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Sleep tabs death, e-cigs, GP examples, underactive thyroid and pregnancy

Duration:
28 minutes
First broadcast:
Tuesday 28 February 2012

10 million prescriptions for sleeping pills are written every year in England. So how alarmed should we be over new American research suggesting that people who take them are more likely to die than those who don't? Dr Mark Porter speaks to a leading British sleep expert about the findings and asks what the alternatives are.

An Inside Health listener asked us to investigate how safe "electronic" cigarettes are. So Dr Max Pemberton, who uses them himself, talked to Professor John Britton from the UK Centre for Tobacco Control Studies at the University of Nottingham about these currently unregulated products. Rumours abound that a tobacco manufacturer is about to launch the world's first so-called "safe" cigarette. But smokers' reactions are mixed and some prefer other products like nicotine gum.

GP Margaret McCartney's column is about whether your doctor's dietary preferences and habits influence your well being.

Half of all pregnancies in the UK are unplanned, so women and their babies lose out on important supplements like folic acid to help prevent spina bifida. But for women with an underactive thyroid gland it's even more important that they do their best for their baby by increasing their thyroxine dose as soon as they know they're pregnant. But research from Leicester shows that women often fall through the gaps when seeking care - as GPs, midwives and consultants often think someone else is helping these women.

Producer: Paula McGrath.

  • Programme Transcript - Inside Health

    THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.


    INSIDE HEALTH

    TX: 28.02.12 2100-2130

    PRESENTER: MARK PORTER

    PRODUCER: PAULA MCGRATH


    Porter
    Hello and welcome to Inside Health - where we look at the real issues behind the stories making the news, providing clarity where there is confusion. In today's programme - are electronic cigarettes dangerous? Amid speculation that a major tobacco manufacturer is about to launch the world's first so-called "safe" cigarette, we look at the burgeoning number of electronic alternatives already on the
    market.

    Clip
    Were you actually smoking in the office?

    I was actually smoking at my desk - puffing away over the monitor.

    And how did your boss feel about that?

    Well I got my boss smoking one as well, so I mitigated the circumstances.

    Porter
    And while we are on the subject of lifestyle and health, could your GP's dietary preferences and habits influence your wellbeing? Margaret McCartney examines the implications of doctors leading by example. And I will also be finding out why women with thyroid problems should plan ahead when it comes to trying for a baby.

    But first, new research from the States suggesting that taking sleeping tablets increase the chances of an early death. The figures look pretty startling - the study followed more than 30,000 people over a two and a half year period, around a third of whom were on commonly used prescription only sleeping tablets. And there were four times as many deaths in people taking the sleeping tablets than among those who weren't. Well to help us explain the significance of the findings I am joined by one of the UK's leading sleep experts, Professor Kevin Morgan from the Clinical Sleep Research Unit at Loughborough University.

    Kevin, were the findings a surprise to you?

    Morgan
    Historically no they're not, this isn't the first time this association has been reported, ever since the first early cancer studies, way back in the 1960s, associations have been found between sleeping tablet use, early mortality and also sleep duration and early mortality. But this is a finding that keeps recurring - it occurs in very large data sets - and it's an issue that needs to be addressed.

    Porter
    Do we think it's a side effect of the drugs used or a reflection that sleep problems, particularly lack of sleep itself, can be bad for you?

    Morgan
    Well I think you can come in on this at several levels. I mean the bottom line is we simply don't know why this association occurs. There is a possibility that in large volumes vulnerable people will be sensitive to perhaps a neurotoxicity or a general toxicity in the drugs themselves but that's unlikely - these drugs have been used for a long time now and the possibility that they are causing direct damage probably is the least likely option here. Other issues - we have to consider that well these are very, very powerful drugs - they affect our behaviour, they affect our thinking, they affect our mood and they affect our general health. So perhaps you could say well it would be kind of surprising if they didn't somehow impact our general wellbeing. But other issues are: well these drugs make us feel sedated - they're sedative drugs - maybe they reduce our levels of activity, making us perhaps a little more sedentary and we know that being sedentary in itself is in itself a risk for all kinds of health issues.

    Porter
    What about these drugs that are self-medicating with, what we would call old fashioned antihistamines, the over-the-counter sleep aids, they weren't covered in this study but because they're sedating might they have the same effect?

