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Sunday, October 13, 2013

Thyroid disease: Hyperthyroidism in Pregnancy

Posted by Chantel Martiromo,  Article By Kyle J. Norton

 Thyroid is one of the largest endocrine glands found in the neck, below the Adam's Apple with the function of regulating the body use of energy, make of proteins by producing its hormones as a result of the stimulation of thyroid-stimulating hormone (TSH) produced by the anterior pituitary.Thyroid disease is defined as a condition of malfunction of thyroid. 
Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones.
Hyperthyroidism during pregnancy mostly happens to younger women and usually is over looked due to the production of hormone HCG (human chorionic gonadotropin) in the first 12 weeks of pregnancy. It is very important that hyperthyroidism is controlled after the 12 weeks of pregnancy, if left untreated, it can increase the risk of miscarriage or birth defect.

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The importance to have hyperthyroidism under controlled in pregnancy
 If hyperthyroidism in pregnancy if not under controlled, it can cause the reduced or lost of ability to respond to the normal control by the pituitary gland, causing autoimmune disease, including antibodies include thyroid stimulating immunoglobulin (TSI antibodies), thyroid peroxidase antibodies (TPO), and TSH receptor antibodies that can result of attacking the fetus tissue, including the placenta by the mother immune system.
1. Miscarriage
Miscarriage is defined as the loss of an embryo before the 20th week of pregnancy as it is incapable of surviving independently. In medical terminology, miscarriage is a type of abortion, as it refers to the pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or medically induced abortion. In US alone, over 15% of pregnancy ends in miscarriage. According to the article of Harmful Effects of Hypothyroidism On Maternal and Fetal Health Drive New Guidelines for Managing Thyroid Disease in Pregnancy posted on Science news, by Mary Ann Liebert, Inc. (2011, July 25), wrote that Clinical studies are producing critical data demonstrating the harmful effects not only of overt hypothyroidism and hyperthyroidism on pregnancy, but also of subclinical thyroid disease and maternal and fetal health. Ongoing research is clarifying the link between miscarriage and preterm delivery in women with normal thyroid function who are thyroid peroxidase antibody positive. Studies are also uncovering the long-term effects of postpartum thyroiditis.

2. Preterm labor
Preterm labor is defined as the condition in which the uterine contractions of sufficient frequency and intensity to effect progressive effacement and dilation of the cervix prior to term gestation as a result of the affect of the over production of thyroid hormone. In an answer to the question of Could hyperthyroidism have caused my pre-term labor? Dr. Samantha Butts, MD MSCE wrote "Inadequately treated hyperthyroidism has been associated with preterm delivery and other risks in pregnancy. It's possible that your hyperthyroidism was related to your preterm labor, but may not be the only cause. You could also have an incompetent cervix".

3. Low birth-weight babies
In a study of Low birth weight and preeclampsia in pregnancies complicated by hyperthyroidism.
Millar LK, Wing DA, Leung AS, Koonings PP, Montoro MN, Mestman JH., researcher found that
Among uncontrolled women compared with those who were controlled during their pregnancies. Elevated TSH-receptor antibody levels were not related to preeclampsia. Maternal thioamide therapy did not adversely affect neonatal outcomes. CONCLUSION:Lack of control of hyperthyroidism significantly increases the risk of low birth weight infants and severe preeclampsia.
4. Stillbirths
According to the aricle of Hyperthyroidism and Pregnancy by WALTER F. BECKER, M.D., PERRY G. SUDDUTH, M.D., researchers indicated that while opinion is divided as to the effect
of thyrotoxicosis on the incidence of abortions, stillbirths, toxemias and certain other complications of pregnancy, there is general agreement that prompt control of the
hyperthyroidism will tend to eliminate whatever influence this factor may have on
the incidence of such complications.

