Pregnancy and a Hashimoto’s or Rheumatoid Arthritis Diagnosis
What sort of treatment will I receive if I am diagnosed with Hashimoto’s while I am pregnant?
The autoimmune disease Hashimoto’s thyroiditis affects the thyroid gland, resulting mainly in symptoms due to low levels of thyroid hormone (hypothyroidism). Occasionally the disease is first diagnosed during pregnancy, though many women with previously diagnosed Hashimoto’s report symptom improvement during pregnancy.
Normally the treatment of Hashimoto’s is the same, whether or not a person is pregnant: replacement thyroid hormone. During pregnancy the dose is rapidly titrated to achieve an acceptable TSH level (less than 2.5mcg). The levels may need to be checked and adjusted multiple times, and a woman may require more thyroid hormone as the pregnancy progresses.
Some women with Hashimoto’s disease have what is called “subclinical hypothyroidism.” In these women, thyroid hormone levels (T3 and T4) are within what is considered the normal reference range, but the TSH is mildly elevated. During pregnancy, it is recommended that these women also be given replacement thyroid hormone until the TSH is within the normal range, though they might or might not be treated for this outside of the pregnancy setting.
Some women have normal T3 and T4 thyroid levels and TSH levels, but are positive for the thyroid antibodies found in most cases of Hashimoto’s disease. These women are not given replacement thyroid hormone initially, but are carefully monitored with follow up tests, since they are highly likely to require thyroid hormone treatment at some point.
What sort of treatment will I receive if I am diagnosed with rheumatoid arthritis while I am pregnant?
This treatment varies somewhat depending on a number of factors, including the stage of pregnancy and the severity of your symptoms. It is important to note that many women go into remission or symptom reduction during pregnancy, and drug treatment may not be immediately required.
Pregnant women will need to be carefully monitored for the severity of their symptoms and may require different treatment at different periods of the pregnancy. Many drugs that might normally be prescribed for rheumatoid arthritis (such as methotrexate or cyclophosmamide) need to be avoided during pregnancy due to the risk of birth defects. If a disease-modifying agent is needed, sulfasalazine and hydroxycholoroquine are good candidates, since they are thought to be relatively safe in pregnancy.
A drug like azathioprine has a less extensive safety record, but it might be used in some patients if the benefits are thought to outweigh the risks, for example, in a patient with acute lung or heart involvement due to her rheumatoid arthritis.
Corticosteroids are generally considered safe in pregnancy, though large doses should be avoided during the first trimester due to a risk of birth defects. These may be given in cases of an acute disease flare. NSAIDS (nonsteroidal anti-inflammatory drugs such as ibuprofen) may be used in the first and second trimester, if necessary, though they should be stopped in the last trimester; aspirin in high doses should be avoided throughout the pregnancy. You will need to speak carefully with your physician(s) about the risks and benefits of each possible treatment during your pregnancy.
Are there any risks to not treating Hashimoto’s or rheumatoid arthritis during pregnancy?
If Hashimoto’s has resulted in hypothyroidism, it is essential that this be treated, since thyroid hormone is crucial to fetal brain and nervous system development. The dangers of not treating rheumatoid arthritis or other rheumatoid autoimmune disease immediately derive mainly from the nonjoint manifestations (e.g., heart, lungs, kidneys, etc). Your doctor should carefully monitor these potential symptoms and help you make thoughtful risk/benefit decisions about medications. Not treating your condition now will not make it more difficult to treat once your pregnancy is complete.
If my Ob-GYN does not want to treat my autoimmune disease before delivery, are there any other specialists that could help me?
Do not hesitate to work directly with an endocrinologist if you have Hashimoto’s disease or with a rheumatologist if you have rheumatoid arthritis, in conjunction with your Ob. Some women report success working with alternative health care providers, like naturopaths or acupuncturists, but realize that in most cases, in-depth clinical research has not been performed about the use of such treatments in pregnant women with autoimmune disease.
Questions for your doctor:
- What are some symptoms I might have if my thyroid levels are too low or too high?
- Are there any topical medications that might be safer for pain relief for my RA?
- What medications might we plan to start after delivery? Are these safe for breastfeeding?
About the Author
Ruth J. Hickman, MD, is a freelance health, science, and medical writer. She specializes in writing about medical topics for the lay public and for health science students. She can be reached at email@example.com or through her website: ruthjhickmanmd.com.
This blog post was originally published by AutoimmuneMom.com, written by Ruth J. Hickman, MD, and first published on May 10, 2013.
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