    Morgan
    Well there are other issues and there are other dangers associated with the so-called over-the-counter drugs. If you receive your sleeping tablets, your hypnotics, from your doctor at least it comes with the security of a prescriber, somebody - somebody looking after you, there are limitations on the size of the prescription and the frequency with which it's dispensed. People who consume over-the-counter there is no regulation, they can consume what they like with whatever they like and there there is another issue. If it's the over-the-counter type drug - the antihistamine drug - that does make people drowsy these are - again these are pharmacologically active drugs, not to be confused with the herbal remedies that are less active but yes there are issues and dangers there too.

    Porter
    How big is the problem here in the UK, can you give us some idea of what's happening in terms of hypnotic sleeping tablet use?

    Morgan
    When we look at the figures for insomnia we find that about 10% of the adult population reliably will report chronic insomnia and of those about half of them will be seeking help for their problem. Now within the UK, or at least within England in particular, we prescribe about 10 million prescriptions each year for sleeping tablets and assuming that that's maybe 21 - that's three weeks - of usage we're looking at just over 200 million doses of drugged nights of sleep each year in England and Wales.

    Porter
    Which is probably far too much.

    Morgan
    It's - well I mean it's too much in relation to the fact that there are better ways of managing insomnia...

    Porter
    Such as?

    Morgan
    ... and safer ways. Well the lead way of doing this is using cognitive behaviour therapy for insomnia. This is the talking therapy that is preferred by the National Institute of Health and Clinical Excellence, it's recommended by the Department of Health, it's preferred by patients and yet it remains relatively inaccessible to most doctors and most patients.

    Porter
    Why do you think that is - is it because people like a quick fix, I mean they see the pills as - because they do work don't they?

    Morgan
    Hypnotic drugs are extremely effective for the management of short-term insomnia and that's what they're licensed for, most insomnia - most insomnias are not short-term, they tend to be chronic problems. So there's a mismatch here between the most used response to insomnia and the nature of the insomnia itself.

    Porter
    But can CBT - I mean could I use CBT in someone who'd been taking sleeping tablets for 10 years or more?

    Morgan
    Yes indeed. I mean we ran trial within the last 10 years in Sheffield where we showed that people who are effectively addicted - people who are dependent on sleeping tablets can adopt CBT practices, significantly reduce their reliance on sleeping tablets and many of them actually abandon sleeping tablets altogether. And - and this is terribly important - and report improved quality of sleep. We mustn't lose sight of the fact that people who take sleeping tablets chronically report levels of insomnia that are indistinguishable from those within untreated groups of insomniacs.

    Porter
    |Professor Kevin Morgan - thank you very much.

    Time now for some of your feedback. Last week's item on giving pregnant smokers vouchers worth £750 if they quit prompted quite a response - not all of it positive! I think Hilary Nicholls summed up most of your feelings up with this email: "I gave up smoking while pregnant in 1990. Can I apply retrospectively for this bribe please?"

    Nice try Hilary.

    And Sarah Asher also contacted us wanting to know more about electronic cigarettes. She has a colleague who puffs away on one at work and wants to know if the nicotine laden vapour she exhales present any hazard to the rest of the office.

    And from the concerned to the converted. When he heard we were planning on looking into their use, Alex Bartman phoned in to sing the praises of his e-cigarette:

    Bartman
    I got in touch with Inside Health because I heard about the upcoming feature on electronic cigarettes and I really wanted to spread the gospel because I'm a complete convert, it's helped me stop smoking. I had major surgery last year and smoking 40 a day my surgeon said you have to stop smoking immediately. I'm a year on, haven't had a single cigarette in that year. I'm here in Cafe Nero, I'm drinking a slightly too hot Americano but I am puffing quite happily away on my e-cigarette and I'm not even getting any strange glances from people.

    Porter
    Well we have an inside man at Inside Health. Dr Max Pemberton uses an e-cigarette in the on-going battle against his addiction - so who better to research the subject further?

    Pemberton
    So the rain has just stopped and presumably all of the smokers will now be coming out of their office buildings so I've come out on to the streets of Central London and I've brought my e-cigarette with me so I can see who's using it and what they think about it.

    Do you know what this is?

    Smoker
    Yeah, yeah, no I have them, I use it because it doesn't have the 150 odd chemicals that a cigarette normally has in it and just nicotine.

    Pemberton
    Were you actually smoking in the office?

    Smoker
    I was actually smoking at my desk - puffing away over the monitor.

    Pemberton
    And how does your boss feel about that?

    Smoker
    Well I got my boss smoking one as well, so I mitigated the circumstances.