5. Complications of pregnancy, including pre-eclampsia (a condition associated with hypertension, low blood platelet count, protein in the urine and mental changes) and heart failure and Graves' disease.
According to the article of Hyperthyroidism in pregnancy.Diagnosis and management by
BŁAŻEJ MĘCZEKALSKI, ADAM CZYŻYK, researchers indicated that The fetus of the mother with hyperthyroidism is atrisk of many complications, of which a preterm labor as an outcome seems to be the most common. On the otherhand, excess amounts of thyroid hormones may lead togrowth retardation and accelerated bone maturation, and it is associated with an increase in the risk of fetal death. It is proved that even controlled hyperthyroidism is linked to 2 fold higher risk of decline of infants weight, whereas in uncontrolled hypothyroid mothers this risk increases up to 4-9 times, in comparison to the incidence among nonhyperthyroid mothers

6. Etc.

Diagnosis of Thyroxine binding globulin (TBG)
Test of Thyroxine binding globulin (TBG) is always important for pregnancy with hyperthyroidism, unfortunately, because of the increasing of the level of thyroid binding globulin (TBG) during pregnancy, the interpretation of the T4 value may be difficult as others factors such as estrogen levels, corticosteroid levels, liver failure and symptoms must be also taken into consideration, according to the study of Interpretation of in-vitro thyroid function tests during pregnancy by Smith SC, Bold AM. Therefore, the test must be focused into the calculation of the free thyroxine index (FTI) or a measurement of the free thyroxine (FT4)
1. Thyrotoxicosis
It is defined as a toxic condition resulting from excessive amounts of thyroid hormones in the body, as that occurring in hyperthyroidism. In pregnancy, if the problem is left untreated, it can may lead to serious consequences, such as Miscarriage, Preterm labor, intrauterine growth
retardation and neonatal thyrotoxicosis and other complications, etc.

2. Transient hyperthyroidism
If the problem is caused by short-term hyperthyroidism due to over active of the thyroid gland as a result of pregnancy, the symptom will go away after 12 weeks of pregnancy. In serve case, antithyroid drugs may be necessary.

1. Weakness
2. Nervousness
3. Heat intolerance
4. Nausea and vomiting
5. Hyperorexia
6. Palpitations
7. lack of concentration
8. Insomnia
9. Breathlessness
10. Increased bowel movements
11. Etc.

Causes and risk factors
A. Transient hyperthyroidism
Hormonal change
In the first trimester, during to hormone change, 1 in 500 women will experience htpwetension as a result of elevating Thyroxine binding globulin (TBG). the symptom will go away after 12 weks of pregnancy and medication given. If the symptoms have become more serve than antithyroid drugs may be given with noharm to the fetus.

B. Thyrotoxicosis
1. Graves' disease.
Graves disease is defined as a condition hyperthyroidism, as a result of the autoimmune diseases causing the overproduction of the hormone thyroxine. It is most common during pregnancy and affects over 95% of all cases

2. Nodular thyroid disease
Nodular thyroid disease is the enlargement of thyroid gland and the incidence is always painless. According to the article of NODULAR THYROID DISEASE - Thyroid nodule growth during pregnancy. In a prospective study we have performed in Brussels, thyroid nodules were diagnosed by ultrasound at initial presentation during early gestation in 3% of a cohort of normal pregnancies [169]. Repeat ultrasound performed within a week after delivery revealed a 60% increase in the size of the nodules and the detection of new nodules in 20% of the women.

3. Thyroiditis
It is a result of inflammation of the thyroid gland.

4. Tumors
Tumors in the pituitary gland and ovaries can cause hyperthyroidism during pregancy.

5. Family history
Increased risk of hyperthyroidism during pregnancy if a directed member in woman's family history of the disease.

6. Heredity
The disease may be caused by genetic passing through from one generation to the next.

7. Personal history
Increased risk of hyperthyroidism in a pregnancy woman, if she has a previous record of the incidence.

8. Smoking
According to an article posted England Journal of Medicine -- October 12, 1995 -- Volume 333, Number 15 "Cigarette Smoking and the Thyroid," the researchers found that smoking is associated with so many abnormalities of thyroid function that it is unlikely it has just one single effect on the thyroid gland.

