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Counsel on Increased Risk with Pregnancy
- Hyperthyroidism during pregnancy can lead to maternal high blood pressure and an increased risk of miscarriage, premature birth or low birth weight.
- Clinical hypothyroidism increases the risk for miscarriage, preeclampsia, preterm delivery, stillbirth, and low birth weight. It can also cause high blood pressure, anemia, muscle pain and weakness.
- Hypothyroidism may reduce fertility by reducing ovulation.
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Management
- For women with thyroid disease, encourage use of effective contraception until thyroid function is well controlled.
- For women with hypothyroidism, check TSH, and counsel about the need to closely monitor TSH and increase thyroid replacement during pregnancy.
- For women with hyperthyroidism, avoid thyroid ablation during pregnancy – monitor thyroid function and treat with medications.
- Refer to Hormone Health Network's patient guide to detecting and treating hypothyroidism before, during, and after pregnancy (See Resources).
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Contraception Counseling
- Consider IUD or sub-dermal contraception.
- All contraceptives are safer than undesired pregnancy.