    Pemberton
    How about you - do you think they look a bit foolish or do you think they look...?

    Smoker
    Well the big thing is in nightclubs because a lot of them light up at the end, but that one's green, so you get the red ones though as well. All you can say about the [indistinct words] and all them they put you on a programme that you're meant to follow and it'll eventually get you off cigarettes, that is just cashing in on people not being able to smoke in certain environments.

    Smoker
    I didn't like the taste of it, it didn't quite give me the same experience as a cigarette.

    Pemberton
    It is quite different isn't it, because it's quite heavy and it feels slightly different in your hand?

    Smoker
    Yeah I mean it does but say when you're at work and you want to run out and have a cigarette it doesn't quite give you the same buzz.

    Pemberton
    Yes so it doesn't give you quite the same hit in the same way that a cigarette does. But we've been talking to some people that were saying that you could use it in the office, is that something you'd ever consider?

    Smoker
    I think I'd feel a bit too self-conscious because it's a dependency isn't it and I don't want people to see well look at her she's desperate, she's got to have one in the office.

    Pemberton
    Do you have any idea what this is?

    Smoker
    That's one of them electric fags.

    Pemberton
    It is yes. Have you ever tried one?

    Smoker
    No I haven't.

    Pemberton
    Why not?

    Smoker
    Number one you've got to send off for them, they're not available in the shops. Number two I've heard they're crap.

    Pemberton
    And who did you hear that they weren't very good from?

    Smoker
    A couple of the blokes on site have tried them; they reckon they're no good.

    Pemberton
    We're just pausing while you light your cigarette. Presumably you're - you work outside a lot?

    Smoker
    Well no I'm inside.

    Pemberton
    Oh you work inside. You can in theory smoke them inside.

    Smoker
    Yeah, yeah, yeah.

    Pemberton
    So is that not an appeal?

    Smoker
    Not if they don't do what they're supposed to.

    Pemberton
    Right.

    Smoker
    I mean it's second best really isn't it?

    Pemberton
    So what do we really know about these devices? Professor John Britton is Director of the UK Centre for Tobacco Control Studies at the University of Nottingham.

    Britton
    You're taking down a vapour of a solution that contains nicotine and probably one or two other propellants or stabilisers within there. You inhale that mist and the nicotine is deposited in your mouth and possibly further down towards the lungs and so you absorb nicotine in much the same way as you might from other medicinal nicotine products and to a degree from cigarettes, though cigarettes tend to get the nicotine much more deeply into the lungs.

    Pemberton
    So it's not just nicotine, it's other things like water?

    Britton
    There's water, many of the products have glycerine in them but the content of the products is difficult to comment on because many of them are untested or un-standardised and so they'll be a statement from the manufacturer as to what they contain but it isn't necessarily clear that they do and how reliable that information is.

    Pemberton
    So there's no regulation surrounding the manufacture and sale of these products?

    Britton
    No at the moment they're on the market through a loophole in the regulations which allow a nicotine product to be sold, as long as no health claim is made for it. So if it was sold as nicotine replacement therapy to help you stop smoking then that would be a health claim and that would be a drug and come under drug regulations but these products just sit in a loophole and are currently unregulated.

    Pemberton
    So things like the gum and the lozenges and the other devices, like the mist and so on, they are regulated because they make specific medical claims?

    Britton
    Yes they fall under regulation by the MHRA, who regulate all drugs in the UK.

    Pemberton
    What's the legal situation around smoking in confined spaces?

    Britton
    Well my understanding would be that as it doesn't involve burning tobacco to use one indoors would be within the law, that's only my understanding. What a proprietor of a restaurant or a bar might say is that the person who uses the products is still exhaling a mist that contains nicotine and other things - we don't know what - and so I'd rather that didn't happen in my premises because potentially there is a risk to other users.

    Pemberton
    And how safe do you think they actually are or do we just not know?

    Britton
    Well we don't know but you can make certain pretty informed guesses. We don't have standardised information about the purity of the content or the reliability of the content from one cigarette to another. Some of them have been tested, some haven't. So in that respect that I guess would be a cause for concern. But on the other hand the yardstick you have to judge them against is the safety of the conventional cigarette which kills half of the people that use them. So against a cigarette it is almost certainly substantially safer. Whether it's as safe or as a reliable as it could or should be in a developed society is another question.

    Pemberton
    So I suppose the essential point really is it's about sort of weighing the risks and the benefits of something?

