April 8, 2003
Diagnosis and Symptoms
Question from Dallas, Texas, USA:
Three years ago, my now 29 year old was diagnosed with gestational diabetes for which she took insulin. A few months after delivery, her blood sugar was tested, and she was declared diabetes free. At around that time, however, she developed a goiter and was diagnosed as hypothyroid for which she began taking Synthroid [a brand of thyroid replacement hormone]. About 12 months postpartum, she went off the Synthroid, was re-tested, and her thyroid was declared fine. She finally felt fine and shortly thereafter became pregnant again.
During her second pregnancy she again was diagnosed with gestational diabetes and took insulin. In addition, she developed a strange rash that the doctors had never seen before but attributed to hormones. Then, shortly after that delivery, she was again diagnosed with hypothyroidism and is now currently taking Synthroid again. Today, 14 months postpartum, her sugar levels are very, very elevated.
In sum, my otherwise healthy wife is now 14 months postpartum with bad thyroid levels and bad sugar levels. I am beginning to think that there is something more going on here than just pregnancy-related quirks, and I am worried.
Answer:
The scenarios you describe are well described and fairly common. With regard to the blood sugar, it is well known that any woman who develops gestational diabetes is at very high risk for developing diabetes later on. Since gestational diabetes recurs with successive pregnancies, that was not a surprise. The additional pregnancy can also be an additional stress and may have accelerated the ultimate result of developing type 2 diabetes. The primary issue here is genetics and not lifestyle, although lifestyle can help with the therapy. It still may not be enough, however.
With regard to the thyroid, it sounds like she developed postpartum thyroiditis after her first pregnancy, and it is not unusual for thyroid function to eventually return to normal. However, just like gestational diabetes, it frequently recurs with subsequent pregnancies. It sounds complicated but these entities are common. The good news is that the thyroid hormone can completely be replaced. A decision will have to be made as to whether her physician will wean her off the thyroid hormone or whether she stays on it permanently.
JTL