9. Exposure to Iodine
Exposure to Iodine over a prolonged period of time can increase the risk of hyperthyroidism

10. Medication
Certain medication such as Interferon Beta-1b and Interleukin-4, immunosuppressant therapy, antiretroviral treatment for AIDS, etc. can increase the risk of the disease.

11. Etc.

There is no effective way to prevent hyperthyroidism during pregnancy,but
A. How to
1. Quit Smoking
2. Prevent exposure to Iodine
As exposure to Iodine increase the risk of hyperthyroidism.
3. Eating healthy
Eating healthy by providing your body before and during pregnancy is the best way to prevent all kins of diseases, including hyperthyroidism. For more information of over 100 healthy foods
4. Meditation or Yoga
Mediation and yoga can help a woman to calm and relax, thus reducing or lessening the risk of the disease caused by stress related
5. Limit intake of saturated fats and fats
As they can increase the risk of heart diseases and stroke.
6. Limit intake of alcohol
7. Moderate exercise to enhance the normal production of certain hormones.
8. Etc.

B. Nutritional supplements
1. Vitamin D
In a study of Vitamin D deficiency modulates Graves' hyperthyroidism induced in BALB/c mice by thyrotropin receptor immunization, researcher found that found that different chromosomes or loci confer susceptibility to TSHR antibody induction versus thyroid function. Our present studies provide evidence that an environmental factor, vitamin D, has only minor effects on induced immunity to the TSHR, but directly affects thyroid function in mice.

2. Vitamins B12
Vitamin B12 is critical for iron metabolism. Increased risk of hyperthyroidism for women with deficiency of Vitamin B12.

3. Magnesium
In a study of Evaluation of ionized and total serum magnesium concentrations in hyperthyroid cats by Cornelia V. Gilroy, Barbara S. Horney, Shelley A. Burton, and Allan L. MacKenzie, researchers found that in the hyperthyroid cats, the range of ionized serum magnesium concentrations was 0.42 to 0.65 mmol/L and the range of total magnesium serum concentrations 0.75 to 1.23 mmol/L. In the healthy cats, the corresponding ranges were 0.47 to 0.67 mmol/L and 0.78 to 1.13 mmol/L.

4. Omega 3 fatty acid
In a study of Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases
Artemis P. Simopoulos, MD, FACN, reseacher found that the clinical condition and biochemical factors of patients with arthritis, but the clinical intervention studies in other autoimmune conditions have given conflicting results, most likely due to lack of an adequate number of subjects in some and not taking into consideration the background diet or genetic variation. There is a clear need for more carefully designed and controlled clinical trials in the therapeutic application of omega-3 fatty acids to human autoimmune and inflammatory conditions.

5. Etc.

Due to limitation of treament of hperthyroidism in pregancy because of the concerns of the safety of the fetus as well as the health of the mother, radiation therapy is rule out as one of the treatment. Treatments can only depend to either medication and surgery, if the medication are not well tolerated in some women.
1. Medicationa. Thionamides
Thionamides, the class of Antithyroid drugs, including methimazole (MMI, Tapazole®), carbimazole, and propylthiouracil (PTU) have been used to treat hyperthyroidism effectively with certain risks and side effects. The use of the medication in low dose are considered necessary as the benefits are greater than the risks.
b. Risks and side effects
1. Nausea and
2. Gastrointestinal distress.
3. Maculopapular pruritic rash
4. Fever.
5. Development of arthralgias
7. Hypoprothrombinemia
8. Etc.

2. Surgery
a. Normally, surgery is not a first priority because of the risk involved the removalof all or parts of the enlarged thyroid gland.
b. Ricks and side effects
b.1. Surgery and anesthetic risks
b.2. Prescribed oral synthetic thyroid hormones to prevent hypothyroidism.
b.3. Etc.

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