Thyroid problems, like any health scare encountered during a pregnancy, can be unsettling for expectant parents—especially when a lump is found.
If as an expectant mom you discover a lump during a thyroid self-check, don’t panic and assume right away that it’s indicative of something serious like cancer. The majority of the time, lumps are found to be benign, says Shivani J. Narasimhan, M.D., a LifeBridge Health board-certified endocrinologist who treats thyroid problems. But Narasimhan cautions: “By the time a patient can palpate the lump, it means it’s probably a significant size … so that should warrant timely evaluation. This can be done by your primary care doctor, who can then refer you to an endocrinologist.”
She adds: “The [thyroid] nodule itself needs to be evaluated by an ultrasound and blood work. Sometimes, the blood work is perfectly fine, and you just have a lump, benign or not. Other times, the thyroid blood work is not normal but the thyroid exam may be normal. The anatomy and the function of the thyroid are not always abnormal, but both need to be checked to complete a thyroid evaluation.”
Often, doctors include a TSH (thyroid-stimulating hormone) blood test among screening blood tests ordered for pregnant women or women who are trying to get pregnant. Some thyroid problems, if they aren’t treated appropriately or timely, could affect the baby’s growth and development. However, that’s typically not in mild thyroid issues.
Hyperthyroidism (Graves’ Disease), a condition in which the gland produces excess thyroid hormone, can cause symptoms such as a goiter (an abnormal enlargement of the butterfly-shaped thyroid gland located at the base of your neck below the Adam’s apple), weight loss and an irregular heartbeat. If medical treatment is needed for hyperthyroidism in pregnancy, usually two medications are prescribed: one for the first trimester and a different one for the remaining trimesters. “This is why thyroid issues need to be evaluated carefully. The endocrinologist will know which medications to use to ensure using only those that are safe for both mother and baby,” Narasimhan says.
Mild, underactive thyroid function (known as hypothyroidism) is not likely to cause serious pregnancy complications. “As long as it’s treated early and well, mother and baby do just fine,” Narasimhan says. “T4 thyroid medications are very safe, especially in pregnancy because it’s one’s own thyroid hormone that the body makes that’s replaced back. The fetus starts to make its own thyroid hormone at around 11 weeks, so the fetus is quite protected from mild thyroid disorders (affecting the mother). But in severe cases, we want to ensure that the mother’s thyroid levels are stable to produce a safe environment for the fetus to grow.”
If thyroid nodules (lumps that may indicate abnormal growth of thyroid cells) are found via ultrasound during pregnancy, the endocrinologist will discuss with the mother and family when it is safe to do a biopsy. “If thyroid cancer is diagnosed, we can often assure patient and family that the tumor doesn’t spread fast during pregnancy,” Narasimhan says.
If thyroid cancer is diagnosed during pregnancy, Narasimhan says, in most cases surgery can wait until after the baby is born. If surgery needs to be done sooner, it can be done safely in the second trimester.
“The key with any thyroid disorder is to keep mother and baby safe, to keep mom calm and comfortable,” Narasimhan says. “Most everything can be taken care of in due time.”
Call 410-601-WELL to learn more about endocrinology services offered at LifeBridge Health or to schedule an appointment with a physician. You can also visit our website