I’m pregnant. At my 28-week growth check last week, the perinatologist went over my results with me and then said “And since you’re on thyroid medication, we’ll need to see you twice a week in your last month for Nonstress Tests and ultrasounds.” I asked what the medication has to do with it and all she said was that women who are on Synthroid have a “risk of placental abnormalities.”
I have Googled the hell out of this, and not found anything at all relating to Synthroid (levothyroxine) causing possible problems. In fact, it’s Pregnancy Category A, which means that studies show no risk. I know that untreated hypothyroidism is a big deal and that can cause all sorts of issues, but I’m being extremely well managed by my endocrinologist and obstetrician, who are in contact with each other about my monthly TSH and T4 results.
I’ll be seeing my OB and asking about it next week, but I’m just trying to figure out what exactly about the Category A medication I’m taking is making them label me with such a high risk. Liability reasons? A desire to get more ultrasound money out of my insurance company? Or is this the normal standard of care for this situation? Am I missing something? I’m not opposed to doing the extra testing if necessary; I’m just very confused about why they want it.
It’s not the synthroid causing your risk to be increased, it’s the hypothyroidism.
Even properly treated hypothyroidism is associated with a greater risk of the following pregnancy complications:
Preeclampsia and gestational hypertension
Placental abruption
Nonreassuring fetal heart rate tracing
Preterm delivery, including very preterm delivery (before 32 weeks)
Low birth weight (which was likely due to preterm delivery for preeclampsia in one study [9], but not in a second study where the rate of preeclampsia was negligible)
Increased rate of cesarean section
Perinatal morbidity and mortality
Neuropsychological and cognitive impairment
Postpartum hemorrhage
But it appears that extra vigilance can substantially reduce those risks. That’s why you’re being seen more often.
Do you see a perinatologist as well as an obstetrician in different offices, or as part of the same practice? When I was pregnant, just eight years ago, it was standard care to see a woman every week during the last month, so two weeks sounds lax-- that’s just a couple of tests. Now, a non-stress test wasn’t standard, and an ultrasound wasn’t standard in my appointments, but the “placental abnormality” could be placenta previa, where the placenta blocks the cervix. It’s not a gestation problem, just a delivery problem, and the solution is a c-section, and an ultrasound would reveal it. I had an anterior placenta-- it was in front. Not a big deal, but it meant that I didn’t feel any kicking until later than most women do, so I had a non-stress test at five months, since I couldn’t do reliable “kick counts” yet. It’s just a measure of the fetal heartrate to its own movements.
I’m not saying this is the problem-- just that “problem with the placenta” is pretty vague, but I would be very surprised if, at this point, they were concerned about a placental abnormality that could cause the fetus developmental problems.
They’re in different offices but affiliated with the same hospital system, so they are in communication. As far as I know, there are no placental (or other) problems. I’ve been told at every appointment that everything is exactly as it should be. But if there are risks of anything bad happening closer to delivery, then I’ve got no problem going in twice a week for a check. They just hadn’t made it clear to me why it was necessary, but I feel better about it now.
When I used to do OB as a Family Medicine doc, I’d generally get at least one consult with a local obstetrician for my hypothyroid patients, and let them manage all but the most stable patients on thyroid replacement.
Sounds like if you’re in good (albeit less that fully informative) hands. Enjoy!
Notwithstanding the above, I’d say that any risk for a pregnant woman (and her fetus/baby) with treated hypothyroidism is still more theoretical than real. cite#1. cite#2.
One point that could be mentioned has to do with the fact that pregnant women tend to require an increased dosage of levothyroxine as the pregnancy progresses (due to rising estrogen levels increasing the amount of thyroid-binding globulin in the woman’s blood, thereby diminishing the level of free, unbound (and hence biologically active) levothyroxine. cite#1. cite#2
A very rare problem is when the mother had hypothyroidism but possesses in her blood a spectrum of thyroid antibodies including ‘thyroid stimulating immunoglobulin’ (the cause of Graves’s hyperthyroidsim). In such a circumstance, the stimulating antibody (irrelevant for the mom whose thyroid has been burned out by the hypothyroid process) crosses the placenta and stimulates baby’s thyroid causing it to become hyperthyroid in utero - a potentially dangerous situation.
Though you do need to take some heightened care - ask if you don’t understand the why of something. If it is legit, there will be an answer - any time a doc doesn’t want to give you a straight answer, feel free to fire them and find a doc who will answer questions about conditions or treatments. I know sometimes doctors can be rushed however there is absolutely no reason to not take that time to actually explain something as it helps the patient understand why it is a good idea to follow directions as closely as possible. Compliance can mean the difference between life and death sometimes. [As a diabetic, not being in compliance means I might lose body parts … and I really want my fingers and toes!]