    Britton
    Yes the point is that most smokers smoke because they're addicted to nicotine and nicotine itself is not a particularly hazardous drug - it's probably on a par with caffeine, which we're all comfortable about using pretty regularly. What kills a smoker is the constituents of the smoke that comes with the nicotine. So what these devices are doing is giving the smoker nicotine without most of those toxins. Their only drawback is that we don't know exactly what they are providing.

    Pemberton
    Do you think that they should be regulated?

    Britton
    Yes I do but in a liberal or in a permissive way because I think in principle these are a very important development. We've got 10 million smokers in the UK at the moment, half of those people - five million alive in the UK now - are going to die if they don't stop smoking and will die losing about 10 years of life, it's a massive health problem. These products, if they can provide an alternative that is acceptable to a proportion of those smokers, potentially have a lot to offer public health. The UK actually leads the world in having that permissive attitude to reduce harm alternatives to smoking. And if you go across to the United States the public health authorities by and large are trying to close these things down, saying no, no they're harmful so don't have them, without thinking well what's the alternative. So one thing I think we should take some credit for is the fact that the last and the present government have embraced this idea, it's hugely powerful. The MHRA is aware obviously that these products exist and is currently reviewing its regulation of them and my hope is that they will come up with a permissive regulation that says you have to meet basic standards of purity and safety with these products, as you would expect of anything else, but we want them on the market, we don't want to put barriers up there that stop innovation and alternatives to cigarettes being provided for smokers.

    Porter
    Professor John Britton.

    Max, John mentioned there that it is the many things other than nicotine in tobacco that cause most of the health problems, but new research out this week suggests that nicotine could be responsible for more than addiction.

    Pemberton
    That's right. There was - researchers at Brown University in the US have discovered that potentially nicotine can be involved in the process in blood vessels which leads to them getting clogged up and that can lead on to things like heart disease, heart attacks and strokes.

    Porter
    Now we know that smoking damages the delicate lining of the blood vessels and accelerates that process but what this study's showing for the first time possibly is that actually nicotine itself, one of the ingredients of tobacco, may play a role as well.

    Pemberton
    That's right. This is worrying for things like nicotine replacement therapy which has always been used and advocated by doctors as a replacement for cigarettes.

    Porter
    But we should say at the moment this is just an interesting finding, so it might be that nicotine isn't harmless, we don't know that for sure yet.

    Pemberton
    That's right.

    Porter
    Which brings me on to another point that there are rumours going round the industry, and I'm sure you've heard them, that one of the major tobacco companies is about to produce a licenced version of a safe cigarette, we're not quite sure whether it's going to be an electronic cigarette but some sort of device, a bit like the electronic cigarettes we were talking about.

    Pemberton
    Yes I have heard this. Now nobody knows the details of this, it's kind of shrouded in secrecy, but it seems likely that a device has been developed that somehow gets nicotine into the lungs rather than just absorbs through the mouth, which is how most nicotine replacement therapies work at the moment.

    Porter
    And the fact they're going for a licence suggests that they're going to try and use this as - for people who want to give up.

    Pemberton
    Yes that's right.

    Porter
    How's that gone down with doc - it seems that they're having their cake and eating it and they're addicting people on the one hand and then selling them the answer on the other?

    Pemberton
    Yes I mean there's a great - understandably there's a great deal of hostility towards the tobacco industry because of what they do and the products they sell. Personally I take a slightly more pragmatic view and I feel that well if this is a product that helps people stop smoking cigarettes then this can only really be a good thing and I don't really mind which company develops this product providing it's available.

    Porter
    They're doing some good probably for the first time. Ok Max, but there is another potential downside to using e-cigarettes, namely, the sort of example that you're setting - given that doctors are supposed to be icons of virtue? Or are they? And does it matter anyway? GP Margaret McCartney is on her soap box again.

    McCartney
    What kind of doctor do you want? The illusory skills and aesthetic pleasures of George Clooney or Gregory House are not in NHS stock. Of course, one may wish for a doctor with experience. One may also wish for youthful vigour and up-to-date knowledge. Can you get both simultaneously?

    In real life, doctors come with imperfections. And there's evidence that a doctor's lifestyle has implications for their patients. For example, doctors who smoke are less likely to advise their smoking patients to quit. It's known that when health professionals offer quitting advice, then between 1 and 3% of people will kick the habit. So does this mean that the personal - and private - freedom of the doctor to smoke is also, therefore, bad for patients? Smoking isn't illegal. But could it be unprofessional? How much "healthy" behaviour should you hope - or expect - your doctor to have? Surely doctors are allowed to have bad habits like everyone else?

