normal thyroid hormone levels.
Preferably, Graves’ disease should be treated with radioactive iodine or by surgery before pregnancy to avoid the use of ant thyroid medication during pregnancy. It is generally recommended to wait six months after radioactive iodine treatment before becoming pregnant. One other cause of infertility in patients with thyroid disease is the uncommon condition of primary ovary failure. This is an autoimmune disorder, like Graves’ disease caused by proteins and white cells in the blood that attack proteins in the patient’s ovaries. This leads to the decreased size of the ovaries, the failure to ovulate, premature menopause, and infertility.

Menstruation
Menstruation tends to be increased in hypothyroidism and decreased in hyperthyroidism. The effects of thyroid hormones on menstrual periods, ovarian function and the endocrine system in general are complicated but important. With too much or too little thyroid hormone a variety of effects on the reproductive system can occur. Girls who become hyper- or hypothyroid during puberty may have delayed menstrual function.

Thyroxine Treatment in Pregnancy
There is no contra-indication to taking thyroxine throughout pregnancy. If hypothyroidism has been diagnosed before pregnancy The Endocrine Society recommends to adjust the dose to reach a TSH not higher than 2.5 mIU/L before pregnancy. It has been observed that thyroxine requirements increase during the pregnancy so most women with thyroid diseases need dose adjustment and monitoring. The baby’s thyroid becomes functional at approximately 12 weeks of gestation. Thyroid hormones play an important role in fetal brain development, so the thyroid hormones provided by the mother during the first trimester of pregnancy are especially important. Thyroxine treatment is adjusted to obtain TSH levels specific to each trimester (less than 2.5 mIU/L in the first trimester or 3 mIU/L during the second and third trimester).

Screening during Pregnancy for Thyroid Disorders
Screening guidelines for thyroid disease differ among the various associations and expert groups. The Endocrine Society recommends screening for thyroid disorders in women at high risk; Women with prior thyroid disease or surgery, goitre, family history, positive thyroid antibodies, other autoimmune diseases, symptoms or signs suggestive of thyroid dysfunction, previous head and neck irradiation for other disease. Screening is performed by measuring the TSH level.

Hyperthyroidism
Hypothyroidism an underactive thyroid is a frequent cause of infertility. If the thyroid in underactive, the hypothalamus and pituitary gland can sense this and try to kick things back to normal by increasing levels of the hormones TRH (thyroid-releasing hormone) and TSH (thyroid-stimulating hormone) in your body. TRH produced by the hypothalamus, prompts the pituitary to release TSH, which in turn stimulates the thyroid to do its job. However, TRH also prompts the pituitary to release more of the hormone Prolactin. Elevations of Prolactin can interfere with ovulation by suppressing release of the hormones LH and FSH, which stimulate the ovary. Low levels of thyroid hormone can also interfere with the rate at which your body metabolizes sex hormones, which can also cause ovulatory disorders.

Excess thyroid hormone resulting either from an overactive thyroid gland or from taking too much thyroid hormone can also cause problems. Thyroid hormone can block the effect of estrogen at various points in the body. That means the estrogen will not be as effective at getting its job done. This can make the endometrium (uterine lining) unstable and cause abnormal uterine bleeding.

Fertility Signs and Symptoms of Hyperthyroidism for Women
·         Loss of libido
·         Amenorrhea (Absent Period)
·         Postpartum thyroiditis, occurs in 7% of women within the first year after childbirth

Hypothyroidism
This is when the thyroid is not producing enough thyroid hormones. This commonly happens when there is iodine deficiency. Hypothyroidism happens in women more often than men.

Fertility Signs and Symptoms of Hypothyroidism for Women
Early signs:
·         Female infertility
·         Any type of problem with the menstrual cycle
·         Hyper-Prolactenimia (elevated Prolactin hormone)
·         Galactorrhea (flow of milk in the absence of pregnancy or childbirth)

Late signs:
·         Abnormal menstrual cycles
·         Low Basal Body Temperature (BBT)

Untreated or poorly treated hypothyroidism may cause serious complications for pregnancy, in both the mother and the baby. Because Hashimoto’s thyroiditis may lead to hypothyroidism, these risks for complications fall under that thyroid problem as well.

Complications for the mother:
·         Anemia (iron deficiency)
·         Miscarriage
·         Preeclampsia
·         Placental abruption (placenta detaches from wall of uterus pre-term)
·         Postpartum hemorrhage

Thyroid function must be controlled before you get pregnant!
It is important to treat thyroid problems right away if you want to have a baby. Preconception planning is essential to a healthy pregnancy for women with thyroid problems. Women with untreated or neglected thyroid problems may affect their baby’s growth and brain development. Untreated thyroid problems may also lead to infertility, miscarriage, or a baby born with birth defects. It is important to see a doctor about thyroid issues. Make a plan with your doctor. If you desire natural treatments it is important to speak with your doctor to see if that is a possibility for you. Below are some ways to supplement and support proper thyroid function. If you are interested in any of these, talk to your doctor about the possibility of adding them to your natural health plan. If you already take medications and are wondering if any of these supplements are safe for use with your medication, please speak with your doctor first, prior to using them.

Iodine Rich Food Sources
A diet rich in whole foods should always be the first way to support overall health, including thyroid health. Poor diet and nutritional deficiency is one of the top reasons for thyroid problems. Choose organic foods when possible, as the thyroid is very sensitive to environmental toxins. Too much iodine can also cause goiter, so do not go overboard. More is not always better, it is about balance. It is important to get a balanced amount of iodine in the diet. People with hypothyroidism due to iodine deficiency may benefit from increasing the recommended daily allowance of iodine rich foods.

Supplementation for Thyroid Support
There are key nutrients to support the thyroid including vitamins, minerals and herbs. Thyroid hormones are made from iodine and tyrosine.
·         Zinc, with vitamins E and A function together in the manufacture of thyroid hormone.
·         Selected B vitamins and Vitamin C are also necessary for normal thyroid hormone manufacture.
·         Zinc, copper and selenium are required co-factors for normal blood levels of thyroid hormones and normalization of thyroid activity.

·         Ashwagandha and rhodiola are two key herbs that may support the thyroid gland, as well as the rest of the endocrine system.

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