If the thyroid levels are not controlled the baby may be born with hyperthyroidism and if the medication is too high the baby may get hypothyroidism , whose worst form manifests as cretinism . This is a serious disorder in children that presents with mental retardation , dwarfism due to stunted growth and physical deformities .
If the mother is not treated for her thyroid disease she is at risk of preterm birth , low birth weight baby and has an increased risk of developing pregnancy induced hypertension . The worst form of this is the patient may get what is known as thyroid storm which represents with fever , dehydration , diarrhoea , rapid irregular heart rate , shock and even death . In view of these complications , it is paramount that the thyroid hormones are well controlled .
Fortunately seeing a thyroid storm is rare but one should not wish to encounter one as managing it is a medical quagmire that requires a multidisciplinary approach to care . By God ’ s grace the pregnancy was uneventful and she remained euthyroid during the entire course of the pregnancy . They welcomed their bundle of joy “ baby Imani ” also not her real name and were overjoyed with the outcome .
I have mentioned that the thyroid disease can either be hyperthyroidism or hypothyroidism . With hypothyroidism the picture is the exact opposite . The thyroid hormones T4 and T3 and very low with elevated TSH . Clinically the patients tend to be obese ( not always the case ), get tired very quickly and are lethargic . They unlike their hyperthroid counterparts now have intolerance to cold and feel cold most of the time .
So was my patient Jeanette . She had a spouse working in South Africa and had planned to join him . She came in as she was unsure whether she would manage with the new doctors in SA . Same old drill , history , physical findings and laboratory tests . Her spouse was around due to covid and they were just about to go back as covid cases had reduced and countries had started going back to the new normal . Tests revealed a classical hypothyroid picture again with no tubal pathology and another donor for semen .
I appraised the couple and started them in conjunction with the endocrinologist on levothyroxine therapy ( treatment for hyperthyroidism ). I advised that they needed to wait until thyroid levels were normal prior to embarking on the pregnancy journey . I told her to be patient and take some folic acid , calcium supplements , have regular sexual relations with the spouse ( at least 3 times per week ) and chillax . She was quite anxious but
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If the mother is not treated for her thyroid disease she is at risk of preterm birth , low birth weight baby and has an increased risk of developing pregnancy induced hypertension . The worst form of this is the patient may get what is known as thyroid storm .
I reassured her and as fate would have it without any ovulation induction , advanced IUI or IVF she managed to conceive spontaneously . She is currently 12 weeks pregnant and I believe doing very well in South Africa .
The other case is Arya , a young teenage Indian girl who presented with irregular cycles but had very heavy menstruation . On investigating it turned out she had thyroid disease . Like Jeanette she was overweight , had frequent bouts of constipation , increased sensitivity to cold , puffy face and reported thinning hair .
Unlike Jeanette she also suffered from memory loss and depression .
In consultation with the endocrinologist we managed her on thyroxine replacement therapy and her menses became more stable and she was able to lose some weight though that is still work in progress . She reports more stable mood and improved memory . It was as if a magic stick had been waved around her . Another happy customer . I wish all my customers could be like this but c ’ est la vie !
The three ‘ patients ’ have illustrated some of the issues that thyroid disease can present to women . So if you can relate to any of the patients kindly see your nearest gynaecologist or endocrinologist .
Till next time do have a fantastic month ahead as we await the August 2022 general elections . I pray for peace and sanity to prevail during the electioneering period and in the aftermath regardless of the outcome . For in any race there must be winners and losers and wahenga ( wise men ) have put it very well “ Asiyekubali kushindwa … si mshindani .” For those not conversant with Kiswahili the direct translation is those who are not willing to concede defeat are not true sportsmen .
Dr . Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant based in Nairobi . You can commune with her on this or related matters via email at : Drmaureenowiti @ gmail . com .