    You may not know if your doctor smokes or not, but it's more obvious whether he or she is overweight. A recent paper, published in the journal Obesity, surveyed 500 US family physicians and concluded that larger doctors were less likely to discuss patients' weight problems. The medics seemed to compare their size to their patient; and, if they perceived themselves to be slimmer, brought up the issue more often. Other research is contradictory - a review last year found no
    relationship and instead suggested that women doctors were most frequent in dishing out advice to overweight patients.

    There are, of course, other explanations. Patients are smart. They may choose to go to a fat or tobacco-addicted doctor where they feel less likely to be nagged about their habits. GPs sometimes talk about patients getting old with us - young patients often prefer young doctors, who are up to speed about contraception and in touch with teenage concerns - and in a kind of mirror of our shared health concerns, grow old together. It may even be that patients can identify better with doctors who struggle with the same health issues they do.

    Thankfully, we've let go of the old-fashioned paternalistic notion that our doctors should be 'god like' and go unquestioned. Yet we are less prepared for the inevitable truth; health professionals are human, with failings and imperfections. And when acknowledged, is that really a problem? Surely our shared humanity is the source of compassion and understanding; and that's the kind of doctor I'd want.

    Porter
    Margaret McCartney. Dr Max Pemberton has been listening to that - Max, do you think your smoking affects your attitude it comes to advising your patients?

    Pemberton
    I knew I wasn't going to get away...

    Porter
    No I'm not going to let you off the hook.

    Pemberton
    I think it does play a role, yes. I would like to think it helps inform me about the struggles that my patients have when they're trying to give up because I too am trying to give up and I understand how it's really, really difficult and the kind of the nature of addiction and how things can be really illogical. Objectively you might want to do something but how at certain times it's very, very difficult.

    Porter
    Max, I thought you'd play the empathy card. Well if you've got what it takes to help Max quit, or you think you have anyway, or you would like us to look into a health issue that is confusing you, then please get in touch - I'll forward the e-mails to him. Usually methods - you can e-mail insidehealth@bbc.co.uk or tweet @bbcradio4 enclosing the hashtag insidehealth.

    Now, just under half of all pregnancies in the UK are unplanned - they may be happy accidents, but could some of these babies be missing out? It has long been recommended, for example, that women should take folic acid supplements - to protect against spina bifida - before they try to conceive but most don't. And this type of forward planning is even more important for women with an underactive thyroid - who often require higher doses of replacement thyroxin hormone during very early pregnancy to ensure that their baby gets the best start. But lack of awareness, combined with confusion about who is monitoring who and when, means many women are not taking as much thyroxin as they should - particularly during the all-important first three months.

    Nikki Keifer, an Endocrine Nurse Specialist, at Leicester Royal Infirmary, recently surveyed GPs and women with underactive thyroids to find out what was going on.

    Keifer
    I suspected that no one was really looking after them because we weren't actually seeing them until they were well into their 12th week and GPs from my studies seemed to think that we were looking after them and of those who said they were looking after them it wasn't very clear as to whether they knew how they should be looking after them. So it wasn't really clear who was looking after them.

    Porter
    So here we have a crucial window - the first three months of pregnancy - when these women need to be exactly the right dose of thyroxin and you're suspicious that probably most of them weren't being properly looked after or monitored, so we don't know whether they were or not?

    Keifer
    No, no and certainly from my findings when they came to see me in the antenatal clinic some of them were not adequately replaced but we had no way of knowing whether they had been adequately replaced in that first 12 weeks because no one had actually done their thyroid functions.

    Porter
    And there's actually nothing you can do about it and by the time they come to see you after three months - by the time they get to see you it's too late?

    Keifer
    Yeah the most important time for them to be seen is in their first 12 weeks because that's when the baby is developing its thyroid, it doesn't actually have a functioning thyroid and so it's totally reliant on the mother for its thyroxin and also that's the time when the brain and the nervous system are being developed and they need thyroxin.

    Beddal-Hall
    I think it would be very easy to fall through the gaps because the GPs believe that the midwives are going to sort it out, the midwives would like you to refer you to the endocrine specialist clinic to be monitored and unfortunately by that point it would be too late because you'd be by the end of your first trimester.

    Porter
    Nicola Beddal-Hall has an underactive thyroid and gave birth last year.

    Beddal-Hall
    I was quite fortunate because I'd already done some reading and research and was aware that I needed to do something about it early on. Even though I pressurised my GP they weren't very interested in helping me. When I actually got pregnant it was a very, very welcome event but it wasn't expected at all and I guess because I was hoping to get pregnant I found out when I was four weeks pregnant, so very early on. But most people may not find out that early on at all.

    Levy
    My name's Miles Levy and I'm a consultant endocrinologist at Leicester Royal Infirmary. What I say to patients is that thyroid is the Greek word for shield because it's the shape of a shield and it's situated in the neck, so it shield's the thyroid cartilage which is the bony Adam's apple that you can feel. And the function of the thyroid gland is it - it's a hormone that's produced - goes round the whole blood stream and it is a bit like the accelerator of a car, it controls your metabolism, it tells your cells how quickly or slowly to tick over, so if you've got too little thyroid hormone it's like taking your foot off the accelerator of a car so everything slows down, you put on weight, you feel tired, you go cold, the pulse slows down. Whereas the opposite occurs with an overactive thyroid - it's a bit like pushing your foot down on the accelerator of the car - everything goes too quickly, your pulse goes quickly, you have a tremor, you sweat, you might feel anxious, you might have difficulty sleeping, your periods might get lighter. So it's really the - controls the metabolic rate.

    Porter
    What is it about pregnancy and an underactive thyroid - why is it an important issue?

    Levy
    Well it's an important issue firstly pre-pregnancy because if you've got an uncontrolled underactive thyroid gland and you're not on enough thyroxin it's quite difficult to get pregnant. But the main thing is if someone has an underactive thyroid gland and become pregnant their requirements for thyroxin increase because of all the changes in the body, if you like you're taking thyroxin for two and the placenta metabolises thyroxin, so you need - usually people need an increase in dose by 25-50%. By about 12 weeks the baby starts to develop its own thyroid gland, no one knows to be precise, so to be on the safe side one would want to start thyroxin as early as possible to make sure that the baby's getting enough thyroxin, before then it's entirely dependent on mum's thyroid levels.

    Beddal-Hall
    In the end I contacted Thyroid UK for some advice and I also contacted Nikki at the Leicester Royal Infirmary for some advice and I'd been monitoring my blood quite carefully anyway because I'd been trying to get pregnant and from that I made an informed decision myself and I increased my dosage, which I'm very glad I did because although I asked to be referred early to the endocrine clinic I still didn't see them until later on but they did start doing the bloods earlier at my GP. So I think without me being quite pushy in some cases then I could have fallen through the gaps.

    Levy
    The reason it's important is because there's an increased risk of pre-term birth and small babies and then the main subtle thing that people worry about - there are a few papers to suggest - well certainly it's very well-known from animal studies and from clinical studies - that thyroxin's important for the brain development, foetal brain development, and that's particularly so in the first 12 weeks, the first trimester because at that point the baby's entirely dependent on maternal thyroxin for its brain development.

    Porter
    So if mum isn't getting enough thyroxin, she's not taking thyroxin for two, that could in theory have an impact on baby's development?

    Levy
    In theory, although the placenta is remarkably good at making use of what little thyroxin there is. But the reason for doing it is because there are a couple of papers to suggest that the cognitive function of the baby - and there are a few different studies at the ages of three or five or seven - there's possibly a slight reduction in IQ and perhaps sort assimilation and spatial awareness.

    Porter
    What advice would you give to a woman who has an underactive thyroid that was planning on starting a family?

    Levy
    Go see your GP and tell them that you're planning to get pregnant, make sure your thyroid function is as well controlled as possible and always err on the side of increasing the dose of thyroxin because in fact in the first trimester of pregnancy there's very little concern about being on slightly too much. I would think of it a bit like taking your folic acid and taking everything else for pregnancy - I would increase and optimise your thyroxin dose just to make sure that all the wind is going in your favour.

    Beddal-Hall
    I've got a little baby girl and she's beautiful. Her name is Alexa Rose. And she arrived in November, she's three months old and doing very well.

    Porter
    A happy ending for Nicola Beddal- Hall. If you would more information on thyroid disease and pregnancy - or the importance of pre conception planning for all women - then you will find some useful information on the website. Go to bbc.co.uk/radio4 and follow the links to Inside Health.

    Just time to tell you about next week when we will be discovering why you are more likely to see a surgical mask on public transport than in some operating theatres, and we follow up on a listener's request to explain the skin condition vitiligo. Join us next week to find out more.

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